Review of the Effects of Visual Biofeedback on
Swallowing in Adult Dysphagia Patients
Background
• The number of adults suffering from swallowing
issues every year is 1 in 25 (ASHA, n.d.).
• An important outcome for this population is improved
swallowing function. This is measured by perceptual
rating scales and self-reports.
• Visual biofeedback can be an alternative or
additional treatment to using swallowing maneuvers
alone. The purpose of this project is to present a
systematic review about the effects of visual
biofeedback on adult patients with dysphagia.
• The specific research question is:
• Is visual biofeedback an effective treatment
method in improving swallowing function in
adult patients with dysphagia as measured by
perceptual rating scales or self-report?
Literature Search
• The following databases were used to retrieve
articles:
• ProQuest, MEDLINE, Science Direct, EBSCO,
CINAHL
• The search terms/key words used were:
• Biofeedback, dysphagia, adults, biofeedback
therapy, intervention, treatment, swallow
disorders, biofeedback training, surface
electromyography, visual biofeedback,
effectiveness, visual feedback, game based
biofeedback
• Additional search criteria included:
• Articles in English, Published 1975 or later,
Treatment was visual biofeedback, Participants
were adults with dysphagia, Outcomes were
measured by perceptual rating scales or self-
reports
• Articles were excluded based on the following criteria:
• Visual biofeedback was being used as an
assessment, not a treatment. The outcome
measure used was not a perceptual rating scale
or a self-report.
Jenna O’Donovan, Monica Donohue and Sarah Poplawski
Seton Hall University
Results
Patient Characteristics
• Across studies participants ranged in age
from 25 to 87 years old. The majority of
participants were between 45 and 70 years old.
• Dysphagia occurred nearly equally across male
and female participants.
• Participants in studies suffered from dysphagia
due to head and neck cancer, stroke, acquired
brain injury and Parkinson Disease.
• Reported effect sizes averaged a Cohen’s d of .99 for
• The average effect size was high Cohen’s d = 1.46
• Limitations include: small population sizes, mostly
• Future directions to explore include determining the
• Video demonstrating visual biofeedback:
Dosage
• The number of sessions ranged from 3 to 28
sessions (average = 13.1).
• sEMG sessions averaged 5 times per week;
game based biofeedback averaged 3 times per
week, and biofeedback using Iowa Oral
performance Instrument averaged 2 times per
week.
• Sessions ranged from 20 minutes to 2 hours
(average = 53.8 minutes).
Findings
sEMG biofeedback, 3.04 for Game based
biofeedback, and 0.83 for Video based biofeedback.
which indicates that visual biofeedback improves
swallowing function.
• Studies that only reported on percentages of patients
who benefitted, include 79% improvement for sEMG
biofeedback and 74% improvement for biofeedback
using the Iowa Oral Performance Instrument.
• Overall average of swallowing function improvement =
78.8%. This indicates that a majority of the patients in
these studies improved swallowing function after
utilizing visual biofeedback.
Limitations and Future
Directions
case studies, lack of blinding, no intent to treat and
lack of fidelity and reliability reported.
effect of home programs on success, developing a
specific treatment protocol, determining if a specific
type of maneuver will have the greatest outcome,
determining if onset affects treatment outcomes, and
determining if a specific population would benefit the
most from visual biofeedback therapy.
https://www.youtube.com/watch?v=b8Qng9VG-ww
References
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http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589942550&section=Incidence_and_Prevalence
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