Skip to main content
Log in

Kinematic Visual Biofeedback Improves Accuracy of Learning a Swallowing Maneuver and Accuracy of Clinician Cues During Training

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Submental surface electromyography (ssEMG) visual biofeedback is widely used to train swallowing maneuvers. This study compares the effect of ssEMG and videofluoroscopy (VF) visual biofeedback on hyo-laryngeal accuracy when training a swallowing maneuver. Furthermore, it examines the clinician’s ability to provide accurate verbal cues during swallowing maneuver training. Thirty healthy adults performed the volitional laryngeal vestibule closure maneuver (vLVC), which involves swallowing and sustaining closure of the laryngeal vestibule for 2 s. The study included two stages: (1) first accurate demonstration of the vLVC maneuver, followed by (2) training—20 vLVC training swallows. Participants were randomized into three groups: (a) ssEMG biofeedback only, (b) VF biofeedback only, and (c) mixed biofeedback (VF for the first accurate demonstration achieving stage and ssEMG for the training stage). Participants’ performances were verbally critiqued or reinforced in real time while both the clinician and participant were observing the assigned visual biofeedback. VF and ssEMG were continuously recorded for all participants. Results show that accuracy of both vLVC performance and clinician cues was greater with VF biofeedback than with either ssEMG or mixed biofeedback (p < 0.001). Using ssEMG for providing real-time biofeedback during training could lead to errors while learning and training a swallowing maneuver.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Clavé P, Shaker R. Dysphagia: current reality and scope of the problem. Nat Rev Gastroenterol Hepatol. 2015;12(5):259–70.

    Article  PubMed  Google Scholar 

  2. Gandevia SC, Refshauge KM, Collins DF. Proprioception: peripheral inputs and perceptual interactions. In: Gandevia SC, Proske U, Stuart DG, editors. Sensorimotor control of movement and posture. Springer US; 2002. p. 61–8.

  3. Abbruzzese G, Trompetto C, Mori L, Pelosin E. Proprioceptive rehabilitation of upper limb dysfunction in movement disorders: a clinical perspective. Front Hum Neurosci. 2014;8:961.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rose DJ, Christina RW. A multilevel approach to the study of motor control and learning; 1997. p. 257–66.

  5. Humbert IA, German RZ. New directions for understanding neural control in swallowing: the potential and promise of motor learning. Dysphagia. 2013;28(1):1–10.

    Article  PubMed  Google Scholar 

  6. Buekers MJ, Magill RA, Hall KG. The effect of erroneous knowledge of results on skill acquisition when augmented information is redundant. Q J Exp Psychol. 1992;44(1):105–17.

    Article  Google Scholar 

  7. Ding R, Larson CR, Logemann JA, Rademaker AW. Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: normal and during the Mendelsohn manuever. Dysphagia. 2002;17(1):1–12.

    Article  PubMed  Google Scholar 

  8. Steele CM, Bennett JW, Oshalla M, Polacco RC, Chapman-Jay S, Molfenter SM. Electromyography as a biofeedback tool for rehabilitating swallowing muscle function. Rijeka: INTECH Open Access Publisher; 2012.

    Google Scholar 

  9. Giggins OM, Persson UM, Caulfield B. Biofeedback in rehabilitation. J Neuroeng Rehabil. 2013;10(1):60.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Azola AM, Greene LR, Taylor-Kamara I, Macrae P, Anderson C, Humbert IA. The relationship between submental surface electromyography and hyo-laryngeal kinematic measures of Mendelsohn Maneuver duration. J Speech Lang Hear Res. 2015;58(6):1627–36.

    Article  PubMed  PubMed Central  Google Scholar 

  11. German RZ, Campbell-Malone R, Crompton AW, Ding P, Holman S, Konow N, Thexton AJ. The concept of hyoid posture. Dysphagia. 2011;26(2):97–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Palmer PM, Jaffe DM, McCulloch TM, Finnegan EM, Van Daele DJ, Luschei ES. Quantitative contributions of the muscles of the tongue, floor-of-mouth, jaw, and velum to tongue-to-palate pressure generation. J Speech Lang Hear Res. 2008;51:828–35.

    Article  PubMed  Google Scholar 

  13. Manor Y, Mootanah R, Freud D, Giladi N, Cohen JT. Video-assisted swallowing therapy for patients with Parkinson’s disease. Parkinsonism Relat Disord. 2013;19(2):207–11.

    Article  PubMed  Google Scholar 

  14. Macrae P, Anderson C, Taylor-Kamara I, Humbert I. The effects of feedback on volitional manipulation of airway protection during swallowing. J Mot Behav. 2014;46(2):133–9.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Crary MA, Carnaby GD, Groher ME. Biomechanical correlates of surface electromyography signals obtained during swallowing by healthy adults. J Speech Lang Hear Res. 2006;49(1):186–93.

    Article  PubMed  Google Scholar 

  16. Logemann JA, Kahrilas PJ, Cheng JOAN, Pauloski BR, Gibbons PJ, Rademaker AW, Lin SHEZHANG. Closure mechanisms of laryngeal vestibule during swallow. Am J Physiol Gastrointest Liver Physiol. 1992;262(2):G338–44.

    CAS  Google Scholar 

  17. Bisch EM, Logemann JA, Rademaker AW, Kahrilas PJ, Lazarus CL. Pharyngeal effects of bolus volume, viscosity, and temperature in patients with dysphagia resulting from neurologic impairment and in normal subjects. J Speech Lang Hear Res. 1994;37(5):1041–9.

    Article  CAS  Google Scholar 

  18. Gelman A, Hill J. Data analysis using regression and multilevel/hierarchical models. Cambridge University Press; 2006.

  19. Jonsdottir J, Cattaneo D, Recalcati M, Regola A, Rabuffetti M, Ferrarin M, Casiraghi A. Task-oriented biofeedback to improve gait in individuals with chronic stroke: motor learning approach. Neurorehabilitation Neural Repair. 2010;24(5):478–85.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding

R01 DC014285 (NIH—Humbert), 14BGIA20380348 (AHA—Humbert). This research received support from the NIH Grant T32HD007414-22, awarded to Hugo W. Moser Research Institute Kennedy Krieger, Baltimore, MD, United States.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alba M. Azola.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Azola, A.M., Sunday, K.L. & Humbert, I.A. Kinematic Visual Biofeedback Improves Accuracy of Learning a Swallowing Maneuver and Accuracy of Clinician Cues During Training. Dysphagia 32, 115–122 (2017). https://doi.org/10.1007/s00455-016-9749-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-016-9749-z

Keywords

Navigation