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The Pathophysiology and Clinical Manifestations of Spinocerebellar Ataxia Type 6. THE CEREBELLUM 2021; 19:459-464. [PMID: 32125675 DOI: 10.1007/s12311-020-01120-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Spinocerebellar ataxias (SCA) constitute of a group of degenerative and progressive disorders that can be identified on a molecular and cellular basis. Along with histological changes, the clinical presentation of SCA differs between subtypes. In addition to basic cerebellar dysfunction symptoms, patients with SCA develop gait ataxia, dysphagia, dysarthria, oculomotor disturbances, pyramidal and extrapyramidal disease signs, rigidity, bradycardia, sensory deficits, and mild cognitive and executive function decline. MRI scans have confirmed reduction in mass of frontal, temporal, and parietal portions of the brain along with the cerebellar peduncles, brainstem, and cranial nerve III. Clinically, these damages manifest as decline in cognition and problems with speech, contemplation, and vision. This review article compares the most prevalent subtypes of SCA based on genetic background, pathogenesis, neurological manifestations, other presenting symptoms, and diagnostic workup. Further goals of research in this field should be directed towards a cure for SCA, which currently does not exist.
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Rönnefarth M, Hanisch N, Brandt AU, Mähler A, Endres M, Paul F, Doss S. Dysphagia Affecting Quality of Life in Cerebellar Ataxia-a Large Survey. THE CEREBELLUM 2021; 19:437-445. [PMID: 32170655 PMCID: PMC7198478 DOI: 10.1007/s12311-020-01122-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dysphagia is a common symptom in neurodegenerative disorders and is generally associated with increased mortality. In the clinical care setting of ataxia patients, no systematical and standardized assessment of dysphagia is employed. Its impact on patients’ health-related quality of life is not well understood. To assess the impact of dysphagia in ataxia patients on diet, body weight, and health-related quality of life. We conducted a large survey using self-reported questionnaires for swallowing-related quality of life (Swal-QOL) and a food frequency list in combination with retrospective clinical data of 119 patients with cerebellar ataxia treated in the neurological outpatient clinic of a large German university hospital. Seventeen percent of ataxia patients suffered from dysphagia based on the Swal-QOL score. Less than 1% of all patients reported dysphagia as one of their most disabling symptoms. Dysphagia was associated with unintentional weight loss (p = 0.02) and reduced health-related quality of life (p = 0.01) but did not affect individual nutritional habits (p > 0.05; Chi-squared test). Dysphagia is a relevant symptom in cerebellar ataxia. A systematic screening for dysphagia in patients with cerebellar ataxia would be desirable to enable early diagnosis and treatment.
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Affiliation(s)
- M Rönnefarth
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - N Hanisch
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - A U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - A Mähler
- Experimental & Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - M Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - F Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Experimental & Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Sarah Doss
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Movement Disorders Section, Department of Neurological Sciences, University of Nebraska Medical Center, 4242 Farnam Street, 68131, Omaha, NE, USA.
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Choi JH, Shin C, Kim HJ, Jeon B. Placebo response in degenerative cerebellar ataxias: a descriptive review of randomized, placebo-controlled trials. J Neurol 2020; 269:62-71. [PMID: 33219422 DOI: 10.1007/s00415-020-10306-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 12/18/2022]
Abstract
Placebo response in degenerative cerebellar ataxias (CAs) has never been studied despite the large number of randomized controlled trials (RCTs) that have been conducted. In this descriptive review, we aimed to examine the placebo response in patients with CAs. We performed a literature search on PubMed for RCTs on CAs that were published from 1977 to January 2020 and collected data on the changes from the baseline to the endpoint on various objective ataxia-associated clinical rating scales. We reviewed 56 clinical trials, finally including 35 parallel-group studies and excluding 21 cross-over studies. The included studies were categorized as follows: (1) studies showing significant improvements in one or more ataxia scales in the placebo groups (n = 3); (2) studies reporting individual placebo responders with improvements in one or more ataxia scales in the placebo groups (n = 5)-the overall proportion of placebo responders was 31.9%; (3) studies showing mean changes in the direction of improvement in at least one ataxia scale in the placebo groups, though not statistically significant (n = 19); (4) studies showing no placebo response in any of the ataxia scales in the placebo groups (n = 4); (5) studies where data on the placebo groups were unavailable (n = 9). This review demonstrated the placebo response in patients with CAs on various objective ataxia scales. Our study emphasizes that the placebo response should be considered when designing, analyzing, and interpreting clinical trials and in clinical practice in CA patients.
