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Barbon CEA, Warneke CL, Ledger B, Rogus-Pulia N, Cunningham L, Coyle JL, Levesque-Boissonneault C, Alvarez C, Valencia D, Hutcheson KA. Reliability and Confidence of Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) Rating Among Research and Clinical Speech Pathologists Before and After Implementation of a Training Manual: A Multi-site Study. Dysphagia 2024:10.1007/s00455-024-10733-y. [PMID: 39181934 DOI: 10.1007/s00455-024-10733-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 07/05/2024] [Indexed: 08/27/2024]
Abstract
DIGEST is a validated, open-source method to grade the severity of pharyngeal dysphagia from the modified barium swallow (MBS) study. Dissemination and implementation of DIGEST is rising, making it critical to understand reliability and facilitators of accurate implementation among users. The aim was to assess reliability of the tool among speech-language pathology (SLP) raters practicing at multiple sites before and after review of a DIGEST training manual and evaluate confidence of DIGEST use pre-and post-training. Thirty-two SLPs from 5 sites participated in a blinded longitudinal DIGEST rating study. Raters were provided a standardized training set of MBS (n = 19). Initial SLP ratings (round 1, R1) were followed by a 2-4 week break before raters rated a re-keyed MBS set (round 2, R2). A minimum 4-8 week wash-out period then preceded self-study of the DIGEST training manual which was followed by a final rating (round 3, R3) and a post-manual survey afterwards. Baseline reliability (R1) of overall DIGEST was on average k = 0.70, reflecting agreement in the substantial range. Seventy-five percent of raters (24/32) demonstrated reliability ≥ 0.61 in the substantial to almost perfect range prior to training. Inter-rater reliability significantly improved from R1 to R3 after review of the DIGEST manual, with the largest change in DIGEST-Efficiency (mean change: DIGEST k = .04, p = .009, DIGEST-Safety k = .07, p = 0.03, and DIGEST-Efficiency k = .14, p = 0.009). Although DIGEST reliability at baseline was adequate in the majority of raters, self-study of the DIGEST training manual significantly improved inter-rater reliability and rater confidence using the DIGEST method, particularly when assigning DIGEST-Efficiency grade. These early data show promise that provider training may be useful to aid in fidelity of DIGEST implementation among SLP clinical users with varying DIGEST experience.
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Affiliation(s)
- C E A Barbon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C L Warneke
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ledger
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, USA
| | - N Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - L Cunningham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - C Alvarez
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - D Valencia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Yoshida T, Yagi N, Ogawa T, Nakanome A, Ohkoshi A, Katori Y, Oku Y. Breathing-Swallowing discoordination after definitive chemoradiotherapy for head and neck cancers is associated with aspiration pneumonia. PLoS One 2024; 19:e0305560. [PMID: 38990865 PMCID: PMC11238977 DOI: 10.1371/journal.pone.0305560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE Swallowing dysfunction and the risk of aspiration pneumonia are frequent clinical problems in the treatment of head and neck squamous cell carcinomas (HNSCCs). Breathing-swallowing coordination is an important factor in evaluating the risk of aspiration pneumonia. To investigate breathing-swallowing discoordination after chemoradiotherapy (CRT), we monitored respiration and swallowing activity before and after CRT in patients with HNSCCs. METHODS Non-invasive swallowing monitoring was prospectively performed in 25 patients with HNSCCs treated with CRT and grade 1 or lower radiation-induced dermatitis. Videoendoscopy, videofluoroscopy, Food Intake LEVEL Scale, and patient-reported swallowing difficulties were assessed. RESULTS Of the 25 patients selected for this study, four dropped out due to radiation-induced dermatitis. The remaining 21 patients were analyzed using a monitoring system before and after CRT. For each of the 21 patients, 405 swallows were analyzed. Swallowing latency and pause duration after the CRT were significantly extended compared to those before the CRT. In the analysis of each swallowing pattern, swallowing immediately followed by inspiration (SW-I pattern), reflecting breathing-swallowing discoordination, was observed more frequently after CRT (p = 0.0001). In 11 patients, the SW-I pattern was observed more frequently compared to that before the CRT (p = 0.00139). One patient developed aspiration pneumonia at 12 and 23 months after the CRT. CONCLUSION The results of this preliminary study indicate that breathing-swallowing discoordination tends to increase after CRT and could be involved in aspiration pneumonia. This non-invasive method may be useful for screening swallowing dysfunction and its potential risks.
