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Schiava M, Lofra RM, Bourke JP, James MK, Díaz-Manera J, Elseed MA, Michel-Sodhi J, Moat D, Mccallum M, Mayhew A, Ghimenton E, Díaz CFB, Malinova M, Wong K, Richardson M, Tasca G, Grover E, Robinson EJ, Tanner S, Eglon G, Behar L, Eagle M, Turner C, Verdú-Díaz J, Heslop E, Straub V, Bettolo CM, Guglieri M. Disease-associated comorbidities, medication records and anthropometric measures in adults with Duchenne muscular dystrophy. Neuromuscul Disord 2024; 41:8-19. [PMID: 38865917 DOI: 10.1016/j.nmd.2024.05.007] [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: 03/22/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 06/14/2024]
Abstract
We investigated the comorbidities, associated factors, and the relationship between anthropometric measures and respiratory function and functional abilities in adults with Duchenne muscular dystrophy (DMD). This was a single-centre cross-sectional study in genetically diagnosed adults with DMD (>16 years old). Univariate and multivariate analyses identified factors associated with dysphagia, constipation, Body Mass Index (BMI), and weight. Regression analysis explored associations between BMI, weight, and respiratory/motor abilities. We included 112 individuals (23.4 ± 5.2 years old), glucocorticoid-treated 66.1 %. The comorbidities frequency was 61.6 % scoliosis (61.0 % of them had spinal surgery), 36.6 % dysphagia, 36.6 % constipation, and 27.8 % urinary conditions. The use of glucocorticoids delayed the time to spinal surgery. The univariate analysis revealed associations between dysphagia and constipation with age, lack of glucocorticoid treatment, and lower respiratory and motor function. In the multivariate analysis, impaired cough ability remained as the factor consistently linked to both conditions. Constipation associated with lower BMI and weight. BMI and weight positively correlated with respiratory parameters, but they did not associate with functional abilities. Glucocorticoids reduce the frequency of comorbidities in adults with DMD. The ability to cough can help identifying dysphagia and constipation. Lower BMI and weight in individuals with DMD with compromised respiratory function may suggest a higher calories requirement.
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Affiliation(s)
- Marianela Schiava
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Robert Muni Lofra
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - John P Bourke
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Meredith K James
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Jordi Díaz-Manera
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Maha A Elseed
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Jassi Michel-Sodhi
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Dionne Moat
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Michelle Mccallum
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Anna Mayhew
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Elisabetta Ghimenton
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Carla Florencia Bolaño Díaz
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Monika Malinova
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Karen Wong
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Mark Richardson
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Giorgio Tasca
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Emma Grover
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Emma-Jayne Robinson
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Stephanie Tanner
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Gail Eglon
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Laura Behar
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | | | - Catherine Turner
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - José Verdú-Díaz
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Emma Heslop
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Volker Straub
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Chiara Marini Bettolo
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK
| | - Michela Guglieri
- The John Walton Muscular Dystrophy Research Centre, Newcastle University and Newcastle Hospitals NHS Foundation Trusts, Newcastle Upon Tyne, UK.
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Roger AL, Biswas DD, Huston ML, Le D, Bailey AM, Pucci LA, Shi Y, Robinson-Hamm J, Gersbach CA, ElMallah MK. Respiratory characterization of a humanized Duchenne muscular dystrophy mouse model. Respir Physiol Neurobiol 2024; 326:104282. [PMID: 38782084 DOI: 10.1016/j.resp.2024.104282] [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: 03/19/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
Duchenne muscular dystrophy (DMD) is the most common X-linked disease. DMD is caused by a lack of dystrophin, a critical structural protein in striated muscle. Dystrophin deficiency leads to inflammation, fibrosis, and muscle atrophy. Boys with DMD have progressive muscle weakness within the diaphragm that results in respiratory failure in the 2nd or 3rd decade of life. The most common DMD mouse model - the mdx mouse - is not sufficient for evaluating genetic medicines that specifically target the human DMD (hDMD) gene sequence. Therefore, a novel transgenic mouse carrying the hDMD gene with an exon 52 deletion was created (hDMDΔ52;mdx). We characterized the respiratory function and pathology in this model using whole body plethysmography, histology, and immunohistochemistry. At 6-months-old, hDMDΔ52;mdx mice have reduced maximal respiration, neuromuscular junction pathology, and fibrosis throughout the diaphragm, which worsens at 12-months-old. In conclusion, the hDMDΔ52;mdx exhibits moderate respiratory pathology, and serves as a relevant animal model to study the impact of novel genetic therapies, including gene editing, on respiratory function.
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Affiliation(s)
- Angela L Roger
- Department of Pediatrics, Duke University, Durham, NC, USA
| | | | | | - Davina Le
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Aidan M Bailey
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Logan A Pucci
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Yihan Shi
- Department of Pediatrics, Duke University, Durham, NC, USA
| | | | | | - Mai K ElMallah
- Department of Pediatrics, Duke University, Durham, NC, USA.
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3
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Subhan F, Zizzo MG, Serio R. Motor dysfunction of the gut in Duchenne muscular dystrophy: A review. Neurogastroenterol Motil 2024; 36:e14804. [PMID: 38651673 DOI: 10.1111/nmo.14804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Duchenne's muscular dystrophy (DMD) is a severe type of hereditary, neuromuscular disorder caused by a mutation in the dystrophin gene resulting in the absence or production of truncated dystrophin protein. Conventionally, clinical descriptions of the disorder focus principally on striated muscle defects; however, DMD manifestations involving gastrointestinal (GI) smooth muscle have been reported, even if not rigorously studied. PURPOSE The objective of the present review is to offer a comprehensive perspective on the existing knowledge concerning GI manifestations in DMD, focusing the attention on evidence in DMD patients and mdx mice. This includes an assessment of symptomatology, etiological pathways, and potential corrective approaches. This paper could provide helpful information about DMD gastrointestinal implications that could serve as a valuable orientation for prospective research endeavors in this field. This manuscript emphasizes the effectiveness of mdx mice, a DMD animal model, in unraveling mechanistic insights and exploring the pathological alterations in the GI tract. The gastrointestinal consequences evident in patients with DMD and the mdx mice models are a significant area of focus for researchers. The exploration of this area in depth could facilitate the development of more efficient therapeutic approaches and improve the well-being of individuals impacted by the condition.
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Affiliation(s)
- Fazal Subhan
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Palermo, Italy
| | - Maria Grazia Zizzo
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Palermo, Italy
- ATeN (Advanced Technologies Network) Center, Viale delle Scienze, University of Palermo, Palermo, Italy
| | - Rosa Serio
- Department of Biological, Chemical and Pharmaceutical Sciences and Technologies (STEBICEF), University of Palermo, Viale delle Scienze, Palermo, Italy
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Bykova KM. Measurement of surface electromyography activity during swallowing in paediatrics: a scoping literature review. Eur J Pediatr 2024:10.1007/s00431-024-05685-2. [PMID: 39037451 DOI: 10.1007/s00431-024-05685-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
Surface electromyography (sEMG) could be used for diagnostic and therapeutic purposes in various health conditions. For example, sEMG biofeedback is shown to be beneficial in adults with swallowing disorders (dysphagia), whereas there are no easily identifiable studies to support such evidence in paediatrics. The current review aimed to evaluate the feasibility of implementing sEMG during swallowing tasks in paediatric populations with various diagnoses. Additionally, the review aimed to describe findings in publications involving participants with cerebral palsy (CP) and dysphagia. Paediatric-related publications were sourced using English keywords and phrases across the following seven databases: PubMed, EMBASE, CINAHL, Web of Science, PsycINFO, and ProQuest Dissertations and Theses Global. The search included all available publications without language and date restrictions. Publications using sEMG during chewing tasks were also accepted in the review as chewing is considered to be part of the act of swallowing. The feasibility of measuring sEMG during swallowing in children with various health conditions was supported by 116 publications (n = 6 literature reviews) that met the inclusion criteria for the final full-text review. However, a few publications described some difficulties occurring directly during the sEMG data collection sessions. The review identified 15 publications involving 177 participants with CP who underwent sEMG while swallowing (n = 1 publication focused solely on the assessment of chewing). Ten publications described studies that recruited children with dysphagia. Children with CP who had dysphagia were recruited in five of these studies. CONCLUSIONS The acquisition of sEMG measurements while performing swallowing tasks was shown to be feasible in children with various diagnoses including those who have CP and dysphagia. Future studies should investigate the implementation of sEMG as a part of paediatric dysphagia therapy alongside biofeedback swallowing skill training. WHAT IS KNOWN • Surface electromyography (sEMG) could be implemented for diagnostic and therapeutic purposes in various health conditions. • Biofeedback using sEMG is beneficial in adults with swallowing disorders (dysphagia). WHAT IS NEW • Implementation of sEMG was shown to be feasible during swallowing tasks in paediatric populations with various diagnoses, including dysphagia and cerebral palsy. • The usage of sEMG biofeedback as a part of paediatric dysphagia management should be investigated in future studies.
