The effect of intensified nonverbal facilitation of swallowing on dysphagia after severe acquired brain injury: A randomised controlled pilot study.
D Jakobsen, I Poulsen, C Schultheiss and 4 others
PMID 31868691WHAT IT FOUND
Intensified nonverbal facilitation of swallowing was feasible but did not significantly improve clinical swallowing scores compared to control.
The intervention group showed positive changes in laryngeal elevation speed and maximum elevation during treatment, while the control group worsened on these measures.
Key findings
01There were no significant differences in score changes between groups in the primary clinical outcomes of Penetration-Aspiration Scale and Functional Oral Intake Scale.
02Maximum laryngeal elevation and speed of laryngeal elevation increased during treatment in the intervention group but decreased or worsened in the control group.
03The study was underpowered with only 10 patients included over 32 months, limiting conclusions about efficacy.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was a pilot with a very small sample size (10 patients), making it underpowered to detect differences in clinical outcomes. Recruitment was extremely slow (3 patients per year), indicating feasibility issues for a definitive trial with these strict inclusion criteria. The intervention was physically demanding, with patient fatigue being a significant barrier to completing the full dose of treatment. Blinding of patients and therapists delivering the intervention was not possible, which may have influenced subjective outcome measures or adherence. The study population was heterogeneous in diagnosis and severity, and all patients were on medications that could affect arousal and swallowing.
Declared interests
One author is a certified F.O.T.T. senior instructor and teaches courses in the intervention. The study was funded by the Danish Occupational Therapist Association, a hospital research grant, and the department where the study was conducted.
The easy way to misread this
Do not conclude that intensified nonverbal facilitation of swallowing is clinically effective for improving safety or oral intake. The primary outcomes showed no significant difference between groups, and the study was a small pilot designed to test feasibility, not efficacy. The positive kinematic findings are exploratory and require confirmation in a larger, adequately powered trial.