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Affiliation(s)
- Takuya Yoshida
- Department of Otolaryngology, Iwate Prefectural Iwai Hospital, Ichinoseki, Iwate, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naomi Yagi
- Advanced Medical Engineering Research Institute, University of Hyogo, Himeji, Hyogo, Japan
| | - Takenori Ogawa
- Department of Otolaryngology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ayako Nakanome
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Ashkenazi Y, Stainer N, Tadmor L, Yaakov L, Friedman I, Rips R, Sella Weiss O. Hybrid SPEAK OUT! protocol improves aerodynamic measurements and PROMs in Parkinson's disease. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38895888 DOI: 10.1111/1460-6984.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND SPEAK OUT! has been shown to enhance various aspects of voice such as intensity, prosody, voice quality and perception of voice. However, their impacts on expiration and communication effectiveness have not yet been evaluated. This study aimed to evaluate the effectiveness of the Hybrid SPEAK OUT! method on aerodynamic measurements and patient-reported outcome measures (PROMs) in individuals with Parkinson's disease (PD). METHODS This study included 157 participants with PD who underwent an intensive 8-week multidisciplinary treatment program. The Hybrid SPEAK OUT! method consisted of three sessions per week, including two group sessions and one individual treatment session. Voice-related aerodynamic measures included maximum phonation time (MPT), vocal cord function using the S/Z ratio, and expiratory flow measures including peak expiratory flow (PEF) and peak cough flow (PCF). Two PROMs were included: the Hebrew version of the voice handicap index-10 and communication effectiveness questionnaire. RESULTS The results of 111 participants were analysed. MPT duration increased, PEF and PCF increased, and better scores were found in PROMs. CONCLUSION These findings would appear to support the effectiveness of the Hybrid SPEAK OUT! methods improving function, activity and participation in individuals with PD. However, further research is needed. WHAT THIS PAPER ADDS What is already known on the subject Prior research has demonstrated the effectiveness of behavioral therapies, including the SPEAK OUT! program, in managing speech symptoms in individuals with Parkinson's disease (PD). These therapies have shown improvements in voice intensity, fundamental frequency, voice quality, and voice perception. However, the impact on aerodynamic measures, expiratory flow, and patient-reported outcome measures has not been extensively studied. What this paper adds to existing knowledge This study adds to the existing knowledge by demonstrating that a Hybrid SPEAK OUT! approach, can lead to improvements in aerodynamic measures, including maximum phonation time (MPT), expiratory and cough peak flow. In terms of motor learning, we found that two non-speech exhalation-related tasks that were not directly trained improved following the intensive speech training protocol. Furthermore, it shows positive changes in patient-reported outcome measures, with reduced voice-related disability and improved communication efficiency. What are the potential or actual clinical implications of this work? The findings of this study have important clinical implications for the management of speech symptoms in individuals with PD. The Hybrid SPEAK OUT! program, which combines group and individual sessions, can effectively improve voice, aerodynamic measurements and patient-reported outcome measures (PROMs), ultimately enhancing the overall quality of life for patients. These findings support the effectiveness of the Hybrid SPEAK OUT! methods for improving function, activity, and participation in individuals with PD.
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Affiliation(s)
- Yarden Ashkenazi
- Rehabilitation Center, Ezra Lemarpe, Bnei-Brak, Israel
- Rehabilitation Unit, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nava Stainer
- Rehabilitation Center, Ezra Lemarpe, Bnei-Brak, Israel
- Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Lyle Tadmor
- Rehabilitation Center, Ezra Lemarpe, Bnei-Brak, Israel
- Reuth Rehabilitation Hospital, Tel-Aviv, Israel
| | - Lilach Yaakov
- Rehabilitation Center, Ezra Lemarpe, Bnei-Brak, Israel
| | | | - Roni Rips
- Rehabilitation Center, Ezra Lemarpe, Bnei-Brak, Israel
- Ben-Yair Rehabilitation Center, Clalit Health Services, Tel-Aviv, Israel
| | - Oshrat Sella Weiss
- Rehabilitation Center, Ezra Lemarpe, Bnei-Brak, Israel
- Schnaider Children's Medical Center, Petah Tikva, Israel
- Department of Communication Disorders, University of Haifa, Haifa, Israel
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Dallal-York J, Troche MS. Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1394110. [PMID: 38933659 PMCID: PMC11199739 DOI: 10.3389/fresc.2024.1394110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
Cough is a powerful, protective expulsive behavior that assists in maintaining respiratory health by clearing foreign material, pathogens, and mucus from the airways. Therefore, cough is critical to survival in both health and disease. Importantly, cough protects the airways and lungs from both antegrade (e.g., food, liquid, saliva) and retrograde (e.g., bile, gastric acid) aspirate contents. Aspiration is often the result of impaired swallowing (dysphagia), which allows oral and/or gastric contents to enter the lung, especially in individuals who also have cough dysfunction (dystussia). Cough hyposensitivity, downregulation, or desensitization- collectively referred to as hypotussia- is common in individuals with dysphagia, and increases the likelihood that aspirated material will reach the lung. The consequence of hypotussia with reduced airway clearance can include respiratory tract infection, chronic inflammation, and long-term damage to the lung parenchyma. Despite the clear implications for health, the problem of managing hypotussia in individuals with dysphagia is frequently overlooked. Here, we provide an overview of the current interventions and treatment approaches for hypotussic cough. We synthesize the available literature to summarize research findings that advance our understanding of these interventions, as well as current gaps in knowledge. Further, we highlight pragmatic resources to increase awareness of hypotussic cough interventions and provide support for the clinical implementation of evidence-based treatments. In culmination, we discuss potential innovations and future directions for hypotussic cough research.