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Affiliation(s)
- Ksenia M Bykova
- Rose Centre for Stroke Recovery and Research, School of Psychology Speech and Hearing, University of Canterbury, 249 Papanui Road, Christchurch, 8052, New Zealand.
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Pauloski BR, Yahnke KM. Reliability of Measuring Geniohyoid Cross-Sectional Area with B-Mode Ultrasound. Dysphagia 2024:10.1007/s00455-024-10712-3. [PMID: 38789680 DOI: 10.1007/s00455-024-10712-3] [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: 08/26/2023] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique. This study examined three methods of transducer placement in the coronal plane by two examiners to determine the reliability of measurement of CSA of the geniohyoid muscle. Forty healthy adults participated in the study. Each participant's geniohyoid muscles were imaged using B-mode ultrasound under three transducer placement conditions in the coronal plane by two examiners. Geniohyoid CSA was measured from each ultrasound image. A three-way mixed-methods ANOVA was used to determine whether there were significant differences in geniohyoid CSA among transducer position conditions, trials, and examiners. There were significant differences among the transducer placement conditions, indicating that each condition was measuring a different portion of the muscle. There were no significant differences among repeated trials nor between examiners within each method of transducer placement. All three conditions of transducer placement were reliable at measuring geniohyoid CSA across trials and examiners. This study emphasizes the need for consistency of placement, whichever method is selected. It also highlights the need for researchers to provide a precise description of methods for positioning the transducer so that placement is reproducible.
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Affiliation(s)
- Barbara R Pauloski
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA.
| | - Kacey M Yahnke
- Department of Communication Sciences and Disorders, College of Health Sciences, University of Wisconsin Milwaukee, 2400 E. Hartford Avenue, Suite 840, Milwaukee, WI, 53211, USA
- Manhattan Star Academy, 180 Amsterdam Avenue, New York, NY, 10023, USA
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Kooi-van Es M, Erasmus CE, Voet NBM, van den Engel-Hoek L, van der Wees PJ. Best practice recommendations for speech-language pathology in children with neuromuscular disorders: A Delphi-based consensus study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:45-58. [PMID: 36896919 DOI: 10.1080/17549507.2023.2181224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE Speech-language pathology (SLP) is considered an essential intervention due to the high prevalence of dysphagia and dysarthria in paediatric neuromuscular disorders (pNMD). Evidence-based guidelines for SLP in pNMD are missing and children could be deprived the best of care. This study aimed to achieve consensus and present best practice recommendations on SLP intervention in pNMD. METHOD A modified Delphi technique was used with a panel of experienced Dutch speech-language pathologists. In two online survey rounds and a face-to-face consensus meeting, the SLP experts proposed intervention items for cases of four types of pNMD (congenital myopathy, Duchenne muscular dystrophy, myotonic dystrophy type 1, and spinal muscular atrophy type 2), covering symptoms of dysphagia, dysarthria, drooling, and oral hygiene problems. They rated the level of agreement. RESULT Intervention items that achieved consensus were incorporated into best practice recommendations. These recommendations cover six core intervention components (wait and see, explanation and advice, training and treatment, aids and adjustments, referral to other disciplines, and monitoring) suitable for the described symptoms. CONCLUSION Insight into treatment options is essential to facilitate speech-language pathologists in clinical decision-making. The current study led to best practice recommendations for speech-language pathologists working within the field of pNMD.
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Affiliation(s)
- Mieke Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Radboud, University Medical Centre, Department of Pediatric Neurology, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nicoline B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands, and
| | | | - Philip J van der Wees
- Department of Rehabilitation and IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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Allen J, Stone-Ghariani A, Quezada G, Banks D, Rose F, Knight W, Newman J, Newman W, Anderson P, Smith C. Living with Dysphagia: A Survey Exploring the Experiences of Adults Living with Neuromuscular Disease and their Caregivers in the United Kingdom. J Neuromuscul Dis 2024; 11:389-410. [PMID: 38250781 DOI: 10.3233/jnd-230002] [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] [Indexed: 01/23/2024]
Abstract
Background Dysphagia is common in adults living with neuromuscular disease (NMD). Increased life expectancy, secondary to improvements in standards of care, requires the recognition and treatment of dysphagia with an increased priority. Evidence to support the establishment of healthcare pathways is, however, lacking. The experiences of people living with NMD (pplwNMD) and their caregivers are valuable to guide targeted, value-based healthcare. Objective To generate preliminary considerations for neuromuscular dysphagia care and future research in the United Kingdom, based on the experiences of those living with, or caring for, people with NMD. Methods Two surveys (one for adults living with NMD and dysphagia, and a second for caregivers) were co-designed with an advisory group of people living with NMD. Surveys were electronically distributed to adults living with NMD and their caregivers between 18th May and 26th July 2020. Distribution was through UK disease registries, charity websites, newsletters, and social media. Results Adults living with NMD receive little information or education that they are likely to develop swallowing difficulties. Most respondents report wanting this information prior to developing these difficulties. Difficulties with swallowing food and medication are common in this group, and instrumental assessment is considered a helpful assessment tool. Both adults living with NMD and caregivers want earlier access to neuromuscular swallowing specialists and training in how best to manage their difficulties. Conclusions Improvement is needed in the dysphagia healthcare pathway for adults living with NMD to help mitigate any profound physical and psychological consequences that may be caused by dysphagia. Education about swallowing difficulties and early referral to a neuromuscular swallowing specialist are important to pplwNMD and their caregivers. Further research is required to better understand the experiences of pplwNMD and their caregivers to inform the development of dysphagia healthcare pathways.
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Affiliation(s)
- Jodi Allen
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Aoife Stone-Ghariani
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Gabriella Quezada
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Donna Banks
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Frank Rose
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - William Knight
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Jill Newman
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - William Newman
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Philip Anderson
- University College London Hospitals, The National Hospital for Neurology & Neurosurgery, Queen Square, London, UK
| | - Christina Smith
- Department of Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
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Maeda K, Nagasaka M, Nagano A, Nagami S, Hashimoto K, Kamiya M, Masuda Y, Ozaki K, Kawamura K. Ultrasonography for Eating and Swallowing Assessment: A Narrative Review of Integrated Insights for Noninvasive Clinical Practice. Nutrients 2023; 15:3560. [PMID: 37630750 PMCID: PMC10460049 DOI: 10.3390/nu15163560] [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: 06/07/2023] [Revised: 07/28/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Dysphagia is a syndrome of abnormal eating function resulting from a variety of causative diseases, and is associated with malnutrition. To date, the swallowing function has been difficult to examine without the use of invasive and expensive methods, such as the videofluorographic swallowing study or fiberoptic endoscopic evaluation of swallowing. In recent years, progress has been made in the clinical application of ultrasound equipment for the evaluation of body compositions near the body surface, including the assessment of nutritional status. Ultrasound examination is a noninvasive procedure and relatively inexpensive, and the equipment required is highly portable thanks to innovations such as wireless probes and tablet monitoring devices. The process of using ultrasound to visualize the geniohyoid muscle, digastric muscle, mylohyoid muscle, hyoid bone, tongue, masseter muscle, genioglossus muscle, orbicularis oris muscle, temporalis muscle, pharynx, esophagus, and larynx, and the methods used for evaluating these structures, are provided in this study in detail. This study also aims to propose a protocol for the assessment of swallowing-related muscles that can be applied in real-world clinical practice for the diagnosis of sarcopenic dysphagia, which can occur in elderly patients with sarcopenia, and has received much attention in recent years.
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Affiliation(s)
- Keisuke Maeda
- Nutrition Therapy Support Center, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Department of Geriatric Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Motoomi Nagasaka
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Ayano Nagano
- Department of Nursing, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya 663-8211, Japan;
| | - Shinsuke Nagami
- Department of Speech Language Pathology and Audiology, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Okayama 701-0193, Japan;
| | - Kakeru Hashimoto
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Masaki Kamiya
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Yuto Masuda
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Kenichi Ozaki
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
| | - Koki Kawamura
- Department of Rehabilitation Medicine, Hospital, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan; (M.N.); (K.H.); (M.K.); (Y.M.); (K.O.); (K.K.)
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Bedside evaluation of swallowing function to predict aspiration pneumonia in Duchenne muscular dystrophy. Auris Nasus Larynx 2023; 50:247-253. [PMID: 35973890 DOI: 10.1016/j.anl.2022.07.006] [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: 05/06/2022] [Revised: 07/01/2022] [Accepted: 07/22/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Aspiration pneumonia is one of the leading causes of death in patients with muscular dystrophy; therefore, it is important to predict its occurrence in the clincal setting. We aimed to examine the usefulness of repeated saliva swallowing test (RSST), modified water swallowing test (MWST), and flexible endoscopic evaluation of swallowing (FEES) for evaluating the Hyodo score at the bedside, to predict the risk of aspiration pneumonia in patients with Duchenne muscular dystrophy (DMD). METHODS In this retrospective cohort study involving 43 patients, we evaluated the swallowing function using the RSST, MWST, and FEES, and predicted the likelihood of aspiration pneumonia within 2 years after the assessment. The Hyodo score, a scoring system for evaluating the swallowing function determined by the FEES, was used. RESULTS Pneumonia was observed in 14 patients (32.6%). The RSST was not significantly useful for predicting the onset of pneumonia. The MWST was reported to have a cutoff value of < 4 points. Significantly more patients in the pneumonia group had an MWST score of < 4 points. The results revealed that the occurrence of pneumonia could be predicted based on a Hyodo cutoff score of ≥ 6. Significantly more patients in the pneumonia group had an MWST score of < 4 or a Hyodo score of ≥ 6. CONCLUSIONS Combining MWST and FEES is useful for evaluating the bedside swallowing function and predicting the onset of pneumonia.
