Does Therapy With Biofeedback Improve Swallowing in Adults With Dysphagia? A Systematic Review and Meta-Analysis

Benfield, Jacqueline K; Everton, Lisa F; Bath, Philip M; England, Timothy J.

doi:10.1016/j.apmr.2018.04.031

Cited by 61 publications

(62 citation statements)

References 56 publications

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“…For five conditions (fecal incontinence, 12 urinary incontinence in women, 13 dysphagia, 14 stroke, 15 and Bell's palsy 16 ), systematic reviews specifically examined biofeedback as an adjunct to another intervention. Five reviews examined the effectiveness of biofeedback for conditions (sleep bruxism, 17 chronic idiopathic constipation, 18 knee osteoarthritis, 10 balance/gait training, 19 and intradialytic hypotension 20 ) independent of other interventions.…”

Section: Resultsmentioning

confidence: 99%

“…2 and Table 3). 19 It is unclear whether biofeedback is effective for the treatment of Bell's palsy, 16 chronic idiopathic constipation, 18 dysphagia, 14 osteoarthritis of the knee, 10 labor pain, 24 Raynaud's, 26 and sleep bruxism. 17 Limited (low-confidence) evidence suggests that biofeedback provides no benefit for urinary incontinence in women once differences in PFMT programs were controlled for, 13 nor was it effective for blood pressure control.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of Biofeedback for Medical Conditions: an Evidence Map

et al. 2019

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BACKGROUND: Biofeedback is increasingly used to treat clinical conditions in a wide range of settings; however, evidence supporting its use remains unclear. The purpose of this evidence map is to illustrate the conditions supported by controlled trials, those that are not, and those in need of more research. METHODS: We searched multiple data sources (MEDLINE, PsycINFO, CINAHL, Epistemonikos, and EBM Reviews through September 2018) for good-quality systematic reviews examining biofeedback for clinical conditions. We included the highest quality, most recent review representing each condition and included only controlled trials from those reviews. We relied on quality ratings reported in included reviews. Outcomes of interest were condition-specific, secondary, and global health outcomes, and harms. For each review, we computed confidence ratings and categorized reported findings as no effect, unclear, or insufficient; evidence of a potential positive effect; or evidence of a positive effect. We present our findings in the form of evidence maps. RESULTS: We included 16 good-quality systematic reviews examining biofeedback alone or as an adjunctive intervention. We found clear, consistent evidence across a large number of trials that biofeedback can reduce headache pain and can provide benefit as adjunctive therapy to men experiencing urinary incontinence after a prostatectomy. Consistent evidence across fewer trials suggests biofeedback may improve fecal incontinence and stroke recovery. There is insufficient evidence to draw conclusions about effects for most conditions including bruxism, labor pain, and Raynaud's. Biofeedback was not beneficial for urinary incontinence in women, nor for hypertension management, but these conclusions are limited by small sample sizes and methodologic limitations of these studies. DISCUSSION: Available evidence suggests that biofeedback is effective for improving urinary incontinence after prostatectomy and headache, and may provide benefit for fecal incontinence and balance and stroke recovery. Further controlled trials across a wide range of conditions are indicated.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Efficacy of Biofeedback for Medical Conditions: an Evidence Map

et al. 2019

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“…In this way, the training accuracy is maintained. Although there is no sufficient evidence that biofeedback benefits overall swallowing functions among patients with dysphagia, in studies that used tongue manometry as biofeedback, significant increases in maximum isometric and swallowing tongue pressure were observed in patients who received biofeedback compared with those who did not [ 69 ]. In addition, a previous study has suggested that home-based therapy can be as effective as office-based therapy if a biofeedback system is applied [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

Kim¹,

Cho²,

Kim³

et al. 2020

JMIR Mhealth Uhealth

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Background Tongue pressure is an effective index of swallowing function, and it decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue-strengthening therapy on tongue function. Tongue exercises delivered through mobile health (mHealth) technologies have the potential to advance health care in the digital age to be more efficient for people with limited resources, especially older adults. Objective The purpose of this study is to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention with biweekly (ie, every 2 weeks) human mediation aimed at improving the swallowing tongue pressure in older adults. Methods We developed an mHealth app intervention that was used for 8 weeks (3 times/day, 5 days/week, for a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age 75.7 years) who complained of swallowing difficulties. The app included a swallowing monitoring and intervention protocol with 3 therapy maneuvers: effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation. The 8-week intervention was mediated by biweekly face-to-face meetings to monitor each participant’s progress and ability to implement the training sessions according to the given protocol. Preintervention and postintervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument. We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12 weeks postintervention. Results Of the 11 participants, 8 adhered to the home-based 8-week app therapy program with the optimal intervention dosage. At the main trial end point (ie, 8 weeks) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median 17.5 kPa before the intervention and 26.5 kPa after the intervention; P=.046). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12 weeks postintervention were not observed. Conclusions Swallowing tongue pressure is known to be closely related to dysphagia symptoms. This is the first study to demonstrate the effectiveness of the combined methods of effortful prolonged swallowing, effortful pitch glide, and effortful tongue rotation using mobile app training accompanied by biweekly human mediation in improving swallowing tongue pressure in older adults. The mHealth app is a promising platform that can be used to deliver effective and convenient therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size and observe the long-term effects of the intervention program, further studies are warranted. International Registered Report Identifier (IRRID) RR2-10.2196/19585

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“…The most common biofeedback technique used in post-stroke dysphagia therapy is surface electromyography (sEMG). sEMG biofeedback uses two small electrodes placed on the submental muscles to measure the timing and force of the muscle contraction, which is displayed graphically on a screen [ 88 , 89 ]. A recent meta-analysis found that sEMG biofeedback coupled with swallowing maneuvers increased hyoid displacement in post-stroke dysphagia patients when compared with controls [ 88 ].…”

Section: How Can We Improve Treatment Of Post-stroke Dysphagia?mentioning

confidence: 99%

“…sEMG biofeedback uses two small electrodes placed on the submental muscles to measure the timing and force of the muscle contraction, which is displayed graphically on a screen [ 88 , 89 ]. A recent meta-analysis found that sEMG biofeedback coupled with swallowing maneuvers increased hyoid displacement in post-stroke dysphagia patients when compared with controls [ 88 ]. sEMG biofeedback has the potential for short-term benefits to dysphagia rehabilitation; however, it has been hypothesized that once patients learn swallowing therapies, biofeedback yields no further benefits.…”

Section: How Can We Improve Treatment Of Post-stroke Dysphagia?mentioning

confidence: 99%

Post-stroke Dysphagia: Recent Insights and Unanswered Questions

Jones¹,

Colletti

Ding

2020

Curr Neurol Neurosci Rep

101

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Purpose of Review We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? Recent Findings There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Summary Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.

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Does Therapy With Biofeedback Improve Swallowing in Adults With Dysphagia? A Systematic Review and Meta-Analysis

Abstract: Dysphagia therapy augmented by biofeedback using sEMG and accelerometry enhances hyoid displacement but functional improvements in swallowing are not evident. However, data are extremely limited and further larger well-designed RCTs are warranted.

Cited by 61 publications

References 56 publications

Efficacy of Biofeedback for Medical Conditions: an Evidence Map

Efficacy of Biofeedback for Medical Conditions: an Evidence Map

Implementation of a Home-Based mHealth App Intervention Program With Human Mediation for Swallowing Tongue Pressure Strengthening Exercises in Older Adults: Longitudinal Observational Study

Post-stroke Dysphagia: Recent Insights and Unanswered Questions

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