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Affiliation(s)
- Ji-Hyun Choi
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong-si, South Korea.,Department of Neurology, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Han-Joon Kim
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
| | - Beomseok Jeon
- Department of Neurology and Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
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Vogel AP, Magee M, Torres-Vega R, Medrano-Montero J, Cyngler MP, Kruse M, Rojas S, Cubillos SC, Canento T, Maldonado F, Vazquez-Mojena Y, Ilg W, Rodríguez-Labrada R, Velázquez-Pérez L, Synofzik M. Features of speech and swallowing dysfunction in pre-ataxic spinocerebellar ataxia type 2. Neurology 2020; 95:e194-e205. [PMID: 32527970 DOI: 10.1212/wnl.0000000000009776] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/17/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine whether objective and quantitative assessment of dysarthria and dysphagia in spinocerebellar ataxia type 2 (SCA2), specifically at pre-ataxic and early disease phases, can act as sensitive disease markers. METHODS Forty-six individuals (16 with pre-ataxic SCA2, 14 with early-stage ataxic SCA2, and 16 healthy controls) were recruited in Holguin, Cuba. All participants underwent a comprehensive battery of assessments including objective acoustic analysis, clinician-derived ratings of speech function and swallowing, and quality of life assessments of swallowing. RESULTS Reduced speech agility manifest at the pre-ataxic stage was observed during diadochokinetic tasks, with the magnitude of speech deficit augmented in the early ataxic stage. Speech rate was slower in early-stage ataxic SCA2 compared with pre-ataxic SCA2 and healthy controls. Reduced speech agility and speech rate correlated with disease severity and time to ataxia onset, verifying that speech deficits occur prior to ataxia onset and increase in severity as the disease progresses. Whereas dysphagia was observed in both pre-ataxic and ataxic SCA2, it was not associated with swallowing-related quality of life, disease severity, or time to ataxia onset. CONCLUSIONS Speech and swallowing deficits appear sensitive to disease progression in early-stage SCA2, with syllabic rate a viable marker. Findings provide insight into mechanisms of disease progression in early-stage SCA2, signaling an opportunity for stratifying early-stage SCA2 and identifying salient markers of disease onset as well as outcome measures in future early-stage therapeutic studies.
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Affiliation(s)
- Adam P Vogel
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany.
| | - Michelle Magee
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Reidenis Torres-Vega
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Jacqueline Medrano-Montero
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Melissa P Cyngler
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Megan Kruse
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Sandra Rojas
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Sebastian Contreras Cubillos
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Tamara Canento
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Fernanda Maldonado
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Yaimee Vazquez-Mojena
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Winfried Ilg
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Roberto Rodríguez-Labrada
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Luis Velázquez-Pérez
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
| | - Matthis Synofzik
- From the Centre for Neuroscience of Speech (A.P.V., M.M., M.P.C., M.K., S.R., T.C., F.M.), The University of Melbourne, Victoria, Australia; Department of Neurodegeneration (A.P.V., M.S.), Hertie Institute for Clinical Brain Research, University of Tübingen; Center for Neurology (A.P.V., W.I., M.S.), University Hospital Tübingen, Germany; Redenlab (A.P.V.), Melbourne, Australia; Center for Research and Rehabilitation of Hereditary Ataxias (CIRAH) (R.T.-V., J.M.-M., Y.V.-M., R.R.-L., L.V.-P.), Holguin, Cuba; Escuela de Fonoaudiologia (S.C.C.), Facultad de Salud, Universidad Santo Tomas, Talca; Physical Medicine & Rehabilitation Service, Speech Therapy Unit (S.C.C.), Hospital of Curico, Chile; and German Center for Neurodegenerative Diseases (DZNE) (M.S.), Tübingen, Germany
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Keage M, Delatycki MB, Dyer J, Corben LA, Vogel AP. Changes detected in swallowing function in Friedreich ataxia over 12 months. Neuromuscul Disord 2019; 29:786-793. [DOI: 10.1016/j.nmd.2019.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/08/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022]
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6