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Affiliation(s)
- Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
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Govender R, Gilbody N, Simson G, Haag R, Robertson C, Stuart E. Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists. Curr Treat Options Oncol 2024; 25:703-718. [PMID: 38691257 PMCID: PMC11222272 DOI: 10.1007/s11864-024-01198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/03/2024]
Abstract
OPINION STATEMENT Dysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.
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Affiliation(s)
- Roganie Govender
- Head & Neck Academic Centre& UCL Division of Surgery & Interventional ScienceGround Floor Central, University College London Hospital, 250 Euston Road, London, NW1 2PQ, UK.
| | - Nicky Gilbody
- North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - Ceri Robertson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Stuart
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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Kaneko H, Suzuki A, Nagai Y, Horie J. Differences in cough strength, respiratory function, and physical performance in older adults with and without low swallowing function in the repetitive saliva swallowing test. J Phys Ther Sci 2024; 36:273-277. [PMID: 38694018 PMCID: PMC11060758 DOI: 10.1589/jpts.36.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/02/2024] [Indexed: 05/03/2024] Open
Abstract
[Purpose] In older adults, the risk of aspiration pneumonia increases because of coexisting factors such as age-related decline in swallowing function, inefficient cough, reduced respiratory function, and poor physical performance. This study aimed to investigate the differences in cough strength, respiratory function, and physical performance in community-dwelling ambulatory older adults with and without low swallowing function. [Participants and Methods] In 225 community-dwelling ambulatory older adults, swallowing function (the repetitive saliva swallowing test, RSST), cough strength (peak cough flow), lung function (forced vital capacity, forced expiratory volume in 1 second/forced vital capacity), respiratory muscle strength (maximum inspiratory and expiratory pressures), and physical performance (30-second chair stand test and Timed Up and Go test) were evaluated. Participants with low swallowing function in RSST (low RSST group) were compared to age- and sex-matched participants without low swallowing function (control group). [Results] Peak cough flow and maximum inspiratory and expiratory pressures were significantly lower in the low RSST group (n=14) than the control group (n=14). [Conclusion] These preliminary results suggest that community-dwelling ambulatory older adults with low swallowing function in RSST might have lower cough and respiratory muscle strength, even if they have relatively preserved lung function and physical performance.
