Original research| Volume 97, ISSUE 4, P567-574, April 2016

The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study

Published:December 19, 2015DOI:



      To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia.


      Intervention study; before-after trial with 4-week follow-up through an online survey.


      Outpatient university clinics.


      A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study.


      Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45min/d.

      Main Outcome Measures

      Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey).


      The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (P<.05, η2=.8146 and P<.05, η2=.799708, respectively) and level of oral intake (P<.005, Cohen d=−1.387). Of the 5 patients who were feeding tube dependent initially, 2 progressed to total oral nutrition, and 2 progressed to partial oral nutrition. One patient remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% confidence interval, 6.38–14.5; P<.00), but not at the posttreatment. No adverse effects were observed/reported.


      The Intensive Dysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied.


      List of abbreviations:

      ASHA (American Speech-Language-Hearing Association), EAT-10 (10-item Eating Assessment Tool), FEES (fiberoptic endoscopic evaluation of swallowing), NOMS (National Outcomes Measurement System), NPO (nothing by mouth), PAS (Penetration Aspiration Scale), QOL (quality of life)
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