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Yang JS, Chen PP, Lin MT, Qian MZ, Lin HX, Chen XP, Shang XJ, Wang DN, Chen YC, Jiang B, Chen YJ, Wang N, Chen WJ, Gan SR. Association Between Body Mass Index and Disease Severity in Chinese Spinocerebellar Ataxia Type 3 Patients. THE CEREBELLUM 2019; 17:494-498. [PMID: 29476441 DOI: 10.1007/s12311-018-0929-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Spinocerebellar ataxia type 3 (SCA3), the most common subtype of SCA worldwide, is caused by mutation of CAG repeats expansion in ATXN3. Body mass index (BMI) is an important modulatory factor in the progression of neurodegenerative disorders such as Huntington disease and amyotrophic lateral sclerosis. However, its relevance in SCA3 is not well understood. In this study, BMI was investigated in 134 molecularly confirmed SCA3 patients and 136 healthy controls from China. The multivariable linear regression models were performed to establish the putative risk factors for BMI, and whether BMI could affect the severity of ataxia. We found that BMI was significantly lower in the case group than that in the control group. The age at onset (positive correlation) and severity of ataxia (negative correlation) were the risk factors affecting BMI. Conversely, BMI along with the disease duration, the age at onset, and the numbers of CAG repeats could also have influence on the severity of ataxia. In conclusion, SCA3 patients had lower BMI than matched controls and BMI is a predictor of disease progression in SCA3. Nutritional intervention to promote weight gain could be a promising strategy to impede SCA3 progression.
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Affiliation(s)
- Jin-Shan Yang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Ping-Ping Chen
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Min-Ting Lin
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Mei-Zhen Qian
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China.,Interdisciplinary Institute of Neuroscience and Technology, Zhejiang University, Hangzhou, China
| | - Hui-Xia Lin
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Xiao-Ping Chen
- School of Mathematics and Computer Science & FJKLMAA, Fujian Normal University, Fuzhou, China
| | - Xian-Jin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Dan-Ni Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Yu-Chao Chen
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Bin Jiang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China.,Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Yi-Jun Chen
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China
| | - Wan-Jin Chen
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China. .,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China.
| | - Shi-Rui Gan
- Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China. .,Fujian Key Laboratory of Molecular Neurology, 20 Chazhong Road, Fuzhou, 350005, China.
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Stephen CD, Brizzi KT, Bouffard MA, Gomery P, Sullivan SL, Mello J, MacLean J, Schmahmann JD. The Comprehensive Management of Cerebellar Ataxia in Adults. Curr Treat Options Neurol 2019; 21:9. [PMID: 30788613 DOI: 10.1007/s11940-019-0549-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW In this review, we present the multidisciplinary approach to the management of the many neurological, medical, social, and emotional issues facing patients with cerebellar ataxia. RECENT FINDINGS Our holistic approach to treatment, developed over the past 25 years in the Massachusetts General Hospital Ataxia Unit, is centered on the compassionate care of the patient and their family, empowering them through engagement, and including the families as partners in the healing process. We present the management of ataxia in adults, beginning with establishing an accurate diagnosis, followed by treatment of the multiple symptoms seen in cerebellar disorders, with a view to maximizing quality of life and effectively living with the consequences of ataxia. We discuss the importance of a multidisciplinary approach to the management of ataxia, including medical and non-medical management and the evidence base that supports these interventions. We address the pharmacological treatment of ataxia, tremor, and other associated movement disorders; ophthalmological symptoms; bowel, bladder, and sexual symptoms; orthostatic hypotension; psychiatric and cognitive symptoms; neuromodulation, including deep brain stimulation; rehabilitation including physical therapy, occupational therapy and speech and language pathology and, as necessary, involving urology, psychiatry, and pain medicine. We discuss the role of palliative care in late-stage disease. The management of adults with ataxia is complex and a team-based approach is essential.