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Affiliation(s)
- Hideo Kaneko
- Department of Physical Therapy, School of Health Sciences
at Fukuoka, International University of Health and Welfare: 137-1 Enokizu, Okawa-shi,
Fukuoka 831-8501, Japan
| | - Akari Suzuki
- Department of Physical Therapy, School of Health Sciences
at Fukuoka, International University of Health and Welfare: 137-1 Enokizu, Okawa-shi,
Fukuoka 831-8501, Japan
| | - Yoshiharu Nagai
- Department of Physical Therapy, School of Health Sciences
at Fukuoka, International University of Health and Welfare: 137-1 Enokizu, Okawa-shi,
Fukuoka 831-8501, Japan
| | - Jun Horie
- Department of Physical Therapy, Faculty of Health Sciences,
Kyoto Tachibana University, Japan
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Cheng SW, Leung KHV, Mok KCJ, Yeung KW, Wong SYI, Lam YL, Ip KM, Lok YW, Wong ACL. Improvement in Swallowing Function in Patients with Previous Irradiation for Nasopharyngeal Carcinoma by Expiratory Muscle Strength Training. Dysphagia 2024; 39:129-139. [PMID: 37392211 DOI: 10.1007/s00455-023-10600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 06/07/2023] [Indexed: 07/03/2023]
Abstract
Dysphagia and chronic aspiration are common post-irradiation complications in nasopharyngeal carcinoma (NPC) survivors. Expiratory Muscle Strength Training (EMST) is a simple device-driven exercise therapy for swallowing training. This study investigates the effectiveness of EMST in a group of post-irradiated NPC patients. This prospective cohort, including twelve patients with previous irradiation for NPC and with swallowing disturbance, was performed between 2019 and 2021 in a single institution. Patients were trained with EMST for 8 weeks. Non-parametric analyses examined effects of EMST on primary outcome, maximum expiratory pressure. Secondary outcomes were measured with Penetration-aspiration scale, Yale pharyngeal residue severity rating scale (YPRSRS) by flexible endoscopic evaluation of swallowing, and Eating Assessment Tool (EAT-10) and M.D. Anderson Dysphagia Inventory questionnaire. Twelve patients, with a mean (SD) age of 64.3 (8.2) were recruited. There was no patient dropout with 88.9% overall compliance of training. Maximum expiratory pressure improved by 41% (median 94.5 to 133.5 cmH2O, p = 0.003). There was reduction in Penetration-aspiration scale with thin liquid (median 4 to 3, p = 0.026), and in YPRSRS at pyriform fossa with mildly thick liquid (p = 0.021) and at vallecula with thin liquid (p = 0.034), mildly thick liquid (p = 0.014) and pureed meat congee (p = 0.016). Questionnaire scores did not significantly change statistically. EMST is an easy-to-use and effective exercise therapy to improve airway safety and swallowing function in post-irradiated NPC survivors.
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Affiliation(s)
- Siu Woon Cheng
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong.
| | - Kwok Hung Vincent Leung
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Kar Cheong Jason Mok
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Kong Wah Yeung
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
| | - Sin Yee Ivy Wong
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Yin Ling Lam
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Ka Man Ip
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Yin Wing Lok
- Department of Speech Therapy, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Andrew Chun Lok Wong
- Department of Otorhinolaryngology, Head and Neck Surgery, Tuen Mun Hospital, 23 Tsing Chung Koon Road, Tuen Mun, New Territories, Hong Kong
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Rameau A, Andreadis K, German A, Lachs MS, Rosen TE, Pitzrick MS, Symes LB, Klinck H. Changes in Cough Airflow and Acoustics After Injection Laryngoplasty. Laryngoscope 2023; 133 Suppl 3:S1-S14. [PMID: 35723533 PMCID: PMC9763552 DOI: 10.1002/lary.30255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE/HYPOTHESIS We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. STUDY TYPE/DESIGN Prospective interventional study. METHODS Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed-rank test was used to compare the differences between pre- and post-injection laryngoplasty in airflow and acoustic measures. A Spearman rank-order correlation was used to evaluate the association between airflow and acoustic cough measures. RESULTS Twenty-five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: -0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2 , SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: -0.31, p = 0.04) and peak power density (coefficient: -0.35, p = 0.02). CONCLUSIONS Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. LEVEL OF EVIDENCE 3 Laryngoscope, 133:S1-S14, 2023.
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Affiliation(s)
- Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Alexander German
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Mark S Lachs
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Tony E Rosen
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, U.S.A
| | - Michael S. Pitzrick
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Laurel Braden Symes
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
| | - Holger Klinck
- K. Lisa Yang Center for Conservation Bioacoustics, Cornell University, Ithaca, New York, U.S.A
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A Primer on Hypotussic Cough: Mechanisms and Assessment. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023. [DOI: 10.1007/s40136-023-00446-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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10
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Alkhuwaiter M, Davidson K, Hopkins-Rossabi T, Martin-Harris B. Scoring the Penetration-Aspiration Scale (PAS) in Two Conditions: A Reliability Study. Dysphagia 2022; 37:407-416. [PMID: 33880656 PMCID: PMC8528890 DOI: 10.1007/s00455-021-10292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
A widely applied metric for identifying airway invasion events is the Penetration-Aspiration Scale (PAS). PAS scores are often included as primary outcome measures in clinical interventional studies, applied to characterize airway protection in a particular disease, used to establish a normal referent for control group comparisons without dysphagia, and as determinants or predictors of clinical outcomes. Despite the widespread use of the PAS, there is variability in scoring condition. One common method used in research studies includes rater scores applied to each single swallow that occurred during a modified barium swallow study (MBSS) of the same patient. A second common method includes raters scoring single swallow segments that have been spliced from full MBSS from different patients. These single swallow segments are then randomly distributed and the rater is blinded to all swallows that occurred during that patient MBSS. The potential effects of different scoring conditions on rater reliability and score accuracy have not been studied and may have high relevance for the conclusion drawn from the result. The primary aim of this investigation is to determine the impact of two scoring conditions on rater reliability and score accuracy: 1. Contextual, unblinded scoring condition and 2. Randomized, blinded condition. Results of the present study show that no statistically significant differences in PAS rater reliability and score accuracy were found between the two scoring conditions. If findings from this pilot study are reproduced in larger sample sizes, the time and intensity involved in splicing and randomizing MBSS for scoring may not be necessary.