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Potente P, Buoite Stella A, Vidotto M, Passerini M, Furlanis G, Naccarato M, Manganotti P. Application of Ultrasonography in Neurogenic Dysphagia: A Systematic Review. Dysphagia 2023; 38:65-75. [PMID: 35556172 PMCID: PMC9873712 DOI: 10.1007/s00455-022-10459-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 04/22/2022] [Indexed: 01/28/2023]
Abstract
Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary to reduce the risk of penetration and aspiration, and to early start rehabilitation protocols. Among the methods that can be used to evaluate dysphagia and its components, ultrasound imaging has been suggested to support the evaluation of dysphagia by providing measures of both static and dynamic anatomical components. The aim of this systematic review is to evaluate the usefulness of ultrasonography in neurogenic dysphagia according to current literature. From 2000 to 2020, 633 studies with the appropriate search terms for ultrasound and dysphagia were identified. After screening them, 10 studies were included in the qualitative analysis. Patients with the following neurologic conditions were studied with ultrasonography for dysphagia: Parkinson's disease, muscle dystrophy, amyotrophic lateral sclerosis, and stroke. The main outcomes of ultrasonography were swallowing muscles thickness (e.g., tongue), and dynamic measures such as hyoid displacement. The different protocols used in the studies, as well as their outcomes, did not allow to provide standard procedures and normative or cut-off values in the presented diseases. Because there are a variety of tools, methods, and techniques that have been used in the studies that were reviewed, it is difficult to evaluate them using established standards. However, ultrasonography correlates well with clinical evaluation of dysphagia and therefore has prognostic and rehabilitation potential. Future studies should aim to develop and utilize a common interdisciplinary protocol that includes standard procedures and outcomes to define normative values applicable in the different conditions.
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Affiliation(s)
- Paola Potente
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Monica Vidotto
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Michelle Passerini
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
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11
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Schindler A, de Fátima Lago Alvite M, Robles-Rodriguez WG, Barcons N, Clavé P. History and Science behind the Eating Assessment Tool-10 (Eat-10): Lessons Learned. J Nutr Health Aging 2023; 27:597-606. [PMID: 37702330 DOI: 10.1007/s12603-023-1950-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/31/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Oropharyngeal dysphagia (OD) is an underdiagnosed medical condition with a high prevalence in populations such as patients with frailty, neurological disease, or head and neck pathology. Potential barriers to its diagnosis include lack of (or low) awareness of the existence and severity of the condition, the hidden nature of the condition within the 'normal ageing' process, clinical limitations, and socioeconomic reasons. Consequently, an effective treatment is not systematically offered in a timely manner, and complications, such as dehydration and respiratory infections or aspiration pneumonia, can arise. To overcome this issue, the early use of screening questionnaires to identify people at risk of swallowing disorders represents the cornerstone of preventive medicine. Several screening tools have been created but few are widely used in clinical practice. The Eating Assessment Tool-10 (EAT-10) was developed as a quick, easy-to-understand, and self-administered screening tool for OD. METHODS A literature review was conducted in five databases with no restrictions on the language, date of publication, or design of the study to identify aspects of the validation, applicability, and usefulness of EAT-10. RESULTS AND CONCLUSIONS Transcultural adaptation and translation studies, as well as studies involving various types of patients with dysphagia in different settings have shown the validity and reliability of EAT-10 in relation to the gold standard and other validation tools. The use of this standardised screening tool could be used as a primary screening instrument of dysphagia in routine clinical practice across a wide range of diseases and settings and thereby increase the likelihood of early diagnosis and management of a condition that lead to serious complications and impaired quality of life.
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Affiliation(s)
- A Schindler
- William Gildardo Robles-Rodriguez FUCS: Fundacion Universitaria de Ciencias de la Salud, Colombia,
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12
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Havner C, Roussakis AÖ, Sjögreen L, Westerlund A. Open Bite Malocclusion and Orofacial Dysfunction in Patients with Myotonic Dystrophy Type 1 and Duchenne Muscular Dystrophy. J Neuromuscul Dis 2023; 10:885-896. [PMID: 37334614 PMCID: PMC10578289 DOI: 10.3233/jnd-230025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/20/2023]
Abstract
Open bite (OB) is a common malocclusion in individuals with orofacial dysfunction and syndromes, especially in neuromuscular diseases. OBJECTIVES The objectives were to explore the prevalence of OB in myotonic dystrophy type 1 (DM1) and Duchenne muscular dystrophy (DMD) and to create and compare orofacial dysfunction profiles. METHODS In this database study, 143 individuals with DM1 and 99 with DMD were included. The Mun-H-Center questionnaire and observation chart were used together with the Nordic Orofacial Test -Screening (NOT-S) to create orofacial dysfunction profiles. OB was categorised as: lateral (LOB); anterior (AOB); severe anterior (AOBS); or both types of anterior OB (AOBTot). Descriptive and multivariate statistics were used to compare the OB prevalence and to study associations with orofacial variables, respectively. RESULTS There was a statistically significant difference in OB prevalence between the DM1 (37%) and DMD (49%) groups (p = 0.048). LOB was seen in < 1% of DM1 and 18% of DMD. LOB was associated with macroglossia and closed mouth posture, AOB with hypotonic lips, and open mouth posture and AOBS with hypotonic jaw muscles. The orofacial dysfunction profiles showed similar patterns, although the mean NOT-S total scores for DM1 and DMD were 4.2±2.8 (median 4.0, min-max 1-8) and 2.3±2.0 (median 2.0, min-max 0-8), respectively. LIMITATIONS The two groups were not age- or gender-matched. CONCLUSION OB malocclusion is common in patients with DM1 and DMD and is associated with different types of orofacial dysfunction. This study highlights the need for multi-disciplinary assessments to support tailored treatment strategies that improve or sustain orofacial functions.
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Affiliation(s)
- Christina Havner
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Anna Ödman Roussakis
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
| | - Lotta Sjögreen
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Gothenburg, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Westerlund
- Department of Orthodontics, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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13
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Hannaford A, Vucic S, van Alfen N, Simon NG. Muscle ultrasound in hereditary muscle disease. Neuromuscul Disord 2022; 32:851-863. [PMID: 36323605 DOI: 10.1016/j.nmd.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/31/2022]
Abstract
In this review we summarise the key techniques of muscle ultrasound as they apply to hereditary muscle disease. We review the diagnostic utility of muscle ultrasound including its role in guiding electromyography and muscle biopsy sampling. We summarize the different patterns of sonographic muscle involvement in the major categories of genetic muscle disorders and discuss the limitations of the technique. We hope to encourage others to adopt ultrasound in their care for patients with hereditary muscle diseases.
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Affiliation(s)
- Andrew Hannaford
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Steve Vucic
- Brain and Nerve Research Center, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Nens van Alfen
- Department of Neurology and Clinical Neurophysiology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Neil G Simon
- Northern Beaches Clinical School, Macquarie University, Suite 6a, 105 Frenchs Forest Rd W, Frenchs Forest, Sydney, NSW 2086, Australia.
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14
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Yamanouchi K, Tanaka Y, Ikeda M, Kato S, Okino R, Nishi H, Hakuno F, Takahashi SI, Chambers J, Matsuwaki T, Uchida K. Macroglossia and less advanced dystrophic change in the tongue muscle of the Duchenne muscular dystrophy rat. Skelet Muscle 2022; 12:24. [PMID: 36258243 PMCID: PMC9580129 DOI: 10.1186/s13395-022-00307-7] [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: 02/21/2022] [Accepted: 10/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Duchenne muscular dystrophy (DMD) is an X-linked muscle disease caused by a complete lack of dystrophin, which stabilizes the plasma membrane of myofibers. The orofacial function is affected in an advanced stage of DMD and this often leads to an eating disorder such as dysphagia. Dysphagia is caused by multiple etiologies including decreased mastication and swallowing. Therefore, preventing the functional declines of mastication and swallowing in DMD is important to improve the patient’s quality of life. In the present study, using a rat model of DMD we generated previously, we performed analyses on the masseter and tongue muscles, both are required for proper eating function. Methods Age-related changes of the masseter and tongue muscle of DMD rats were analyzed morphometrically, histologically, and immunohistochemically. Also, transcription of cellular senescent markers, and utrophin (Utrn), a functional analog of dystrophin, was examined. Results The masseter muscle of DMD rats showed progressive dystrophic changes as observed in their hindlimb muscle, accompanied by increased transcription of p16 and p19. On the other hand, the tongue of DMD rats showed macroglossia due to hypertrophy of myofibers with less dystrophic changes. Proliferative activity was preserved in the satellite cells from the tongue muscle but was perturbed severely in those from the masseter muscle. While Utrn transcription was increased in the masseter muscle of DMD rats compared to WT rats, probably due to a compensatory mechanism, its level in the tongue muscle was comparable between WT and DMD rats and was similar to that in the masseter muscle of DMD rats. Conclusions Muscular dystrophy is less advanced in the tongue muscle compared to the masseter muscle in the DMD rat. Supplementary Information The online version contains supplementary material available at 10.1186/s13395-022-00307-7.
