Table 3.

Swallow postures and swallow maneuvers (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	Shaker et al. [28]	27 Diverse neurological pathologies, post pharyngeal radiotherapy, diverse cardiovascular diseases	Videofluoroscopy, clinical evaluation (FOAMS: Functional Outcome Assessment of Swallowing Score) Blinding	G1 Sham exercise (N = 7) G2 Head-raising exercise program (N = 27c)	Pretreatment, all subjects suffered from abnormal UES opening. After treatment, G1 showed no significant changes in the measured biomechanical parameters. Following real exercise, both G2 and G1 (when crossed over to the real exercise group) exhibited a significant improvement in the anteroposterior diameter of the UES opening, in the anterior laryngeal excursion, and in the FOAMS scores. A significant decrease was found for postdeglutitive residue and resolution of aspiration.
B (non-randomized clinical trial)	Statistical analysis	Bülow et al. [31]	8 CVA, head and neck cancer	Videofluoroscopy, other (videomanometry) Blinding?	Supraglottic swallow, chin tuck, and effortful swallow (single session)	None of the techniques reduced the number of misdirected swallows, but effortful swallow and chin tuck significantly reduced the depth of contrast penetration into the larynx and pharyngeal retention. The swallowing techniques did not improve weak pharyngeal constriction.
		Logemann et al. [29]	5 Acute brainstem stroke (unilateral dysphagia)	Videofluoroscopy	Head rotation (single session)	The fraction of the bolus swallowed and the UES opening diameter increased significantly with the head turned toward the paretic side.
		Logemann et al. [30]	9 Head and neck cancer	Videofluoroscopy	Super-supraglottic swallow (single session)	With use of the super-supraglottic maneuver, fewer swallowing motility disorders were observed than without use of the maneuver. The maneuver contributed to the elimination or reduction of aspiration in three subjects.
	Descriptive statistics	Bogaert et al. [34]	30 Diverse neurological pathologies	Videofluoroscopy	Chin tuck versus supraglottic swallow (single session)	Both head flexion and supraglottic swallow could improve the pharyngeal phase of swallowing (e.g., reduction of premature spilling, elimination or reduction of aspiration, or penetration), but a consistent effect could not be proven.
		Lewin et al. [33]	21 Esophagectomy with aspiration	Videofluoroscopy	Chin tuck (single session)	Aspiration was eliminated in 81% (17/21) of aspirators using the chin-tuck maneuver.
		Logemann et al. [36]	32 Supraglottic laryngectomy, oral cancer resection, other resections	Videofluoroscopy	Postural techniques with or without supraglottic swallow (single session)	Postural techniques were effective in at least 60% of the patients with 1- and 3-ml volumes. If the patient first aspirated at 3-ml volumes, the posture was effective with 5-ml boluses in 80% of the patients. All patients who were able to swallow 10-ml boluses without aspiration using the posture were also able to swallow from a cup using the posture, an important step toward more normal eating.
		Logemann et al. [37]	9 Post supraglottic laryngectomy	Videofluoroscopy Blinding?	Supraglottic swallow	3/9 of the patients were able to eat orally at 2 weeks postoperatively, whereas 7/9 of the patients were successful oral feeders by 3 months.
		Shanahan et al. [32]	30 Diverse neurological pathologies	Videofluoroscopy	Chin tuck (single session)	All subjects showed preswallow aspiration because of delayed pharyngeal swallow triggering. Use of chin tuck eliminated aspiration in 15 out of 30 subjects.
		Zuydam et al. [35]	13? Tongue-base resection Patient attrition?	Videofluoroscopy Blinding?	Chin tuck; combination of chin tuck and supraglottic swallow G1 Tongue-base resection less than ¼ (N = 6?) G2 Tongue-base resection ¼ or more (N = 7?)	Compensatory procedures and therapy techniques were successful in a third of cases in the larger resection group and in all cases in the smaller resection group.

^aAdult men and women, unless otherwise stated

^bGroups based on etiology, treatment, or study design

^cIncluding crossover of G1 (N = 7) to G2