Objectives: To conduct a scoping review of all available literature on interventions for dysphagia rehabilitation among individuals with acquired brain injury (ABI), to answer the research question: What literature is available investigating dysphagia-specific interventions for moderate-severe non-stroke ABI?

Methods: A literature search was conducted using PubMed, MEDLINE, Embase, and CINAHL for studies published in English up to July 2018. Studies were included if: (1) a dysphagia rehabilitation intervention was provided to participants, (2) any of the participants had moderate to severe non-stroke ABI, and (3) there were n≥1 adult (≥18 years) participants. For each study meeting inclusion criteria, data on author(s), year, country of publication, study design, sample size, demographic information (age, gender, injury etiology), intervention type, comparators, and outcome measures were extracted. Levels of evidence were assigned to each study using the modified Sackett scale. 

Results: Among the 16 studies which met our inclusion criteria, eight studies had a population of <50% ABI, three had >50% ABI, and five included an unspecified percentage of ABI. Eleven studies (68.75%) were published in the last six years (2012-2018), with the five remaining studies (31.25%) published more than ten years ago (1990-2007). Fourteen studies were published as journal articles, and two were conference abstracts. Four studies originated in the United States, three from Spain, two from each of the following countries, Canada, Korea, and Japan, and one each from South Africa, Germany, and Italy. Two randomized controlled trials (RCTs) provided level 1b evidence, six studies (3 RCTs, 3 prospective controlled trials) were level 2 evidence, six (3 post-test, 3 pre-post) were level 4 evidence, and two case studies provided level 5 evidence. Nine different interventions were investigated for dysphagia rehabilitation, with electrical stimulation, individualized management programs, and diet manipulation being the most common interventions. Eleven unique outcome measures were used overall, which crossed several domains and evaluated various outcomes including swallowing function, nutritional status, and aspiration. 

Conclusions: The literature investigating dysphagia rehabilitation interventions for non-stroke ABI is limited, with wide variability in terms of intervention types, interventional study designs, study population injury etiology, and outcome assessment across studies. Although a growth in the number of dysphagia studies has been observed within recent years, there remains an important gap in the literature pertaining to dysphagia rehabilitation in non-stroke ABI populations.

Dysphagia Rehabilitation Intervention Strategies in Moderate-Severe Acquired Brain Injury: A Scoping Review