Endoscopic Biofeedback Training for Cough and Swallowing: The What, Why, and How

Abstract

Purpose: Endoscopic biofeedback training is a type of augmented extrinsic feedback that provides information about physiological processes and bolus flow information through the use of flexible endoscopy. The goal of this tutorial is to describe why and how to incorporate endoscopic biofeedback training into cough and swallowing treatment when working with people with dystussia and dysphagia. Method: In this tutorial, we will review the diagnostic advantages and limitations of flexible endoscopic evaluation of swallowing as it relates to biofeedback training. We will then (a) review what is known about endoscopic biofeedback training in the field of speech-language pathology; (b) identify which airway protective behaviors clinicians might be best suited for endoscopic biofeedback training; and (c) provide a guide, including sample scripts and video demonstrations, that clinicians can use to aide in the implementation of endoscopic biofeedback training. Conclusions: Endoscopic biofeedback training for cough and swallowing habilitation and rehabilitation may be a useful addition to a speech-language pathologist's therapeutic armamentarium. However, more research is needed to comprehensively characterize the long-term effects on endoscopic biofeedback training on cough and swallowing treatment-related outcomes. Supplemental Material: https://doi.org/10.23641/asha.25043579

Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation

“…Through an individual's own proprioceptive feedback and kinesthetic motor control ( 107 ), these approaches adapt levels of function to harness a transient improvement in cough and/or underlying mechanisms of airway protection ( 58 , 59 , 67 , 103 ). Internal strategies are primarily volitional maneuvers which apply a cough or components of a cough in isolation or as part of a sequence of upper airway behaviors ( 105 , 108 , 109 ). Voluntary airway clearance maneuvers often require self-monitoring, the cognitive ability to retain multi-step instructions, and practice repeatedly.…”

“…Moreover, endoscopy can be used to provide feedback for the effectiveness of a maneuver or strategy. In a recent tutorial ( 105 ), a subjective review of endoscopic biofeedback targets for cough training with the application of compensatory strategies is reviewed.…”

“…Prior to removing the endoscope, the clinicians ask the patient to visualize the screen. Endoscopic biofeedback on cough effectiveness in response to remaining subglottic aspirate is provided ( 105 ), which revealed stimulability for improving cough effectiveness with biofeedback and cueing. The patient is then provided with information for biobehavioral rehabilitation, which will target oral hygiene, secretion management, EMST and voluntary cough skill training.…”