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Affiliation(s)
- Munirah Alkhuwaiter
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA.
| | - Kate Davidson
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Theresa Hopkins-Rossabi
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
| | - Bonnie Martin-Harris
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, 2240 Campus Drive, Evanston, IL, 60208, USA
- Edward Hines, Jr. VA Hospital, 5000 South 5th Avenue, Hines, IL, USA
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11
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Borders JC, Troche MS. Voluntary Cough Effectiveness and Airway Clearance in Neurodegenerative Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:431-449. [PMID: 34936376 DOI: 10.1044/2021_jslhr-21-00308] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Voluntary cough dysfunction is highly prevalent across multiple patient populations. Voluntary cough has been utilized as a screening tool for swallowing safety deficits and as a target for compensatory and exercise-based dysphagia management. However, it remains unclear whether voluntary cough dysfunction is associated with the ability to effectively clear the airway. METHOD Individuals with neurodegenerative disorders performed same-day voluntary cough testing and flexible endoscopic evaluations of swallowing (FEES). Participants who were cued to cough after exhibiting penetration to the vocal folds and/or aspiration with thin liquids during FEES met inclusion criteria. One-hundred and twenty-three trials were blinded, and the amount of residue before and after a cued cough on FEES was measured with a visual analog scale. Linear and binomial mixed-effects models examined the relationship between cough airflow during voluntary cough testing and the proportion of residue expelled. RESULTS Peak expiratory flow rate (p = .004) and cough expired volume from the entire epoch (p = .029) were significantly associated with the proportion of aspiration expelled from the subglottis. Peak expiratory flow rate values of 3.00 L/s, 3.50 L/s, and 5.30 L/s provided high predicted probabilities that ≥ 25%, ≥ 50%, and ≥ 80% aspirate was expelled. Accounting for depth of aspiration significantly improved model fit (p < .001). CONCLUSIONS These findings suggest that voluntary cough airflow is associated with cough effectiveness to clear aspiration from the subglottis, although aspiration amount and depth may play an important role in this relationship. These findings provide further support for the clinical utility of voluntary cough in the management of dysphagia.
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Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Mir MJ, Hegland KW. A Survey of Speech-Language Pathologists' Experience With Clinical Cough Assessment. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2021; 6:1627-1640. [PMID: 35546793 PMCID: PMC9084607 DOI: 10.1044/2021_persp-21-00144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to determine if students (clinicians-intraining) and clinicians of speech-language pathology assess cough during clinical swallow evaluations. We also sought to determine if participants received background education and training regarding implementation of clinical cough assessment. Finally, we aimed to identify participant interest in a cough assessment training program. METHOD A clinician-researcher panel developed a 20-question survey to address specific aims. The final survey was distributed via social media and a clinical dysphagia website after two phases of revision. RESULTS A percentage (84.6%) of the survey participants reported that they assess cough in clinical swallow evaluations, mainly using subjective measures. The majority of clinicians reported no background education or skilled training to implement cough assessment. Background education and training was higher for participants outside the United States, although the total sample size of that group was small. Almost all participants (97.8%) were interested in a cough training program. CONCLUSIONS Many practicing clinicians in this survey reported that they complete cough assessments, despite limited education and training to do so. However, they also reported high interest in participating in a clinical cough assessment training program, which would support the field of speech-language pathology and patients at risk of airway protective dysfunction.