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Affiliation(s)
- Christopher D Stephen
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Movement Disorders Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Kate T Brizzi
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marc A Bouffard
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Division of Advanced General and Autoimmune Neurology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pablo Gomery
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Stacey L Sullivan
- Speech Language Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie Mello
- Physical Therapy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Julie MacLean
- Occupational Therapy, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeremy D Schmahmann
- Ataxia Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Laboratory for Neuroanatomy and Cerebellar Neurobiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Cognitive Behavioral Neurology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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O'Keeffe ST. Use of modified diets to prevent aspiration in oropharyngeal dysphagia: is current practice justified? BMC Geriatr 2018; 18:167. [PMID: 30029632 PMCID: PMC6053717 DOI: 10.1186/s12877-018-0839-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 06/19/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although modifying diets, by thickening liquids and modifying the texture of foods, to reduce the risk of aspiration has become central to the current management of dysphagia, the effectiveness of this intervention has been questioned. This narrative review examines, and discusses possible reasons for, the apparent discrepancy between the widespread use of modified diets in current clinical practice and the limited evidence base regarding the benefits and risks of this approach. DISCUSSION There is no good evidence to date that thickening liquids reduces pneumonia in dysphagia and this intervention may be associated with reduced fluid intake. Texture-modified foods may contribute to undernutrition in those with dysphagia. Modified diets worsen the quality of life of those with dysphagia, and non-compliance is common. There is substantial variability in terminology and standards for modified diets, in the recommendations of individual therapists, and in the consistency of diets prepared by healthcare staff for consumption. Although use of modified diets might appear to have a rational pathophysiological basis in dysphagia, the relationship between aspiration and pneumonia is not clear-cut. Clinical experience may be a more important determinant of everyday practice than research evidence and patient preferences. There are situations in the management of dysphagia where common sense and the necessity of intervention will clearly outweigh any lack of evidence or when application of evidence-based principles can enable good decision making despite the absence of robust evidence. Nevertheless, there is a significant discrepancy between the paucity of the evidence base supporting use of modified diets and the beliefs and practices of practitioners. CONCLUSION The disconnect between the limited evidence base and the widespread use of modified diets suggests the need for more careful consideration as to when modified diets might be recommended to patients. Patients (or their representatives) have a choice whether or not to accept a modified diet and must receive adequate information, about the potential risks and impact on quality of life as well as the possible benefits, to make that choice. There is an urgent need for better quality evidence regarding this intervention.
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Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland.
- Unit 4, Merlin Park University Hospital, Galway, Ireland.
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Vogel AP, Rommel N, Oettinger A, Stoll LH, Kraus EM, Gagnon C, Horger M, Krumm P, Timmann D, Storey E, Schöls L, Synofzik M. Coordination and timing deficits in speech and swallowing in autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). J Neurol 2018; 265:2060-2070. [PMID: 29968200 DOI: 10.1007/s00415-018-8950-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a rare early onset neurodegenerative disease that typically results in ataxia, upper motor neuron dysfunction and sensorimotor peripheral neuropathy. Dysarthria and dysphagia are anecdotally described as key features of ARSACS but the nature, severity and impact of these deficits in ARSACS are not known. A comprehensive quantitative and qualitative characterization of speech and swallowing function will support diagnostics, provide insights into the underlying pathology, and guide day-to-day clinical management. METHODS 11 consecutive non-Quebec ARSACS patients were recruited, and compared to healthy participants from several published and unpublished cohorts. A comprehensive behavioural assessment including objective acoustic analysis and expert perceptual ratings of motor speech, the Clinical Assessment of Dysphagia in Neurodegeneration (CADN), videofluoroscopy and standardized tests of dysarthria and swallowing related quality of life was conducted. RESULTS Speech in this ARSACS cohort is characterized by pitch breaks, prosodic deficits including reduced rate and prolonged intervals, and articulatory deficits. The swallowing profile was characterized by delayed initiation of the swallowing reflex and late epiglottic closure. Four out of ten patients were observed aspirating thin liquids on videofluoroscopy. Patients report that they regularly cough or choke on thin liquids and solids during mealtimes. Swallowing and speech-related quality of life was worse than healthy controls on all domains except sleep. CONCLUSIONS The dysphagia and dysarthria profile of this ARSACS cohort reflects impaired coordination and timing. Dysphagia contributes to a significant impairment in functional quality of life in ARSACS, and appears to manifest distinctly from other ARSACS dysfunctions such as ataxia or spasticity.
