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Mitigation of oropharyngeal swallowing impairments and health sequelae: Two meta-analyses and an experiment using surface electromyographic biofeedback

Coyle, James L (2008) Mitigation of oropharyngeal swallowing impairments and health sequelae: Two meta-analyses and an experiment using surface electromyographic biofeedback. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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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.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Coyle, James Ljcoyle@pitt.eduJCOYLE
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairRogers, Joan C.jcr@pitt.eduJCR
Committee MemberGrayhack, Judith
Committee MemberHolm, Margo B.mbholm@pitt.eduMBHOLM
Committee MemberBaker, Nancy A.nab36@pitt.eduNAB36
Committee MemberCarrau, Ricardo
Date: 19 May 2008
Date Type: Completion
Defense Date: 7 February 2008
Approval Date: 19 May 2008
Submission Date: 21 February 2008
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: deglutition; dysphagia therapy; meta-analysis; swallowing disorders
Other ID:, etd-02212008-142618
Date Deposited: 10 Nov 2011 19:31
Last Modified: 15 Nov 2016 13:36


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