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Affiliation(s)
- Keitaro Yamanouchi
- Laboratory of Veterinary Physiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan.
| | - Yukie Tanaka
- Laboratory of Veterinary Physiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Masanari Ikeda
- Laboratory of Veterinary Physiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Shizuka Kato
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Ryosuke Okino
- Laboratory of Animal Cell Regulation, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Hiroki Nishi
- Laboratory of Animal Cell Regulation, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Fumihiko Hakuno
- Laboratory of Animal Cell Regulation, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Shin-Ichiro Takahashi
- Laboratory of Animal Cell Regulation, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - James Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Takashi Matsuwaki
- Laboratory of Veterinary Physiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo, 113-8657, Japan
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15
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Lotta S, Lisa B. Congenital or Early Developing Neuromuscular Diseases Affecting Feeding, Swallowing and Speech – A Review of the Literature from January 1998 to August 2021. J Neuromuscul Dis 2022; 9:581-596. [PMID: 35848032 PMCID: PMC9535595 DOI: 10.3233/jnd-210772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. Objective: The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control. Methods: A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords “feeding”, “dysphagia”, “swallowing”, “dysarthria”, “speech”, “drooling” and “sialorrhea” were used in combination with “paediatric neuromuscular disease” or specific diagnoses. Results: Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases. Conclusions: Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
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Affiliation(s)
- Sjögreen Lotta
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| | - Bengtsson Lisa
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
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16
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Mhandire DZ, Burns DP, Roger AL, O'Halloran KD, ElMallah MK. Breathing in Duchenne muscular dystrophy: Translation to therapy. J Physiol 2022; 600:3465-3482. [PMID: 35620971 PMCID: PMC9357048 DOI: 10.1113/jp281671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/17/2022] [Indexed: 11/08/2022] Open
Abstract
Duchenne muscular dystrophy (DMD) is an X-linked neuromuscular disease caused by a deficiency in dystrophin - a structural protein which stabilizes muscle during contraction. Dystrophin deficiency adversely affects the respiratory system leading to sleep-disordered breathing, hypoventilation, and weakness of the expiratory and inspiratory musculature, which culminate in severe respiratory dysfunction. Muscle degeneration associated respiratory impairment in neuromuscular disease is a result of disruptions at multiple sites of the respiratory control network, including sensory and motor pathways. As a result of this pathology, respiratory failure is a leading cause of premature death in DMD patients. Currently available treatments for DMD respiratory insufficiency attenuate respiratory symptoms without completely reversing the underlying pathophysiology. This underscores the need to develop curative therapies to improve quality of life and longevity of DMD patients. This review summarises research findings on the pathophysiology of respiratory insufficiencies in DMD disease in humans and animal models, the clinical interventions available to ameliorate symptoms, and gene-based therapeutic strategies uncovered by preclinical animal studies. Abstract figure legend: Summary of the therapeutic strategies for respiratory insufficiency in DMD (Duchenne muscular dystrophy). Treatment options currently in clinical use only attenuate respiratory symptoms without reversing the underlying pathology of DMD-associated respiratory insufficiencies. Ongoing preclinical and clinical research is aimed at developing curative therapies that both improve quality of life and longevity of DMD patients. AAV - adeno-associated virus, PPMO - Peptide-conjugated phosphorodiamidate morpholino oligomer This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Doreen Z Mhandire
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center Box 2644, Durham, North Carolina, 27710, USA
| | - David P Burns
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Angela L Roger
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center Box 2644, Durham, North Carolina, 27710, USA
| | - Ken D O'Halloran
- Department of Physiology, School of Medicine, College of Medicine & Health, University College Cork, Cork, Ireland
| | - Mai K ElMallah
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center Box 2644, Durham, North Carolina, 27710, USA
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17
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Hijikata N, Kawakami M, Wada A, Ikezawa M, Kaji K, Chiba Y, Ito M, Fujino E, Otsuka T, Liu M. Assessment of dysarthria with Frenchay dysarthria assessment (FDA-2) in patients with Duchenne muscular dystrophy. Disabil Rehabil 2022; 44:1443-1450. [PMID: 32772581 DOI: 10.1080/09638288.2020.1800108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to test the psychometric properties of the Japanese version of Frenchay Dysarthria Assessment (FDA-2) and to use this tool to describe the features of speech in patients with Duchenne muscular dystrophy (DMD). MATERIALS AND METHODS The Japanese version of FDA-2 was culturally adapted, and reliability and validity were examined in 22 and 50 patients, respectively. The Japanese version of FDA-2 was administered to 51 patients with DMD. Multiple regression analysis was performed to identify factors related to FDA-2 scores. RESULTS Inter-/intra-rater reliabilities (ICCs) and internal consistency (Cronbach's α) for total scores were 0.76, 0.97, and 0.94 respectively. For construct validity, two-way ANOVA showed a significant interaction between the disorders and FDA-2 sections (p < 0.05). In DMD patients, the item of tongue at rest was most severely affected, reflecting tongue hypertrophy. Multiple regression analysis identified age, swallowing status, and ventilator use as significantly related. CONCLUSIONS The results showed that the Japanese version of FDA-2 has satisfactory reliability and validity. The present study demonstrated the features of dysarthria and related factors in patients with DMD.Implications for rehabilitationIn Duchenne muscular dystrophy (DMD), an absent or defective dystrophin protein causes progressive weakness of respiratory and oropharyngeal muscles, both of which are crucial contributors to speech production.This study shows that the Japanese version of FDA-2 has satisfactory reliability and validity compared to original version.The Japanese version of FDA-2 characterizes dysarthria in patients with DMD in this cohort.
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Affiliation(s)
- Nanako Hijikata
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Wada
- Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Maki Ikezawa
- Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Kentaro Kaji
- Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Yasuhiro Chiba
- Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Miyuki Ito
- Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Eri Fujino
- Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Tomoyoshi Otsuka
- Department of Rehabilitation Medicine, National Hospital Organization Higashisaitama National Hospital, Saitama, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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18
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Tang YC, Tsui PH, Wang CY, Chien YH, Weng HL, Yang CY, Weng WC. Hepatic Steatosis Assessment as a New Strategy for the Metabolic and Nutritional Management of Duchenne Muscular Dystrophy. Nutrients 2022; 14:nu14040727. [PMID: 35215377 PMCID: PMC8875407 DOI: 10.3390/nu14040727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
Growing evidence suggests that patients with Duchenne muscular dystrophy (DMD) have an increased risk of obesity and metabolic syndrome (MetS). The aim of this study was to investigate the potential risk factors for MetS and hepatic steatosis in patients with different stages of DMD. A total of 48 patients with DMD were enrolled and classified into three stages according to ambulatory status. Body mass index (BMI), serum fasting glucose, insulin, and lipid profiles including triglycerides (TG) and high-density lipoprotein were measured, and the homeostatic model assessment for insulin resistance (HOMA-IR) index was evaluated. Ultrasound examinations of the liver were performed to assess hepatic steatosis using the Nakagami parameter index (NPI). The results showed that BMI, TG, HOMA-IR, and ultrasound NPI differed significantly among DMD stages (p < 0.05). In contrast to the low rates of conventional MetS indices, including disturbed glucose metabolism (0%), dyslipidemia (14.28%), and insulin resistance (4.76%), a high proportion (40.48%) of the patients had significant hepatic steatosis. The ultrasound NPI increased with DMD progression, and two thirds of the non-ambulatory patients had moderate to severe hepatic steatosis. Steroid treatment was a risk factor for hepatic steatosis in ambulatory patients (p < 0.05). We recommend that DMD patients should undergo ultrasound evaluations for hepatic steatosis for better metabolic and nutritional management.
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Affiliation(s)
- Ya-Chun Tang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan 333423, Taiwan;
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (P.-H.T.); (C.-Y.W.)
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan 333423, Taiwan
| | - Chiao-Yin Wang
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan; (P.-H.T.); (C.-Y.W.)
