Senior Honors Projects, 2010-2019

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation

Spring 2019

Document Type


Degree Name

Bachelor of Arts (BA)


Department of Communication Sciences and Disorders


Erin E. Kamarunas

Rachel J. Rinehart

Louise M. Temple


Biofeedback is as a visual way to self-assess muscle contraction, particularly during rehabilitative exercises. Speech language pathologists and otolaryngologists have investigated the use of visual biofeedback in swallowing therapy, especially for volitional swallowing rehabilitative exercises such as the effortful swallow, which requires the patient to maximally swallow with all their strength. In contrast to the effortful swallow, “effortful skilled swallowing” is the ability to swallow with a specific and precise amount of effort, which is an emerging topic in dysphagia research. Dysphagia, also known as disordered swallowing, can be an organic congenital disorder treated via feeding tubes, or an acquired disorder as a result of a old age, traumatic injury, intubation, neurodegenerative diseases, or a stroke, among other etiologies. In the United States, one quarter of the population will struggle with swallowing at some point. It plagues 13-15% of acute care hospital patients, 30-35% of those in rehabilitation settings, and 40-50% of individuals living in nursing homes. This study examined the use of skilled swallowing targets in healthy, non-dysphagic participants, concentrating on examining the following: 1) the participants’ ability to differentiate and execute different skill level targets, 2) the effectiveness of visual biofeedback at improving participant’s accuracy at skilled swallowing tasks, and 3) participant accuracy over time, over the course of 30 successive swallows. Data was collected from eight participants, seven of which were used in this study. Participants were trained and then randomly instructed to swallow at three different effort levels: 50%, 75%, and 100%. They were then evaluated to see how closely they swallowed compared to the target effort level. This was defined as the level of accuracy. Accuracy was measured by surface electromyography (sEMG) electrodes placed on the anterior submental region of the neck. Visual biofeedback of their EMG signal was provided to the participant for fifteen random swallows of the thirty swallows in each experimental exercise. The results indicate that participants are able to modulate their swallowing effort to approximate three different effort levels, but that biofeedback did not affect participants’ accuracy. Additionally, participants’ accuracy in achieving skilled swallow targets did not change over the course of 30 swallows. These results indicate that swallowing effort can be modulated and used as a skilled task during treatment. Biofeedback, while useful in training a swallowing task, may not be needed during every trial to ensure accuracy. Finally, in these healthy participants, there did not seem to be an effect of boredom or fatigue while successively performing 30 skilled swallow tasks over the course of 22 minutes. It is not known if these results are generalizable to an older, dysphagic population.



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