A Proof‐of‐Concept Study Investigating Biofeedback Manipulations During a Common Dysphagia Assessment in Healthy Adults

Abstract

ABSTRACT Dysphagia is a complex medical condition denoted by difficulty or the inability to swallow. Although swallowing is a complex skill, strength deficits in individual muscle groups may contribute to dysfunction of the overall response. One component of swallowing involves the suprahyoid muscles, which are commonly assessed and trained with the tongue press exercise. Standard Verbal Encouragement (SVE) is frequently used to estimate maximum voluntary isometric contractions during assessment; however, this approach may underestimate true muscular capacity. A previously termed reinforcement‐based maximum voluntary isometric contraction (RMVIC) strategy, in which surface electromyography‐informed auditory feedback is systematically manipulated, has previously produced higher contraction values than SVE when applied to the vastus medialis oblique and pelvic floor muscles. The present study replicated and extended this strategy to the tongue press response. Using a single‐case reversal design, tongue press contractions were compared across SVE and RMVIC conditions in three healthy adults. A secondary analysis focused specifically on the removal of established feedback. Results indicated that the RMVIC arrangement consistently produced higher contraction magnitudes than SVE across participants, particularly when feedback was withdrawn following a successful response history. These findings suggest that prescribed biofeedback manipulation may improve estimates of maximal voluntary effort in the muscles involved in swallowing and warrant further investigation in clinical populations.

The authors' abstract, as published at the source. Behavioral Interventions, 2026 · DOI ↗