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital, Taipei 100225, Taiwan;
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Hui-Ling Weng
- Department of Dietetics, National Taiwan University Hospital, Taipei 100225, Taiwan;
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
| | - Chung-Yi Yang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 824005, Taiwan;
- Department of Medical Imaging, E-Da Hospital, Kaohsiung 824410, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei 100225, Taiwan;
- Department of Pediatrics, College of Medicine, National Taiwan University, Taipei 100233, Taiwan
- Department of Pediatric Neurology, National Taiwan University Children’s Hospital, Taipei 100226, Taiwan
- Correspondence: ; Tel.: +886-2-23123456 (ext. 71609)
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19
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Narayan S, Pietrusz A, Allen J, Docherty K, Emery N, Ennis M, Flesher R, Foo W, Freebody J, Gallagher E, Grose N, Harris D, Hewamadduma C, Holmes S, James M, Maidment L, Mayhew A, Moat D, Moorcroft N, Muni-Lofra R, Nevin K, Quinlivan R, Sodhi J, Stuart D, White N, Yvonne J. Adult North Star Network (ANSN): Consensus Document for Therapists Working with Adults with Duchenne Muscular Dystrophy (DMD) - Therapy Guidelines. J Neuromuscul Dis 2022; 9:365-381. [PMID: 35124658 DOI: 10.3233/jnd-210707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S Narayan
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - A Pietrusz
- UCL Queen Square Institute of Neurology, MRC Centre for Neuromuscular Diseases, UK
| | - J Allen
- Neuromuscular Complex Care Centre (NMCCC), National Hospital for Neurology and Neurosurgery, UK
| | - K Docherty
- University Hospitals Dorset NHS Foundation Trust, UK
| | - N Emery
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
| | - M Ennis
- The Walton Centre NHS Foundation Trust, UK
| | - R Flesher
- The Walton Centre NHS Foundation Trust, UK
| | - W Foo
- Manchester University NHS Foundation Trust, UK
| | - J Freebody
- John Radcliffe Hospital -OxfordUniversity Hospitals NHS Foundation Trust, UK
| | | | - N Grose
- North Bristol NHS Foundation Trust, The South West Neuromuscular Operational Delivery Network (SWNODN), UK
| | - D Harris
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - C Hewamadduma
- Sheffield Teaching Hospitals NHS Foundation Trust, UK.,Sheffield Institute for Translational Neurosciences (SITRAN), University of Sheffield, UK
| | - S Holmes
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UK
| | - M James
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - L Maidment
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - A Mayhew
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - D Moat
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - N Moorcroft
- West Midlands Rehabilitation Centre, Birmingham Community Healthcare NHS Foundation Trust, UK
| | - R Muni-Lofra
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | - K Nevin
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Quinlivan
- UCL Queen Square Institute of Neurology, MRC Centre for Neuromuscular Diseases, UK
| | - J Sodhi
- The John Walton Muscular Dystrophy Research Centre, Newcastle, UK
| | | | - N White
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, UK
| | - J Yvonne
- University Hospitals of Leicester Emergency and Specialist Medicine, UK
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20
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Tomiate AN, Barbosa GK, Rici REG, de Almeida SRY, Watanabe IS, Ciena AP. Structural and Ultrastructural Changes in the Tongue of mdx Mice. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2022; 28:1-8. [PMID: 35067262 DOI: 10.1017/s1431927622000022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The mdx mouse is an experimental model of Duchenne muscular dystrophy, a genetic disorder characterized by progressive muscular degeneration which affects the oral cavity musculature, and promotes difficulty in swallowing. This study aimed to describe morphological, structural, and ultrastructural changes in the tongue mucosa and musculature of mdx mice. Forty six-month-old mice were divided into two groups: Control C57bl/10 (n = 20) and mdx C57bl/10mdx (n = 20). The tongue was dissected and analyzed with light microscopy, scanning electron microscopy, and transmission electron microscopy techniques. Our results showed conical and triangular filiform, fungiform, foliate, and vallate papillae, and their connective tissue cores. The epithelium layers identified were corneum, granulosum, spinosum, and basale. The mdx group had a thicker epithelium. Lamina propria was composed of reddish and greenish collagen. In mdx, collagen was present in the musculature of the tongue's body and in the muscular tissue between mucous and serous glands of the caudal region. Musculature was also characterized by a shorter length of sarcoplasmic invaginations, myocytolysis in mitochondrial groupings, and inflammatory focus. In conclusion, the tongue of 6-month-old mdx mice had morphology, structure, and ultrastructure revealed, showing higher wear of filiform papillae indirect reflex from the muscular degeneration process.
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Affiliation(s)
- André N Tomiate
- Laboratório de Morfologia e Atividade Física (LAMAF), Instituto de Biociências, Universidade Estadual Paulista (UNESP), Rio Claro, São Paulo, Brasil
| | - Gabriela K Barbosa
- Laboratório de Morfologia e Atividade Física (LAMAF), Instituto de Biociências, Universidade Estadual Paulista (UNESP), Rio Claro, São Paulo, Brasil
| | - Rose E G Rici
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brasil
| | - Sonia Regina Y de Almeida
- Departamento de Anatomia, Instituto de Ciências Biomédicas - ICB III, Universidade de São Paulo, São Paulo, Brasil
| | - Ii-Sei Watanabe
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brasil
- Departamento de Anatomia, Instituto de Ciências Biomédicas - ICB III, Universidade de São Paulo, São Paulo, Brasil
| | - Adriano P Ciena
- Laboratório de Morfologia e Atividade Física (LAMAF), Instituto de Biociências, Universidade Estadual Paulista (UNESP), Rio Claro, São Paulo, Brasil
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21
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Umemoto G, Fujioka S, Arahata H, Sakae N, Sasagasako N, Toda M, Furuya H, Tsuboi Y. Longitudinal Changes of Tongue Thickness and Tongue Pressure in Neuromuscular Disorders. BMC Neurol 2021; 21:302. [PMID: 34353291 PMCID: PMC8340465 DOI: 10.1186/s12883-021-02225-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background Swallowing dysfunction is related to major cause of adverse events and an indicator of shorter survival among patients with neuromuscular disorders (NMD). It is critical to assess the swallowing function during disease progression, however, there are limited tools that can easily evaluate swallowing function without using videofluoroscopic or videoendoscopic examination. Here, we evaluated the longitudinal changes in tongue thickness (TT) and maximum tongue pressure (MTP) among patients with amyotrophic lateral sclerosis (ALS), myotonic dystrophy type 1 (DM1), and Duchenne muscular dystrophy (DMD). Methods Between 2010 and 2020, TT and MTP were measured from 21 ALS, 30 DM1, and 14 DMD patients (mean ages of 66.9, 44.5, and 21.4 years, respectively) at intervals of more than half a year. TT was measured, by ultrasonography, as the distance from the mylohyoid muscle raphe to the tongue dorsum, and MTP was determined by measuring the maximum compression on a small balloon when pressing the tongue against the palate. Then we examined the relationship between these evaluations and patient background and swallowing function. Results Mean follow-up periods were 24.0 months in the ALS group, 47.2 months in the DM1group, and 61.1 months in the DMD group. The DMD group demonstrated larger first TT than the other groups, while the DM1 group had lower first MTP than the ALS group. The ALS group showed a greater average monthly reduction in mean TT than the DM1 group and greater monthly reductions in mean body weight (BW) and MTP than the other groups. Significant differences between the first and last BW, TT, and MTP measures were found only in the ALS group. Conclusions This study suggests that ALS is associated with more rapid degeneration of tongue function over several years compared to DMD and DM1.
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Affiliation(s)
- George Umemoto
- Swallowing Disorders Center, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan. .,Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan.
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hajime Arahata
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Nobutaka Sakae
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Naokazu Sasagasako
- Department of Neurology, Neuro-Muscular Center, NHO Omuta National Hospital, Fukuoka, Japan
| | - Mine Toda
- Department of Clinical Nutrition & Food services, NHO Omuta National Hospital, Fukuoka, Japan
| | - Hirokazu Furuya
- Department of Neurology, Faculty of Medicine, Kochi University, Kochi, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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22
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Blok LS, Goosen YM, van Haaften L, van Hulst K, Fisher SE, Brunner HG, Egger JIM, Kleefstra T. Speech-language profiles in the context of cognitive and adaptive functioning in SATB2-associated syndrome. GENES BRAIN AND BEHAVIOR 2021; 20:e12761. [PMID: 34241948 PMCID: PMC9285502 DOI: 10.1111/gbb.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
SATB2‐associated syndrome (SAS) is a neurodevelopmental disorder caused by heterozygous pathogenic variants in the SATB2 gene, and is typically characterized by intellectual disability and severely impaired communication skills. The goal of this study was to contribute to the understanding of speech and language impairments in SAS, in the context of general developmental skills and cognitive and adaptive functioning. We performed detailed oral motor, speech and language profiling in combination with neuropsychological assessments in 23 individuals with a molecularly confirmed SAS diagnosis: 11 primarily verbal individuals and 12 primarily nonverbal individuals, independent of their ages. All individuals had severe receptive language delays. For all verbal individuals, we were able to define underlying speech conditions. While childhood apraxia of speech was most prevalent, oral motor problems appeared frequent as well and were more present in the nonverbal group than in the verbal group. For seven individuals, age‐appropriate Wechsler indices could be derived, showing that the level of intellectual functioning of these individuals varied from moderate–mild ID to mild ID‐borderline intellectual functioning. Assessments of adaptive functioning with the Vineland Screener showed relatively high scores on the domain “daily functioning” and relatively low scores on the domain “communication” in most individuals. Altogether, this study provides a detailed delineation of oral motor, speech and language skills and neuropsychological functioning in individuals with SAS, and can provide families and caregivers with information to guide diagnosis, management and treatment approaches.
