, Volume 32, Issue 1, pp 115–122 | Cite as

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

  • Alba M. AzolaEmail author
  • Kirstyn L. Sunday
  • Ianessa A. Humbert
Original Article


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.


Deglutition Deglutition disorders Biofeedback Swallowing rehabilitation Submental Surface EMG Videofluoroscopy 




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.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Alba M. Azola
    • 1
    Email author
  • Kirstyn L. Sunday
    • 2
  • Ianessa A. Humbert
    • 2
  1. 1.Department of Physical Medicine and RehabilitationJohns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Speech, Language, and Hearing SciencesUniversity of FloridaGainesvilleUSA

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