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Affiliation(s)
- Michela Jean Mir
- Rehabilitation Science PhD, College of Public Health and Health Professions, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Karen Wheeler Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
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14
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Wallace E, Macrae P, Huckabee ML. Objective measurement of acoustic intensity of coughing for clearance of penetration and aspiration on video-fluoroscopy. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:313-320. [PMID: 32664756 DOI: 10.1080/17549507.2020.1784280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE This preliminary, exploratory study evaluated the acoustic intensity of effective and ineffective clearance of penetrated and aspirated material from the laryngeal vestibule in patients with dysphagia. METHOD A lapel microphone was attached anterior to participants' tragus and recorded coughing in decibels during their videofluoroscopic swallowing studies (VFSS). RESULT Eighty-eight patients were recruited. Thirteen patients, with visible airway invasion and coughing were included in the final analysis. No coughs were effective at expelling aspirated material from the airway (n = 10). Both effective (4/7) and ineffective (3/7) coughing to penetration were recorded. The mean acoustic intensity of effective coughing to penetration was -44.0 dBFS (decibel level relative to full scale) [SD = 7.3, 95% CI = -51.14, -36.86], and ineffective coughing to penetration was only marginally lower at -42.9 dBFS [SD = 2.0, 95% CI = -45.21, -40.59]. CONCLUSION No coughs were effective at expelling aspirated material from the airway. Some coughs effectively expelled penetrated material from the airway. However, the relationship between acoustic intensity and cough effectiveness is unclear due to the limited number of observations. Given that perceptual evaluation of coughing is widely used in dysphagia clinical practice to determine cough effectiveness, this is an important area for future research.
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Affiliation(s)
- Emma Wallace
- Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand
| | - Phoebe Macrae
- Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand
| | - Maggie-Lee Huckabee
- Department of Communication Disorders, Rose Centre for Stroke Recovery and Research, University of Canterbury, Christchurch, New Zealand
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Reflex vs. volitional cough differences amongst head and neck cancer survivors characterized by time since treatment and aspiration status. Respir Physiol Neurobiol 2021; 293:103702. [PMID: 34033947 DOI: 10.1016/j.resp.2021.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to investigate differences in reflexive and volitional cough airflows in advanced stage head and neck cancer survivors as it relates to aspiration status and time since treatment. The hypothesis is that those who aspirate several years after treatment completion would demonstrate reduced airflows for all cough parameters compared to those recently status post treatment completion given the known progressive deterioration associated with radiotherapy. METHODS Demographic and airflow data during both reflexive and volitional cough tasks and aspiration status as determined during fiberoptic endoscopic evaluation of swallow function were collected from 33 Head and Neck Cancer (HNC) survivors. RESULTS Omnibus MANOVA for dependent airflow variables and independent variables aspiration status, time since treatment and cough type (reflex or volitional) was significant (F(3,1) = 184, p < 0.000) indicating that peak expiratory flow rates (PEFR) were reduced under reflex (mean PEFR 1.88 SD 0.7) versus volitional (mean PEFR 2.3, SD 0.7) cough types; reduced for aspirators versus non-aspirators (F(2,1) = 4.1, p = 0.04) and reduced for those in the subacute versus chronic phase status post Intensity Modulated Radiotherapy (IMRT) (F(2,1) = 10.05, p = 0.002). CONCLUSION Findings of reduced reflexive compared to volitional cough airflows in head and neck cancer survivors are consistent with those from both healthy and other diseased populations. Additional findings that aspirators demonstrate reduced cough airflows compared to non-aspirators supports the hypothesis. Surprisingly, those recently status post treatment completion show worse cough airflows compared to those remotely status post treatment completion.
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16
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Cavalieri S, Colombo E, Bottiglieri A, Massa G, Platini F, Ottini A, Filippini DM, Zattarin E, Bergamini C, Resteghini C, Alfieri S, Di Martino V, Tiraferri V, Locati LD, Licitra L. Monitoring patients with head and neck cancer for flu-like symptoms during the COVID-19 pandemic. TUMORI JOURNAL 2021; 108:240-249. [PMID: 33849307 DOI: 10.1177/03008916211007940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To capture and monitor flu-like symptoms in relation to the clinical characteristics and the oncologic treatment of a large head and neck cancer (HNC) patient cohort during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS Patients were monitored through by 2 rounds of interviews. Clinical characteristics of patients with no symptoms (group 0) and of those reporting ⩾1 (group A), ⩾3 (group B), or ⩾5 symptoms (group C) were analyzed. Patients with ⩾1 symptom at both interviews were defined as group A2. RESULTS Five hundred patients with HNC were analyzed. A higher frequency of patients with the following characteristics was observed in group A vs group 0: active treatment (40% vs 24%, p = 0.0002), gastrostomy (6% vs 2%, p = 0.027), recent active treatment (48% vs 29%, p < 0.0001), and higher number of concomitant medications (p = 0.01). A lower median age was observed in group B vs group no-B (patients with fewer than three symptoms) (59 vs 63.55 years, p = 0.016) and in group A2 vs group no-A2 (patients without at least one symptom at both interviews) (56 vs 63 years, p = 0.021); patients in group B received more recent active treatment than those in group no-B and in group A2 vs those in group no-A2 (p = 0.024 and 0.043, respectively); patients in group B had a lower body mass index than those in group no-B (22.4 vs 23.93 kg/m2, p = 0.0066). CONCLUSIONS This work is based on patient-reported symptoms and signs independently of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. In the future, these results might serve as a a benchmark for clinicians triaging and managing patients with HNC during infectious outbreaks involving flu-like symptoms.