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Affiliation(s)
- L Snijders Blok
- Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands.,Language & Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Y M Goosen
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - L van Haaften
- Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K van Hulst
- Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S E Fisher
- Language & Genetics Department, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition & Behaviour, Centre for Neuroscience, Radboud University, Nijmegen, the Netherlands
| | - H G Brunner
- Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.,Department of Clinical Genetics, MHeNS School of Neuroscience, and GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - J I M Egger
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands.,Stevig Specialized and Forensic Care for People with Intellectual Disabilities, Dichterbij, Oostrum, The Netherlands.,Donders Institute for Brain, Cognition & Behaviour, Centre for Cognition, Radboud University, Nijmegen, the Netherlands
| | - T Kleefstra
- Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands.,Donders Institute for Brain, Cognition & Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.,Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
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23
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Audag N, Liistro G, Goubau C, Vandervelde L, Poncin W, Toussaint M, Van den Bergh P, Reychler G. Screening for oropharyngeal dysphagia in adult patients with neuromuscular diseases using the Sydney Swallow Questionnaire. Muscle Nerve 2021; 64:277-284. [PMID: 33890683 DOI: 10.1002/mus.27254] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Oropharyngeal dysphagia is common in patients with neuromuscular diseases (NMDs). Its early recognition is vital for proper management. We tested a large cohort of adult NMD patients for oropharyngeal dysphagia using the Sydney Swallow Questionnaire (SSQ). We also looked for possible differences in characteristics of oropharyngeal dysphagia in various NMD groups and diseases. Finally, we compared results of this screening with those from their corresponding medical records for eventual "clinical history" of dysphagia. METHODS We asked patients to fill in the SSQ during follow-up outpatient visits at our neuromuscular reference center. A total score above the cutoff score of 118.5 out of 1700 was indicative of oropharyngeal dysphagia. RESULTS Of the 304 adult patients assessed for eligibility, 201 NMD patients (96 women and 105 men, aged 49.0 ± 16.2 years) were included and tested in this study. Oropharyngeal dysphagia was detected in 45% of all the NMD patients when using the SSQ, whereas only 12% had a positive medical record for dysphagia. The median SSQ scores for patients with myotonic syndromes (including myotonic dystrophy type 1), with amyotrophic lateral sclerosis, and with facioscapulohumeral dystrophy were above the cutoff score. The SSQ scores obtained revealed distinct oropharyngeal dysphagia characteristics in the different NMD groups and diseases. DISCUSSION The SSQ tests positively for oropharyngeal dysphagia in a higher proportion of NMD patients compared with their medical records. The distinct oropharyngeal dysphagia characteristics we revealed in different NMD groups and diseases may help to elaborate adapted clinical approaches in the management of oropharyngeal dysphagia.
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Affiliation(s)
- Nicolas Audag
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute École Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - Giuseppe Liistro
- Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Goubau
- Unité de Pneumologie pédiatrique, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Centre de Référence Neuromusculaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - William Poncin
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Peter Van den Bergh
- Centre de Référence Neuromusculaire, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique, Pôle de Pneumologie, ORL & Dermatologie, Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium.,Secteur de Kinésithérapie et Ergothérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Haute École Léonard de Vinci, Parnasse-ISEI, Brussels, Belgium
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24
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Kooi-van Es M, Erasmus CE, de Swart BJM, Voet NBM, van der Wees PJ, de Groot IJM, van den Engel-Hoek L. Dysphagia and Dysarthria in Children with Neuromuscular Diseases, a Prevalence Study. J Neuromuscul Dis 2021; 7:287-295. [PMID: 32176651 PMCID: PMC7369072 DOI: 10.3233/jnd-190436] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dysphagia and dysarthria are frequently described in pediatric neuromuscular diseases (pNMD). The consequences can be substantial: failure to thrive, malnutrition, aspiration pneumonia, or communication problems. Early detection and identification of risk factors and etiology support preventing complications and morbidity, including impact on quality of life. Information about the prevalence of dysphagia and dysarthria in pNMD is scarce. OBJECTIVE To describe the pooled prevalence of dysphagia and dysarthria in pNMD in the Netherlands. In addition, we describe the prevalence of dysphagia and dysarthria each, and the prevalence of chewing (oral) and swallowing problems per diagnostic group, based on their anatomic origin. METHODS Data were collected from 295 children (mean age 11;0 years, range 2;6-18;0) with pNMD in 12 hospitals and rehabilitation centers in the Netherlands. A speech language therapist established whether dysphagia and dysarthria were present or not. RESULTS In almost all the 14 diagnostic groups of pNMD, dysphagia and dysarthria were present. Pooled overall prevalence of dysphagia and dysarthria was 47.2% and 31.5%, respectively. Of 114 children with dysphagia, 90.0% had chewing problems, 43.0% showed swallowing problems and 33.3% showed both chewing and swallowing problems. CONCLUSIONS The overall pooled prevalence of dysphagia and dysarthria was high in the population of pNMD. It can be argued that periodic monitoring of dysphagia and dysarthria and early referral to a speech language therapist should be a necessity from the start of the diagnosis in the whole pNMD population.
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Affiliation(s)
- Mieke Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Radboud University Medical Centre, Department of Pediatric Neurology - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Bert J M de Swart
- Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Nicoline B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Department of Rehabilitation and IQ Healthcare, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
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25
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Luo X, Victoria Gutierrez Pulido H, Rutkove S, Sanchez B. A Bioimpedance-Based Device to Assess the Volume Conduction Properties of the Tongue in Neurological Disorders Affecting Bulbar function. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2021; 2:278-285. [PMID: 35402988 PMCID: PMC8940204 DOI: 10.1109/ojemb.2021.3117871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 12/03/2022] Open
Abstract
Goal: Current instruments for bulbar assessment exhibit technical limitations that hinder the execution of clinical studies. The volume conduction properties (VCP) of the tongue reflect ionic content and myofiber integrity and they can serve as a new biomarker for evaluating neurological disorders with bulbar dysfunction. Methods: We designed a standalone bioimpedance measurement system that enables accurate, multi-frequency measurement of tongue anisotropic VCP including conductivity and relative permittivity. The system includes a tongue depressor with 16 non-invasive surface sensors for electrical contact with the tongue at directions 0\documentclass[12pt]{minimal}
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}{}$^{\circ }$\end{document}. The depressor is interfaced with the tongue electronic system with Bluetooth connectivity, and a smartphone application. De-identified patient data is sent by email. Results: We first determined the accuracy of the hardware performing phantom measurements mimicking a broad range of tongue values and determined the error to be \documentclass[12pt]{minimal}
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}{}$< $\end{document}1%. We then validated our new technology measuring a cohort of 7 healthy human subjects under Institutional Review Board approval. Conclusions: None of the subjects who participated suffered discomfort or gag reflexes. The novel technique presented for intra-oral assessment of tongue VCP provides standard, objective and quantitative data potentially sensitive to alterations in tongue internal structure and composition.
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Affiliation(s)
- Xuesong Luo
- Sanchez Research Lab, Department of Electrical and Computer EngineeringUniversity of Utah Salt Lake City UT 84112 USA
| | | | - Seward Rutkove
- Department of Neurology, Beth Israel Deaconess Medical CenterHarvard Medical School Boston MA 02115 USA
| | - Benjamin Sanchez
- Sanchez Research Lab, Department of Electrical and Computer EngineeringUniversity of Utah Salt Lake City UT 84112 USA
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26
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Argov Z, de Visser M. Dysphagia in adult myopathies. Neuromuscul Disord 2020; 31:5-20. [PMID: 33334661 DOI: 10.1016/j.nmd.2020.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Dysphagia (impaired swallowing) is not a rare problem in various neuromuscular disorders, both in the pediatric and the adult patient population. On many occasions such patients are first presented to other medical specialists or health professionals. Disorders of deglutition are probably underrecognized in patients with a neuromuscular disease as a result of patient's and doctor's delay. This review will focus on dysphagia in adults suffering from a myopathy. Dysphagia in myopathies usually affects the oropharyngeal phases which rely mostly on voluntary muscle activity of the mouth, pharynx and upper esophageal sphincter. Dysphagia is known to contribute to a reduction of quality of life and may also lead to increased morbidity and mortality. The review includes an overview on symptomatology and tools of assessments, and elaborates on dysphagia in specific hereditary and acquired myopathies.
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Affiliation(s)
- Zohar Argov
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands.
