Table 2.
Facilitation techniques (compensatory techniques and/or rehabilitative techniques)
| Level of evidence | Data analysis | Reference (literature) | Subjectsa/etiology | Evaluation techniques | Treatment(s)/groups (G)b | Authors’ conclusions / key findings |
|---|---|---|---|---|---|---|
| A (randomized controlled trial) | Statistical analysis | Bülow et al. [19] |
25 Chronic dysphagia |
Quality-of-life measure, videofluoroscopy, clinical evaluation (dietary level classification, oral motor function test) Blinding |
G1 traditional swallowing therapy (N = 13) G2 Neuromuscular electrical stimulation: NMES (N = 12) |
Statistically significant positive therapy effects were found for both NMES and traditional swallowing therapy combined but there was no statistically significant difference in therapy effect between the groups. The correlations between measurements were low. |
| Power et al. [20] |
16 Acute stroke |
Videofluoroscopy Blinding? |
Surface electrical stimulation at anterior faucial pillars (single session) G1 Electrical stimulation (N = 8) G2 Sham stimulation (N = 8) |
Compared with baseline, no significant differences were observed in oral transit time, swallow response time, pharyngeal transit time, laryngeal closure duration, cricopharyngeal opening duration, or aspiration severity within subjects or between G1 and G2. | ||
| Rosenbek et al. [21] |
7 (male) Multiple stroke |
Videofluoroscopy Blinding? |
Thermal application at anterior faucial pillars A 1 week no therapy B 1 week thermal application G1 ABAB sequence (N = 1) G2 BABA sequence (N = 6) |
2/3 judges did report a treatment-related decrease in duration of stage transition for 2/7 patients, without any changes in the occurrence of aspiration or penetration. Overall, no strong evidence was found that dysphagia improved after 2 weeks of thermal application alternating with 2 weeks of no thermal application. | ||
| Rosenbek et al. [22] |
22 ≥ 1 stroke Excluding: N = 1 (unable to complete protocol) |
Videofluoroscopy Blinding |
Thermal application at anterior faucial pillars A 10 swallows without therapy B 10 swallows with thermal application (30-min rest period between conditions) G1 ABAB sequence (N = 9) G2 BABA sequence (N = 13) |
Thermal application significantly reduced duration of stage transition and total swallow duration compared to no treatment. | ||
| B (non-randomized clinical trial) | Statistical analysis | Blumenfeld et al. [23] (retrospective design) |
80 Acute care patients Patient attrition? |
Clinical evaluation (swallow severity scale) No blinding |
G1 Surface electrical stimulation: pharyngeal/laryngeal musculature (N = 40) G2 Traditional therapy: exercises, compensatory maneuvers and diet-texture modifications (N = 40) |
After therapy, both G1 and G2 showed significant improvement in severity score. Significantly more improvement was found in G1 compared to G2; G1 required fewer treatment sessions and displayed a trend toward a shorter length of hospitalization than G2. |
| Ludlow et al. [24] |
11 Diverse neurological pathologies with chronic dysphagia |
Videofluoroscopy Blinding |
Surface electrical stimulation Different conditions: G1 Stimulation at sensory threshold level during swallow (N = 8) G2 Stimulation at motor threshold level during swallow (N = 10) G3 Stimulation at motor threshold level at rest (N = 10) G4 No therapy/no stimulation (N = 28 trials by N = 11?) |
Only significant hyoid depression occurred during stimulation at rest. Aspiration and pooling were significantly reduced only with low sensory threshold levels of stimulation and not during maximum levels of surface electrical stimulation. Those patients who had reduced aspiration and penetration during swallowing with stimulation had greater hyoid depression during stimulation at rest. Stimulation may have acted to resist patients’ hyoid elevation during swallowing. | ||
| Shaw et al. [25] (retrospective design) |
18 Diverse neurological pathologies, post laryngeal radiotherapy |
Quality-of-life measure (N = 11), videofluoroscopy (N = 16), FEES (N = 2), clinical evaluation (dietary status) Blinding? |
Surface electrical stimulation: anterior neck G1 Near-functional swallow (N = 2) G2 Limited swallowing requiring compensatory maneuvers (N = 4) G3 Enteral feedings, ability to swallow small amounts of certain consistencies (N = 7) G4 Tube feeding (N = 5) |
Most patients improved with therapy. G2 improved significantly and G1 improved to normal. In G3 most patients (6/7) discontinued tube feeding, whereas in G4 no patient could stop tube feeding. In G4 only 2 patients out of 5 showed any improvement. | ||
| Descriptive statistics | Lazzara et al. [27] |
25 Diverse neurological pathologies |
Videofluoroscopy | Thermal stimulation at anterior faucial pillars (single session) | Thermal stimulation improved triggering of the swallowing reflex in 23/25 patients on swallows of at least one consistency (liquids or paste). Total transit time improved in 9/10 patients for liquids and 14/14 patients for paste. | |
| Leelamanit et al. [26] |
22 Diverse neurological pathologies Excluding: N = 1 (broken device), N = 2 (failed treatment) |
Videofluoroscopy, clinical evaluation, other (weight gain) Blinding? |
Synchronous electrical stimulator treatment (SES treatment): thyrohyoid muscle | SES treatment was ended in 2 subjects because of failure to improve and indication for gastrostomy. The remaining 20 subjects showed improved swallowing function after SES. 6 patients relapsed after a first SES treatment but were successfully treated with an additional SES treatment. Stimulating synchronous contraction of the thyrohyoid muscle by synchronous electrical stimulation during swallowing improves dysphagia resulting from reduced laryngeal elevation. |
aAdult men and women, unless otherwise stated
bGroups based on etiology, treatment, or study design