Cross-System Integration of Respiration and Deglutition: Function, Treatment, and Future Directions.
Bonnie Martin-Harris, Cagla Kantarcigil, Erin L Reedy and 1 others
PMID 36378345WHAT IT FOUND
Training head and neck cancer survivors to swallow during expiration improved airway protection and swallowing mechanics.
This preliminary evidence suggests better timing reduces residue and penetration, though larger randomized trials are still needed to confirm efficacy.
Key findings
01Respiratory-Swallow Training (RST) significantly increased the frequency of swallows initiated during expiration compared to baseline.
02RST improved airway safety measures, specifically Penetration-Aspiration Scale scores, without worsening them.
03Physiologic components of swallowing, including laryngeal vestibular closure, tongue base retraction, and pharyngeal residue, showed significant improvements after RST.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The primary evidence comes from a small, non-randomized Phase I trial (n=28) without a control group, so improvements cannot be definitively attributed to RST alone versus natural recovery or other factors. The authors are the developers of the RST protocol, which may introduce bias in the selection and interpretation of data. The review describes ongoing trials but does not present their results, so current evidence is limited to preliminary findings. The study population was restricted to head and neck cancer survivors; applicability to other dysphagia populations (e.g., neurologic) is theoretical and not tested here.
Declared interests
The authors state that the work was conducted in their combined labs over 30 years. No specific funding sources or commercial conflicts are declared in the provided text, but the authors are the developers of the therapy being reviewed.
The easy way to misread this
Do not assume RST is proven effective for general clinical use. The positive results come from a small, uncontrolled pilot study, and the authors explicitly state that larger randomized trials are ongoing to confirm efficacy. Current evidence is preliminary.