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27
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In vivo muscle conduction study of the tongue using a multi-electrode tongue depressor. Clin Neurophysiol 2020; 132:683-687. [PMID: 33309468 DOI: 10.1016/j.clinph.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/08/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To test a novel technology for assessment of the volume conduction properties (VCPs) of the tongue. These properties are electrophysiological data that might reflect alterations in patients with tongue involvement. METHODS Seven healthy individuals were self-measured. The depressor was placed on the surface of the anterior tongue. Directional differences of VCPs were determined with standard descriptive statistics. RESULTS Conductivity in longitudinal direction was larger than in transverse direction at 16 (p < 0.05), 32 (p < 0.05), 64 (p < 0.01), and 128 kHz (p < 0.01). No differences were found in relative permittivity. The intraclass correlation was 0.778 and 0.771, respectively. CONCLUSIONS Our technology provides, for the first time, VCPs of the healthy human tongue. SIGNIFICANCE Tongue VCPs are standard electrophysiological, quantitative and objective data reflecting ionic content and membrane integrity which could find value for diagnostic purposes and treatment monitoring.
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28
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Lloyd Morris EH, Estilow T, Glanzman AM, Cusack SV, Yum SW. Improving Temporomandibular Range of Motion in People With Duchenne Muscular Dystrophy and Spinal Muscular Atrophy. Am J Occup Ther 2020; 74:7402205080p1-7402205080p10. [DOI: 10.5014/ajot.2020.030825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Evan Harry Lloyd Morris
- Evan Harry Lloyd Morris, MBA, MA, OTR/L, is Manager, Developmental Services, Rady Children’s Hospital, San Diego, CA;
| | - Timothy Estilow
- Timothy Estilow, OTR/L, is Occupational Therapist, Occupational Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Allan M. Glanzman
- Allan M. Glanzman, PT, DPT, is Physical Therapist, Physical Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Stacy Victoria Cusack
- Stacy Victoria Cusack, MS, OTR/L, is Occupational Therapist, Occupational Therapy Department, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sabrina W. Yum
- Sabrina W. Yum, MD, is Attending Physician, Neurology Department, Children’s Hospital of Philadelphia, Philadelphia, PA, and Assistant Professor of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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29
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Lagarde ML, van Alfen N, Geurts AC, de Groot IJ, van den Engel‐Hoek L. Orofacial muscles may be affected in early stages of Becker muscular dystrophy: A preliminary study. Muscle Nerve 2020; 61:213-217. [PMID: 31778229 PMCID: PMC7003962 DOI: 10.1002/mus.26771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 11/21/2019] [Accepted: 11/23/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dysphagia is reported in patients with Duchenne or Becker muscular dystrophy. Our clinical experience suggests that, compared with Duchenne patients, impaired mastication and swallowing occur early in Becker patients relative to their skeletal muscle involvement. The aim of this study was to assess dysphagia in Duchenne and Becker patients in relation to ambulatory capacity. METHODS In patients in the early ambulatory stage, clinical symptoms, quantitative muscle ultrasound of the orofacial muscles, and maximum bite force were assessed. The 6-Minute Walk Test (6MWT) was used to measure ambulatory capacity. RESULTS Eleven Duchenne and 11 Becker patients were included. Although Becker patients had a greater 6MWT distance than Duchenne patients, the occurrence of mastication and swallowing difficulties was similar. The temporalis muscle was significantly thicker in Becker patients. CONCLUSIONS Clinicians should be aware of dysphagia in both groups, even when ambulation is still well preserved.
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Affiliation(s)
- Marloes L.J. Lagarde
- Radboud University Medical Center, Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Nens van Alfen
- Radboud University Medical Center, Department of NeurologyDonders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Alexander C.H. Geurts
- Radboud University Medical Center, Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Imelda J.M. de Groot
- Radboud University Medical Center, Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
| | - Lenie van den Engel‐Hoek
- Radboud University Medical Center, Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourNijmegenThe Netherlands
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30
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Es MKV, Erasmus CE, Houwen S, de Groot IJM, Voet NBM, van den Engel-Hoek L. Early detection of dysphagia and dysarthria in children with neuromuscular disorders: Diagnostic accuracy of a Screeninglist for Physicians. J Pediatr Rehabil Med 2020; 13:17-23. [PMID: 32176663 DOI: 10.3233/prm-180569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Regardless of age or disease stage, children with neuromuscular disorders (NMD) are at risk of developing dysphagia and/or dysarthria. It is important to screen these children regularly in order to detect and treat problems as soon as possible. To date, there are no standardized tools for screening for dysphagia and dysarthria in children with NMD (pNMD). Thus, children are not always referred for assessment by a speech language therapist (SLT). A new screening instrument for dysphagia and dysarthria has been developed, the Screeninglist Physician of the Diagnostic list for Dysphagia and Dysarthria in pediatric NMD (DDD-pNMD). The diagnostic accuracy was estimated in this study. METHODS Sensitivity and specificity were assessed in 131 children aged 2.0-18.0 years by comparing the outcome of the Screeninglist Physician with the diagnosis of dysphagia and/or dysarthria established by an SLT. RESULTS The sensitivity of the Screeninglist Physician was 88% and its specificity was 63%. The AUC was 0.83. The prevalence of dysphagia and/or dysarthria was 53%. CONCLUSION The Screeninglist Physician of the DDD-pNMD is the first valid screening tool for physicians to identify children with NMD with possible dysphagia and/or dysarthria, thereby enabling timely referral to an SLT.
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Affiliation(s)
- M Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, The Netherlands
| | - C E Erasmus
- Radboud University Medical Centre, Department of Pediatric Neurology - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - S Houwen
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands
| | - I J M de Groot
- Radboud University Medical Center, Nijmegen, Department of Rehabilitation, Nijmegen, The Netherlands
| | - N B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Nijmegen, Department of Rehabilitation, Nijmegen, The Netherlands
| | - L van den Engel-Hoek
- Radboud University Medical Center, Nijmegen, Department of Rehabilitation, Nijmegen, The Netherlands
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31
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Management of the dentoalveolar effects of tongue hypertrophy in patients with Duchenne muscular dystrophy: A pilot study. Neuromuscul Disord 2019; 30:105-110. [PMID: 32001146 DOI: 10.1016/j.nmd.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/11/2019] [Accepted: 11/21/2019] [Indexed: 01/06/2023]
Abstract
Subjects affected by Duchenne muscular dystrophy (DMD) develop severe malocclusions with the progression of the disease, due to changes in orofacial musculature and function, including tongue hypertrophy. We aimed to evaluate the benefits of maintaining mandibular interarch width with the help of a simple fixed orthodontic appliance. Three adolescent DMD boys were selected consecutively to receive a passive rigid mandibular lingual arch, and followed for 4-5 years. An untreated age-matched control group was chosen and followed for a similar period. Study casts were obtained at baseline and after follow-up. Outcomes measured were overjet, overbite, maxillary and mandibular intermolar widths, mandibular arch depth, molar relationships, and the presence of lateral crossbites and anterior or lateral openbites. Changes in measurements obtained between the two time points were compared in each age-matched pair. There was a clinically important increase in the mandibular intermolar width in the non-treated children ranging from 2.5 mm to 9 mm, but not in those treated. Malocclusions generally deteriorated in untreated children while they remained stable in treated children. The use of a rigid mandibular lingual arch in boys with DMD can help slow down the rapid deterioration of the developing malocclusions that accompanies the progression of the disease.
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Abstract
Advances in high-resolution ultrasound have provided clinicians with unique opportunities to study diseases of the peripheral nervous system. Ultrasound complements the clinical and electrophysiology exam by showing the degree of abnormalities in myopathies, as well as spontaneous muscle activities in motor neuron diseases and other disorders. In experienced hands, ultrasound is more sensitive than MRI in detecting peripheral nerve pathologies. It can also guide needle placement for electromyography exam, therapeutic injections, and muscle biopsy. Ultrasound enhances the ability to detect carpal tunnel syndrome and other focal nerve entrapment, as well as pathological nerve enlargements in genetic and acquired neuropathies. Furthermore, ultrasound can potentially be used as a biomarker for muscular dystrophy and spinal muscular atrophy. The combination of electromyography and ultrasound can increase the diagnostic certainty of amyotrophic lateral sclerosis, aid in the localization of brachial plexus or peripheral nerve trauma and allow for surveillance of nerve tumor progression in neurofibromatosis. Potential limitations of ultrasound include an inability to image deeper structures, with lower sensitivities in detecting neuromuscular diseases in young children and those with mitochondrial myopathies, due to subtle changes or early phase of the disease. As well, its utility in detecting critical illness neuromyopathy remains unclear. This review will focus on the clinical applications of neuromuscular ultrasound. The diagnostic values of ultrasound for screening of myopathies, neuropathies, and motor neuron diseases will be presented.
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Porcheri C, Meisel CT, Mitsiadis T. Multifactorial Contribution of Notch Signaling in Head and Neck Squamous Cell Carcinoma. Int J Mol Sci 2019; 20:E1520. [PMID: 30917608 PMCID: PMC6471940 DOI: 10.3390/ijms20061520] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) defines a group of solid tumors originating from the mucosa of the upper aerodigestive tract, pharynx, larynx, mouth, and nasal cavity. It has a metastatic evolution and poor prognosis and is the sixth most common cancer in the world, with 600,000 new cases reported every year. HNSCC heterogeneity and complexity is reflected in a multistep progression, involving crosstalk between several molecular pathways. The Notch pathway is associated with major events supporting cancerogenic evolution: cell proliferation, self-renewal, angiogenesis, and preservation of a pro-oncogenic microenvironment. Additionally, Notch is pivotal in tumor development and plays a dual role acting as both oncogene and tumor suppressor. In this review, we summarize the role of the Notch pathway in HNSCC, with a special focus on its compelling role in major events of tumor initiation and growth.