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Affiliation(s)
- Adam P Vogel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. .,Center for Neurology, University Hospital Tübingen, Tübingen, Germany. .,Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia. .,Redenlab, Melbourne, Australia.
| | - Natalie Rommel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Oettinger
- Neurology and Rehabilitation, Kliniken Schmieder, Gailingen am Hochrhein, Germany
| | - Lisa H Stoll
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Therapiezentrum, University Hospital Tübingen, Tübingen, Germany
| | - Eva-Maria Kraus
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Jonquière, QC, Canada.,Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours du Centre de santé et de services sociaux de Jonquière, Jonquière, QC, Canada.,Centre hospitalier affilié universitaire régional (CAUR) de Chicoutimi, Centre de santé et de services sociaux de Chicoutimi, Chicoutimi, QC, Canada
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Dagmar Timmann
- Department of Neurology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Elsdon Storey
- Department of Medicine, Monash University, Melbourne, Australia
| | - Ludger Schöls
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Center for Neurology, University Hospital Tübingen, Tübingen, Germany.,Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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11
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Vogel AP, Rommel N, Oettinger A, Horger M, Krumm P, Kraus EM, Schöls L, Synofzik M. Speech and swallowing abnormalities in adults with POLG associated ataxia (POLG-A). Mitochondrion 2017. [PMID: 28634151 DOI: 10.1016/j.mito.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mutations in the nuclear-encoded mitochondrial DNA polymerase gamma (POLG) can result in a wide spectrum of neurological deficits. A common presentation is progressive ataxia (POLG-A) which includes impaired speech and swallowing. The nature, severity and impact of these deficits in POLG-A is not known. A comprehensive quantitative and qualitative characterization of dysarthria and dysphagia in this recurrent ataxia disorder will assist in diagnostics, provide insights into the underlying pathology, and establish the foundation for future therapy trials. METHODS 14 consecutive patients with POLG (9 females, mean age=50.1y, SD=11.2) and 34 healthy controls were enrolled. Comprehensive assessments of motor speech and swallowing function, acoustic analysis of speech, videofluoroscopy and measures of quality of life were conducted. RESULTS The speech profile of individuals with POLG-A was characterized by poor control of pitch and strain-strangled voice quality, reduced rate of speech and longer variable silences between words, and articulatory breakdown including imprecise consonants and vowel distortions. Swallowing deficits included slower initiation of the swallow reflex, poor control of bolus and late epiglottic closure. Speech and swallowing related quality of life was worse than healthy controls. CONCLUSIONS The dysarthria and dysphagia profiles in POLG-A are largely symptomatic of impaired timing, indicating a mainly spinocerebellar deficit. Dysarthria and dysphagia contribute to a significant impairment in functional quality of life, and progress distinctly from other POLG-A dysfunctions like ataxia or cognitive impairment. Our assessments establish meaningful patient focused outcome measures that will be suitable for use in natural history studies and clinical trials.