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Affiliation(s)
- Stefano Cavalieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Elena Colombo
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Achille Bottiglieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Giacomo Massa
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Francesca Platini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Arianna Ottini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Daria Maria Filippini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Emma Zattarin
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Carlo Resteghini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Vito Di Martino
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Valentina Tiraferri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Laura Deborah Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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Ebersole B, McCarroll L, Ridge JA, Liu JC, Bauman J, Donnelly S, Galloway TJ. Identification and management of late dysfunction in survivors of head and neck cancer: Implementation and outcomes of an interdisciplinary quality of life (IQOL) clinic. Head Neck 2021; 43:2124-2135. [PMID: 33749012 DOI: 10.1002/hed.26681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Identifying and treating late dysfunction in survivors of head and neck cancer (HNC) is important; however, an effective way to do so is not established. METHODS A quality improvement initiative altering our HNC survivorship clinic to include surveillance by rehabilitation providers was undertaken. The nature of dysfunction identified, along with the number and type of referrals to ancillary/support services were collected and compared to baseline. RESULTS The baseline, single-provider, clinic evaluated 61 patients and referred 2 (3%) to ancillary/support services. Fifty-seven patients were evaluated in the interdisciplinary clinic, with 36 (63%) referred to at least one ancillary/support service for new/progressive dysfunction. Of 59 referrals made, 22 (37%) were for dysphagia, 17(29%) were for neck/shoulder dysfunction, and 28 (47%) were attended by the patient. CONCLUSION Many HNC survivors exhibit late dysfunction appropriate for referral to ancillary/support services. A survivorship clinic including surveillance by rehabilitation specialists may optimize identification of dysfunction.
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Affiliation(s)
- Barbara Ebersole
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Liane McCarroll
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Speech Pathology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - John A Ridge
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Jeffrey C Liu
- Department of Otolaryngology-Head & Neck Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Jessica Bauman
- Department of Hematology Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Steven Donnelly
- Department of Surgical Oncology, Fox Chase Cancer Center, Temple Head and Neck Institute, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania, USA
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Tabor Gray L, Vasilopoulos T, Plowman EK. Response to the Commentary on ‘Concordant Validity of a Digital Peak Cough Flow Meter to Assess Voluntary Cough Strength in Individuals with ALS’. Dysphagia 2020; 35:876-878. [DOI: 10.1007/s00455-020-10132-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/08/2020] [Indexed: 11/28/2022]
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Reflexive Airway Sensorimotor Responses in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia 2020; 36:574-582. [PMID: 32778945 DOI: 10.1007/s00455-020-10171-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Progressive motor denervation in amyotrophic lateral sclerosis (ALS) leads to reduced expiratory cough flow and diminished airway clearance physiologic capacity. Although ALS is thought to primarily impact motor systems, preliminary data from our laboratory suggest degradation of afferent pathways that regulate reflexive cough responses to radiographically confirmed aspiration. We, therefore, aimed to delineate both sensory and motor responses to a tussigenic airway irritant in individuals with ALS compared to healthy controls. METHODS Thirty-two individuals with ALS and 34 healthy age and gender-matched controls completed reflex cough testing. Capsaicin stimuli (0, 50, 100, 150, 200 μM) were presented in a randomized three-block design and motor (cough spirometry metrics) and sensory (patient-rated urge to cough, UtC) ratings collected. ALS patients underwent videofluoroscopy with penetration-aspiration ratings completed. Descriptives, Mann-Whitney U, and mixed models ANOVAs were performed. RESULTS Sensory: Individuals with ALS demonstrated greater UtC sensitivity slopes (i.e., increased stimulus sensitivity) vs. healthy controls (p = 0.036). Within the ALS group, however, silent aspirators (PAS = 8) demonstrated blunted UtC sensitivity slopes compared to ALS patients who did not (PAS ≤ 7, p = 0.0001). Motor: Compared to healthy controls, ALS individuals demonstrated reduced peak expiratory flow rates (p = 0.004), longer peak expiratory rise time (p = 0.017), and lower cough volume acceleration (p = 0.000). CONCLUSIONS ALS individuals demonstrated increased sensitivity to an upper airway irritant; however, they demonstrated slower and weaker expiratory cough motor output compared to healthy controls. In ALS silent aspirators, blunted sensorimotor responses were observed, suggesting that sensory degradation may occur at the final or most severe stage of bulbar disease progression.
