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Summary of Systematic Review

Evidence-Based Systematic Review: Oropharyngeal Dysphagia Behavioral Treatments. Part IV. Impact of Dysphagia Treatment on Individuals' Postcancer Treatments
McCabe, D., Ashford, J., et al. (2009).
Journal of Rehabilitation Research & Development, 46(2), 205-214.
 
 
 
This review meets the criteria for a high-quality evidence-based systematic review.
Indicators of Review Quality:
The review addresses a clearly focused question 
 Yes
Criteria for inclusion of studies are provided 
 Yes
Search strategy is described in sufficient detail for replication 
 Yes
Included studies are assessed for study quality 
 Yes*
Quality assessments are reproducible 
 Yes
Characteristics of the included studies are provided  
 Yes

*Reviewed with the following supporting documents: 1) Evidence-Based Systematic Review: Oropharyngeal Dysphagia Behavioral Swallowing Treatments. Part I - Background and Methodology and 2) Evidence-Based Systematic Review: Oropharyngeal Dysphagia Behavioral Swallowing Treatments. Part V - Applications for Clinicians and Researchers

These supporting documents, which provide the systematic search results and address the application of the findings of this review to assist in clinical decision making, are available in the Journal of Rehabilitation Research and Development.

Description:
This is a review of case studies and case series that investigated the use of seven behavioral swallowing treatments on individuals post cancer treatments. This systematic review is part of a series of systematic reviews on dysphagia.

Question(s) Addressed:
  1. What is the effectiveness of dysphagia behavioral interventions (i.e. side lying, chin tuck or head rotation postures; effortful swallow, Mendelssohn, supraglottic swallow or super supraglottic swallow maneuvers) on swallowing physiology for populations with a structural disorders (i.e., head and neck cancer)?
  2. What is the effectiveness of dysphagia behavioral interventions (i.e. side lying, chin tuck or head rotation postures; effortful swallow, Mendelssohn, supraglottic swallow or super supraglottic swallow maneuvers) on functional swallowing outcomes for populations with a structural disorders (i.e., head and neck cancer)?
  3. What is the effectiveness of dysphagia behavioral interventions (i.e. side lying, chin tuck or head rotation postures; effortful swallow, Mendelssohn, supraglottic swallow or super supraglottic swallow maneuvers) on pulmonary health for populations with a structural disorders (i.e., head and neck cancer)?

Population:
Adults with structurally-induced dysphagia (i.e. head and neck cancer).

Intervention/Assessment:
Side lying posture, chin tuck posture, head rotation posture, effortful swallow maneuver, Mendelssohn maneuver, supraglottic swallow maneuver, super supraglottic swallow maneuver.

Number of Studies Included:
6

Years Included:
1985 to 2007

Conclusions:

  • Treatment

Swallowing

Compensatory Strategies

  • “No studies were found that investigated the use of side lying or head rotation in the population with head and neck cancer” (p. 208).
  • Findings from one study indicated fewer swallowing disorders among participants using the super-supraglottic swallowing maneuver than control participants. “However, data reported from two additional studies suggest that this maneuver may not be as effective in preventing aspiration as other interventions, such as the Mendelsohn maneuver” (p. 210).
  • “Depending on the circumstances with each individual patient, [the effortful swallow maneuver] may assist some to approach near-normal swallowing pressures, thus improving oropharyngeal clearing efficiency. As with all postural or maneuver interventions, patients with head and neck cancer should only be recommended the effortful swallow maneuver after observation of its effectiveness under fluoroscopic or endoscopic evaluation” (p. 211).
  • “The Mendelsohn maneuver with or without sEMG appears to be the treatment approach that produces the best results in returning patients to oral feeding. Promising intervention results that pair the Mendelsohn maneuver and sEMG suggest that the use of this biofeedback approach produces positive effects in patients with swallowing problems secondary to structurally based cancers” (p. 212).
  • “Ultimately, with little evidence available at this time, the impact of the supraglottic swallow is difficult to determine in populations with head and neck cancer” (p. 212).

Sponsoring Body:
This review was unfunded and based on work supported by ASHA's National Center for Evidence-based Practice in Communication Disorders.

Keywords: Head and Neck Cancer, Maneuvers, Positioning