Behavioral treatments performed in patients with dysphagia are designed to produce immediate or short-term outcomes that eliminate physiologic or biomechanical impairments of oropharyngeal swallowing. These short-term outcomes are expected to reduce aspiration of swallowed food into the respiratory system, and improve delivery of swallowed material into the digestive system. In the long-term these interventions are justified by expectations that they will reduce patient risk for dysphagia-related consequences such as pneumonia, malnutrition, and death.
Two distinct investigations were performed in this dissertation. The first, a meta-analysis, was performed to evaluate available evidence regarding the efficacy of individually administered dysphagia interventions in neurogenic dysphagia, and the effectiveness of systematic, institutional dysphagia protocols at mitigating public health risks associated with dysphagia. The second investigation, an experimental study, was executed to evaluate whether the addition of surface electromyographic biofeedback to traditional training of the Mendelsohn maneuver, a common individually administered dysphagia intervention, altered the initial (first training session) efficacy of volitional prolongation of muscle activity responsible for upper esophageal sphincter opening during the swallow.
The meta-analysis revealed that well designed investigations of individually administered treatments for short-term elimination of biomechanical impairments demonstrated small to large effect sizes (r = .13 - .45) for these treatments, all but one of which were statistically significant, and that overall, their combined effect size was small to medium (r = .29) and significant (p = .03). However studies of institutionally deployed dysphagia protocols demonstrated moderate effect sizes (Odds Ratio = .44 - .79) which, combined, were not statistically significant (p = .08). Overall, few published investigations of sufficiently robust evidence quality were found to justify their inclusion in the meta-analysis, suggesting that more research of this type is needed.
The experiment revealed that training of the Mendelsohn maneuver with and without surface electromyographic biofeedback, produced significantly increased duration (p < .01) and average amplitude (p = .02) of swallowing myoelectric activity. There were no significant differences between treatment groups in swallow duration or amplitude, however a trend toward increased preparatory myoelectric consistency was observed for the biofeedback trained group (p = .052) compared to the non-biofeedback trained group.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-02212008-142618 |
| Date | 19 May 2008 |
| Creators | Coyle, James L |
| Contributors | Ricardo L. Carrau, M.D., Nancy A. Baker, Sc.D., Joan C. Rogers, Ph.D., Margo B. Holm, Ph.D., Judith P. Grayhack, Ph.D. |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-02212008-142618/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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