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Borders JC, Brates D. Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review. Dysphagia 2019; 35:583-597. [PMID: 31538220 DOI: 10.1007/s00455-019-10064-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022]
Abstract
The penetration-aspiration scale (PAS) is an 8-point scale used to characterize the depth and response to airway invasion during videofluoroscopy. Though widely used in the field of deglutition, there is a lack of consensus regarding the statistical properties of the scale. In order to better understand the state of the literature and the statistical use of the PAS, a systematic review was undertaken to descriptively examine trends in statistical and reporting practices of the PAS since its inception. Online databases were searched for studies citing the original PAS article, which yielded 754 unique articles. Of these, 183 studies were included in the review. Results showed inconsistencies in the statistical use of the scale; 79 studies treated the PAS as ordinal, 71 as categorical, and 49 as interval. Ten types of categorizations were identified. Reporting of power analyses (9%), as well as inter- (26%) and intra-rater (17%) reliability, was uncommon. Among studies that administered multiple bolus volumes or consistencies, 55% reported PAS analyses at the participant/group level only. This review confirms the existence of discrepancies in the statistical treatment of the PAS. A lack of consensus among researchers limits comparisons between studies. The approach to handling this scale dictates the statistical tests used, potentially affecting results and interpretations. Consistent application of statistically sound approaches to PAS analyses is vital for the future of deglutition research.
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Affiliation(s)
- James C Borders
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA.
| | - Danielle Brates
- Department of Communication Sciences and Disorders, New York University, New York, NY, USA
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21
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Tabor-Gray L, Vasilopoulos T, Plowman EK. Concordant Validity of a Digital Peak Cough Flow Meter to Assess Voluntary Cough Strength in Individuals with ALS. Dysphagia 2019; 35:568-573. [DOI: 10.1007/s00455-019-10060-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
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Tabor-Gray LC, Gallestagui A, Vasilopoulos T, Plowman EK. Characteristics of impaired voluntary cough function in individuals with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:37-42. [PMID: 30652513 PMCID: PMC6513719 DOI: 10.1080/21678421.2018.1510011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/26/2018] [Accepted: 07/29/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although cough impairment (dystussia) is common in individuals with amyotrophic lateral sclerosis (ALS) and contributes to a reduced physiologic capacity to defend the airway, characteristics of dystussia have not yet been delineated. Therefore, we aimed to compare voluntary cough spirometry airflow patterns between individuals with ALS and healthy age and gender-matched controls. METHODS Thirty-two individuals with a diagnosis of probable-definite ALS (El-Escorial Criterion) and 29 healthy age and gender-matched controls underwent voluntary cough spirometry testing. Two blinded raters derived six objective voluntary cough airflow measures including: peak inspiratory phase duration, peak inspiratory flow rate, compression phase duration, peak expiratory rise time, peak expiratory flow rate, and cough volume acceleration. Independent samples t-tests with Cohen's d effect sizes were performed between Healthy versus ALS groups for cough metrics (alpha =0.05). RESULTS ALS individuals demonstrated prolonged inspiratory phase and expiratory phase rise time durations, reduced inspiratory and expiratory flow rates, and lower cough volume acceleration during voluntary cough production compared with healthy controls (p < 0.05). No differences in compression phase duration were observed (p > 0.05). CONCLUSIONS This study compared characteristics of voluntary cough airflow patterns of individuals with ALS to healthy-matched controls. Findings identified impairments in both inspiratory and expiratory voluntary cough airflow, resulting in slower, weaker, and thus less effectiveness voluntary cough production in ALS individuals. These data afford insight into the impaired physiology underlying inadequate airway clearance and secretion management in individuals with ALS.
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Affiliation(s)
- Lauren C Tabor-Gray
- a Department of Neurology , Phil Smith Neuroscience Institute , Fort Lauderdale , FL , USA
- b Swallowing Systems Core , University of Florida , Gainesville , FL , USA
| | | | - Terrie Vasilopoulos
- c Department of Anesthesiology and Orthopedics, College of Medicine , University of Florida , Gainesville , FL , USA
| | - Emily K Plowman
- b Swallowing Systems Core , University of Florida , Gainesville , FL , USA
- d Department of Speech, Language and Hearing Science , University of Florida , Gainesville , FL , USA
- e Department of Neurology , University of Florida , Gainesville , FL , USA
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