Barriers and Facilitators in Using Surface Electromyography in Swallowing Management: An Implementation Science Study

Abstract

Purpose: This study aimed to identify clinician-perceived barriers and facilitators before the implementation of surface electromyography (sEMG) for swallowing management, implement sEMG biofeedback in swallowing rehabilitation sessions using implementation strategies, and investigate the perceived benefits and drawbacks after the implementation of the sEMG device from the perspectives of speech-language pathologists (SLPs). Method: An initial pre-implementation survey characterized the SLPs' practices in swallowing management regarding the use of biofeedback modalities as well as facilitators and barriers to the implementation of sEMG. In the implementation phase, six SLPs attended educational and training meetings, tested, and used sEMG with patients during their swallowing sessions. Finally, a postimplementation survey and focus group assessed the six SLPs' perceptions and experiences using sEMG and identified areas for improvement in the implementation process. Results: The majority of the 44 SLPs who answered the pre-implementation survey did not use sEMG in swallowing therapy. The most frequently reported barriers to implementation were reduced sEMG knowledge and lack of training (86.4%), lack of equipment access or availability (68.2%), and patient-related barriers (36.6%). The six SLPs who participated in the implementation phase used sEMG with 30 different patients, conducting a total of 105 sessions. They reported that it was easy to use sEMG during sessions and that sEMG helped them to teach swallowing maneuvers. Additionally, they stated that patients were motivated during sEMG sessions. Ongoing training and mentoring were some of the suggestions for implementation improvements. Conclusions: This study exemplifies the collaborative work between researchers and clinicians to facilitate the translation of technologies into clinical practice. Identifying determinants of sEMG implementation and strategies to address barriers was critical to its acceptability and adoption into clinical practice.