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Affiliation(s)
- Adam P Vogel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Centre for Neuroscience of Speech, The University of Melbourne, Victoria, Australia; Redenlab, Melbourne, Australia.
| | - Natalie Rommel
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Therapiezentrum, University Hospital Tübingen, Germany
| | - Andreas Oettinger
- Neurology and Rehabilitation, Kliniken Schmieder, Gailingen am Hochrhein, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Eva-Maria Kraus
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany & Center for Neurology, University Hospital Tübingen, Germany; Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
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Keage MJ, Delatycki MB, Gupta I, Corben LA, Vogel AP. Dysphagia in Friedreich Ataxia. Dysphagia 2017; 32:626-635. [PMID: 28474131 DOI: 10.1007/s00455-017-9804-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 04/19/2017] [Indexed: 01/31/2023]
Abstract
The objective of the study was to comprehensively characterise dysphagia in Friedreich ataxia (FRDA) and identify predictors of penetration/aspiration during swallowing. We also investigated the psychosocial impact of dysphagia on individuals with FRDA. Sixty participants with FRDA were screened for dysphagia using a swallowing quality of life questionnaire (Swal-QOL) and case history. Individuals reporting dysphagia underwent a standardised oromotor assessment (Frenchay Dysarthria Assessment, 2, FDA-2) and videofluoroscopic study of swallowing (VFSS). Data were correlated with disease parameters (age at symptom onset, age at assessment, disease duration, FXN intron 1 GAA repeat sizes, and Friedreich Ataxia Rating Scale (FARS) score). Predictors of airway penetration/aspiration were explored using logistic regression analysis. Ninety-eight percent (59/60) of participants reported dysphagia, of whom 35 (58.3%) underwent FDA-2 assessment, and 38 (63.3%) underwent VFSS. Laryngeal, respiratory, and tongue dysfunction was observed on the FDA-2. A Penetration-Aspiration Scale score above 3 (deemed significant airway compromise based on non-clinical groups) was observed on at least one consistency in 13/38 (34.2%) participants. All of those who aspirated (10/38, 26.3%) did so silently, with no overt signs of airway entry such as reflexive cough. Significant correlations were observed between dysphagic symptoms and disease duration and severity. No reliable predictors of penetration or aspiration were identified. Oropharyngeal dysphagia is commonly present in individuals with FRDA and worsens with disease duration and severity. Individuals with FRDA are at risk of aspiration at any stage of the disease and should be reviewed regularly. Instrumental analysis remains the only reliable method to detect aspiration in this population. Dysphagia significantly affects the quality of life of individuals with FRDA.
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Affiliation(s)
- Megan J Keage
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | - Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Clinical Genetics, Austin Health, Melbourne, Australia
| | - Isabelle Gupta
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia
| | - Louise A Corben
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Melbourne, Australia.,School of Psychological Sciences, Monash University, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Monash Health, Melbourne, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, 550 Swanston Street, Parkville, Melbourne, VIC, 3010, Australia. .,Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Melbourne, Australia. .,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany. .,Redenlab Pty Ltd, Melbourne, Australia.
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Ilott I, Gerrish K, Eltringham SA, Taylor C, Pownall S. Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study. BMC Health Serv Res 2016; 16:406. [PMID: 27538983 PMCID: PMC4991017 DOI: 10.1186/s12913-016-1653-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/10/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change. The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability of this safety initiative. METHODS An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011 to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the organisational and clinical level through interviews (n = 30) and document review. The coding frame combined the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff trained about dysphagia and impact related to changes in practice. RESULTS The features and processes associated with hierarchical control and participatory adaptation were identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and support (participatory adaptation). CONCLUSIONS Frameworks for spread and sustainability were combined to create a 'small theory' that described the interventions, the processes and desired outcomes a priori. This novel methodological approach confirmed what is known about spread and sustainability, highlighted the particularity of change and offered new insights into the factors associated with hierarchical control and participatory adaptation. The findings illustrate the dualities of organisational change as universal and context specific; as particular and amendable to theoretical generalisation. Appreciating these dualities may contribute to understanding why many innovations fail to become routine.
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Affiliation(s)
- Irene Ilott
- Formerly Knowledge Translation Project Lead with the NIHR CLAHRC SY, Sheffield, UK
| | - Kate Gerrish
- School of Nursing and Midwifery University of Sheffield and Sheffield Teaching Hospitals NHS Foundation Trust, NIHR CLAHRC Yorkshire and Humber, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, D Floor Research, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | | | - Carolyn Taylor
- Dietetic Department, Sheffield Teaching Hospital NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU UK
| | - Sue Pownall
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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