Early Feasibility and Efficacy of a Novel Skill-Based Training Program for Poststroke Dysphagia.

Objective: To develop a skill-based swallowing training program for poststroke survivors with dysphagia, to examine the acceptability, appropriateness, and feasibility of the program from the perspective of clinicians and researchers, and to investigate the early efficacy of the program. Design: The Plan-Do-Study-Act framework was used to conduct a clinician survey and to measure within-subject changes pre and posttreatment. Setting: Inpatient rehabilitation hospital. Participants: Fifteen swallowing clinicians and 7 researchers with a background in speech-language pathology responded to a survey about the intervention's acceptability, appropriateness, and feasibility (n = 22). Two patients (a 56y woman and a 33y man) with moderate-severe dysphagia secondary to poststroke received the swallowing intervention during inpatient rehabilitation (n = 2). Interventions: The Effort Accuracy Timing-Skill Training Applied to Rehabilitation in Swallowing (EAT-STARS) program is a novel, systematic, and progressive skill-based training program designed to improve swallowing function in poststroke dysphagia. The program consists of up to 8 treatment sessions, spanning 2 weeks, and incorporates principles of motor learning and neuroplasticity to enhance participants' ability to recognize correct/incorrect motor patterns, thereby promoting skill acquisition and mastery. It requires patients to generate different levels of swallowing effort (ie, regular swallow, effortful swallow) and control the timing of swallowing (ie, prompt swallow, swallow with bolus hold) using real-time surface electromyography visual biofeedback. Main Outcome Measures: Clinicians and researchers answered a survey that included the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measurequestionnaires. The early efficacy of the EAT-STARS program was assessed through standardized pre- and postswallowing measurements, including the Mann Assessment of Swallowing Ability, the Modified Barium Swallowing Impairment Profile, the Eating Assessment Tool, and a visual analog scale to indicate patient-perceived swallowing difficulty. Results: The EAT-STARS program met preestablished cutoff scores for the Acceptability of Intervention Measure (90%), Intervention Appropriateness Measure (87.5%), and Feasibility of Intervention Measure (83.4%) measures, indicating excellent acceptability, appropriateness, and feasibility, respectively. The early efficacy measures indicated that patients demonstrated improvements in both clinical swallowing ability and swallowing physiologyposttreatment. Moreover, patients reported perceived improvements in swallowing (visual analog scale and Eating Assessment Tool). Conclusions: The novel EAT-STARS program showed excellent acceptability, appropriateness, and feasibility measures. Clinical, physiologic, and patient-reported swallowing outcome measures indicated benefits of the program for poststroke patients with dysphagia. Further early-phase testing will include more patients and provide data on patients' satisfaction.