Arquivo da tag: side-lying posture

Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part V-Applications for clinicians and researchers

Karen Wheeler-Hegland, PhD; Tobi Frymark, MA; Tracy Schooling, MA; Daniel McCabe, DMA; John Ashford, PhD; Robert Mullen, MPH; Carol Smith Hammond, PhD; Nan Musson, MA

JRRD, Volume 46 Number 2, 2009, Pages 215 — 222

Abstract —

Evidence-based practice (EBP) involves the integration of three essential principles: (1) the current best available research, (2) the clinician’s experience and expertise, and (3) the patient’s values and preferences. This report is the last in a series that presents the culmination of a collaborative effort between the American Speech-Language-Hearing Association and the Department of Veterans Affairs to examine the state of the evidence on seven behavioral swallowing interventions. This article addresses how speech-language pathologists treating individuals with oropharyngeal dysphagia can incorporate EBP into their clinical decision-making process. A fictitious patient scenario is presented and discussed as an example of the clinical application of the findings from the three systematic reviews in this series on evidence for the use of behavioral swallowing interventions. Also, recommendations for researchers studying dysphagia treatment are discussed, with the overall goal of facilitating the generation of a stronger evidence base for clinicians.

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Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part III-Impact of dysphagia treatments on populations with neurological disorders

John Ashford, PhD; Daniel McCabe, DMA; Karen Wheeler-Hegland, PhD; Tobi Frymark, MA; Robert Mullen, MPH; Nan Musson, MA; Tracy Schooling, MA; Carol Smith Hammond, PhD

JRRD, Volume 46 Number 2, 2009, Pages 195 — 204

Abstract —

This evidence-based systematic review (EBSR) is part of a series of reviews examining the state of the research regarding behavioral interventions for dysphagia. This EBSR focuses primarily on dysphagia secondary to neurological disorders (e.g., brain injury, stroke, Parkinson’s disease, and dementia). The seven behavioral treatments investigated were three postural interventions (side lying, chin tuck, and head rotation) and four swallowing maneuvers (effortful swallow, Mendelsohn, supraglottic swallow, and super-supraglottic swallow). We systematically searched the dysphagia literature from March 2007 to April 2008 using 14 electronic databases. Seven studies met the inclusion and exclusion criteria and were evaluated for methodological quality and stage of research. Of the included studies, only two were judged to be efficacy research; the remaining five were considered exploratory. Methodological quality of studies ranged from one to seven out of eight possible quality markers. Five of seven treatment interventions were addressed by at least one study. No studies were found to address the effortful swallow or the super-supraglottic swallow. Currently, limited evidence from seven studies shows the potential effects of dysphagia behavioral interventions for select groups of individuals with neurologically induced dysphagia. Further research is needed to evaluate the effectiveness of these and the remaining interventions with various populations with neurological disorders.

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Evidence-based systematic review: Oropharyngeal dysphagia behavioral treatments. Part II-Impact of dysphagia treatment on normal swallow function

Karen Wheeler-Hegland, PhD; John Ashford, PhD; Tobi Frymark, MA; Daniel McCabe, DMA; Robert Mullen, MPH; Nan Musson, MA; Carol Smith Hammond, PhD; Tracy Schooling, MA

JRRD, Volume 46 Number 2, 2009, Pages 185 — 194

Abstract —

This article is the second in a series of evidence-based systematic reviews. Data reported cover the impact of dysphagia behavioral interventions on swallow physiology in healthy adults. The behavioral treatments investigated were three postural interventions-side lying, chin tuck, and head rotation-and four swallowing maneuvers-effortful swallow, the Mendelsohn maneuver, supraglottic swallow, and super-supraglottic swallow. A systematic search of the dysphagia litera-ture was conducted in 14 electronic databases. Seventeen studies meeting the inclusion criteria were evaluated for methodological quality with the American Speech-Language-Hearing Association’s levels-of-evidence scheme and were characterized by research stage (i.e., exploratory, efficacy, effectiveness, cost-benefit/public policy research). Effect sizes were calculated when possible. All studies were exploratory research ranging from two to five of seven possible quality markers. The majority of studies (8 of 17) investigated effortful swallow. Three studies examined the Mendelsohn maneuver, chin tuck, supraglottic swallow, and super-supraglottic swallow and two studies addressed head rotation. No study addressed side lying. For nondisordered populations, the existing evidence demonstrates differential effects of postural changes and maneuvers on swallowing physiology. Some effects reinforced existing recommendations for the applications of the interventions, while others suggested new ways that the treatments may impact swallow function. Avenues for future research are suggested.

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