Ask an answerable question (PICO)：
When nerve innervation is compromised following a stroke, it can result in delayed swallowing times during the oral and pharyngeal phases and a postponement in larynx elevation, potentially leading to challenges in the pre-swallowing and swallowing phases (Li et al., 2022). Dysphagia, affecting 20%-90% of stroke patients, as reported by Zhuang et al., 2017, can predispose individuals to aspiration pneumonia, which is a leading cause of mortality in stroke patients (Chen & Zhuang, 2015). To address these critical issues, healthcare professionals should assess the severity of swallowing disorders in patients, offer personalized health education, and aim to reduce incidents of choking and coughing in individuals with swallowing difficulties. This article conducts a comprehensive literature review to investigate the potential benefits of Mendelsen swallowing exercises in improving dysphagia, lowering coughing rates, and enhancing the overall quality of care for stroke patients.
The Method and Analysis of Literature Review：
To conduct an exhaustive literature search, we explored multiple reputable databases, including CEPS Electronic Journals, CINAHL, PubMed, MEDLINE, Cochrane, Nursing & Allied Health Premium-Proquest, and EMBASE. Our search was guided by a set of carefully chosen keywords: for the Patient (P) category, we utilized 'Stroke,' 'post-stroke,' and 'after stroke'; for the Outcome (O) category, we focused on 'dysphagia,' 'dysphagic,' 'swallowing disorders,' and 'deglutition disorders'; in the Intervention (I) category, our emphasis was on 'Mendelsohn swallowing exercise,' 'Mendelsohn Exercise,' and 'Mendelsohn maneuvers.' We established specific search criteria, including adult populations, articles in English, the use of Mesh terms, publication dates from 2010 to 2023, and the application of Bollinger logic.
The types of articles we sought encompassed Systematic Reviews (SR), Meta-Analyses, Randomized Controlled Trials (RCT), Review articles, and clinical trials. In total, we excluded 24 research articles, with 20 not meeting PICO criteria or duplicating records. Additionally, we excluded two similar experiments. Ultimately, two randomized controlled clinical research articles were screened and selected for inclusion in our comprehensive literature review.
Critical Appraisal：
The evaluation tool employed in this study is the Critical Appraisal Skills Program (CASP) evaluation. McCullough et al. (2012) conducted a two-week investigation into the duration of maximum hyoid elevation (DOHME) and the duration of maximum hyoid anterior displacement (DOHMAE). The results revealed significant improvements in the duration of upper esophageal sphincter opening (DOHME, p = .011), DOHMAE (p = .009), while no significant change was observed in DOUESO (p = .472).
In a subsequent study by McCullough et al. (2013), a significant difference was found between the first and second weeks of treatment, particularly in the maximum anterior excursion of the hyoid bone (HMAE, p = 0.05), maximum elevation of the hyoid bone (HME, p = .01), and mean width of esophageal sphincter opening (MWUESO, p = .016). The outcomes assessed using the 8-point penetration-aspiration (P/A), Pyriform Residue, and Dysphagia Outcome and Severity Scale (DOSS) demonstrated consistent positive changes before and after treatment, with statistical significance (p < .05).
These findings suggest that the CASP evaluation and the associated studies can serve as valuable references for guiding clinical practice.
Results, Conclusions and Recommendations：
The utilization of Mendelsen exercises has been shown to enhance the swallowing process, reducing the incidence of choking and coughing during meals. This approach offers the added advantages of cost-effectiveness, non-invasiveness, and ease of implementation following appropriate teaching. However, it is important to exercise caution and refrain from employing Mendelsen exercises when patients are unable to sit up or cooperate due to impaired consciousness or a compromised cough reflex.