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Affiliation(s)
- Cristina Porcheri
- University of Zurich, Institute of Oral Biology, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Christian Thomas Meisel
- University of Zurich, Institute of Oral Biology, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Thimios Mitsiadis
- University of Zurich, Institute of Oral Biology, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
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Swallowing with Noninvasive Positive-Pressure Ventilation (NPPV) in Individuals with Muscular Dystrophy: A Qualitative Analysis. Dysphagia 2019; 35:32-41. [PMID: 30859305 DOI: 10.1007/s00455-019-09997-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/05/2019] [Indexed: 12/13/2022]
Abstract
The purpose of the study is to describe experiences of swallowing with two forms of noninvasive positive-pressure ventilation (NPPV): mouthpiece NPPV (M-NPPV) and nasal bilevel positive airway pressure (BPAP) in people with muscular dystrophy. Ten men (ages 22-42 years; M = 29.3; SD = 7.1) with muscular dystrophy (9 with Duchenne's; 1 with Becker's) completed the Eating Assessment Tool (EAT-10; Ann Otol Rhinol Laryngol 117(12):919-924 [33]) and took part in semi-structured interviews. The interviews were audio recorded, transcribed, and verified. Phenomenological qualitative research methods were used to code (Dedoose.com) and develop themes. All participants affirmed dysphagia symptoms via responses on the EAT-10 (M = 11.3; SD = 6.38; Range = 3-22) and reported eating and drinking with M-NPPV and, to a lesser extent, nasal BPAP. Analysis of interview data revealed three primary themes: (1) M-NPPV improves the eating/drinking experience: Most indicated that using M-NPPV reduced swallowing-related dyspnea. (2) NPPV affects breathing-swallowing coordination: Participants described challenges and compensations in coordinating swallowing with ventilator-delivered inspirations, and that the time needed to chew solid foods between ventilator breaths may lead to dyspnea and fatigue. (3) M-NPPV aids cough effectiveness: Participants described improved cough strength following large M-NPPV delivered inspirations (with or without breath stacking). Although breathing-swallowing coordination is challenging with NPPV, participants reported that eating and drinking is more comfortable than when not using it. Overall, eating and drinking with NPPV delivered via a mouthpiece is preferred and is likely safer for swallowing than with nasal BPAP. M-NPPV (but not nasal BPAP) is reported to improve cough effectiveness, an important pulmonary defense in this population.
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Printza A, Goutsikas C, Triaridis S, Kyrgidis A, Haidopoulou K, Constantinidis J, Pavlou E. Dysphagia diagnosis with questionnaire, tongue strength measurement, and FEES in patients with childhood-onset muscular dystrophy. Int J Pediatr Otorhinolaryngol 2019; 117:198-203. [PMID: 30579082 DOI: 10.1016/j.ijporl.2018.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/02/2018] [Accepted: 12/03/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Dysphagia in progressive muscle diseases is primarily due to muscle weakness. Objective of our study is to investigate the prevalence and phenotypes of dysphagia in patients with childhood onset muscular dystrophy (MD) with the use of a validated questionnaire, the measurement of tongue strength and Flexible Endoscopic Evaluation of Swallowing (FEES). METHODS Prospective observational longitudinal study of dysphagia in a cohort of 58 patients attending the Pediatric Department Center for Neuromuscular Diseases. Control participants were 56 age and sex matched healthy volunteers. Dysphagia was evaluated with the Eating Assessment Tool-10 (EAT-10), and the measurement of Maximal Isometric Tongue Pressure (MITP) and tongue endurance (Iowa Oral Performance Instrument-IOPI). Dysphagic patients were submitted to FEES. Recorded data included demographic and anthropometric characteristics, type of MD, feeding status, and spirometry. RESULTS Our patients' cohort consisted of 41 children, 11 adolescents, and 6 adults. Based on EAT-10, 20.7% of the patients were dysphagic: 14.63% of children, 27.3% of adolescents and 50% of adults. The main complain was solid food dysphagia. Spirometry parameters mean values for children and adolescent patients corresponded to lower than the fifth percentile. Means of FVC and FEV1 expressed as % predicted for adult patients were 27.8 (SD:25.05) and 28.8 (SD:28.44) respectively. Reduced tongue strength was measured to children aged 9-10, adolescent and adult MD patients. The main FEES findings were pharyngeal residue, spillage of food before the swallow, and supraglottal penetration. DISCUSSION This is the first study to use a validated questionnaire to evaluate dysphagia in childhood onset MD and report dyphagia prevalence at different patients' age. This is the first study reporting MITP in children and adults with generalised MD. Tongue pressures are reduced well before clinical signs of dysphagia are present. CONCLUSION Screening of potentially dysphagic MD patients can be based on a validated questionnaire. Patients with an EAT-10 score suggestive of dysphagia at regular follow-up can have the MITP measured and in the case of reduced values a thorough dysphagia evaluation with FEES is indicated.
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Affiliation(s)
- Athanasia Printza
- 1st Otolaryngology Department, Medical Dept, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Greece.
| | - Charalambos Goutsikas
- 1st Otolaryngology Department, Medical Dept, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Greece.
| | - Stefanos Triaridis
- 1st Otolaryngology Department, Medical Dept, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Greece.
| | - Athanasios Kyrgidis
- 1st Otolaryngology Department, Medical Dept, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Greece.
| | - Katerina Haidopoulou
- 2nd Paediatric Department, Center for Neuromuscular Diseases, Medical Dept, School of Health Sciences, Aristotle University of Thessaloniki, Greece.
| | - Jannis Constantinidis
- 1st Otolaryngology Department, Medical Dept, School of Health Sciences, Aristotle University of Thessaloniki, 54124, Greece.
| | - Evagelos Pavlou
- 2nd Paediatric Department, Center for Neuromuscular Diseases, Medical Dept, School of Health Sciences, Aristotle University of Thessaloniki, Greece.
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Vanderwegen J, Van Nuffelen G, Elen R, De Bodt M. The Influence of Age, Sex, Visual Feedback, Bulb Position, and the Order of Testing on Maximum Anterior and Posterior Tongue Strength in Healthy Belgian Children. Dysphagia 2019; 34:834-851. [DOI: 10.1007/s00455-019-09976-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/02/2019] [Indexed: 02/06/2023]
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Egli F, Botteron S, Morel C, Kiliaridis S. Growing patients with Duchenne muscular dystrophy: longitudinal changes in their dentofacial morphology and orofacial functional capacities. Eur J Orthod 2019; 40:140-148. [PMID: 28520860 DOI: 10.1093/ejo/cjx038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aim The aim of this study was to describe the longitudinal changes in facial morphology, dental arch alterations and oral functional capacities that occur in growing patients with Duchenne muscular dystrophy (DMD) in order to identify the effects of the progression of the disease. Subjects and Methods Twelve DMD patients (6.5-17.5 years of age) and 12 matched controls were screened on two different occasions (T1 and T2), 2 years apart. Dental casts, lateral cephalometric radiographs, maximal posterior bite force and labial force were measured to determine changes in their functional capacities and dentofacial morphology. Furthermore, the thickness and echogenicity of the masseter muscle were measured during clenching. Statistical evaluation Unpaired t-tests were performed to evaluate the differences between the DMD patients and their healthy matched controls; paired t-tests were used to assess the changes that occurred within each group between T1 and T2. Results Between T1 and T2 the following changes were observed: widening of the lower dental arch for the DMD patients of 2.6mm (±0.9mm) compared to a slight reduction of -0.1mm (±0.8mm) for the control group (P = 0.001). We found a statistically significant reduction of the sagittal skeletal intermaxillary relationship (ANB-angle) of 2.0° (±2.0°) in the DMD group (P = 0.012). In T1 and T2, the maximal posterior bite force and the labial force were lower for the DMD patients compared to the control group (P = 0.001), who showed an increase during this period. Conclusion The results indicate that DMD influences the facial morphology, dental arch dimensions and oral functional capacities. The longitudinal perspective of this study revealed that the worsening of most of the measured parameters is associated with the progression of the disease. Besides the expected deterioration of the functional measurements, we found in all patients, a marked transverse increase of the posterior part of the dental arches, more in the lower than in the upper, resulting in posterior crossbites, as well as a tendency towards a skeletal Class III relationship.
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Affiliation(s)
- Fabienne Egli
- Division of Orthodontics, School of Dentistry, University of Geneva, Switzerland
| | - Sébastien Botteron
- Division of Orthodontics, School of Dentistry, University of Geneva, Switzerland
| | - Catherine Morel
- Division of Orthodontics, School of Dentistry, University of Geneva, Switzerland
| | - Stavros Kiliaridis
- Division of Orthodontics, School of Dentistry, University of Geneva, Switzerland
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Davidson ZE, Billich NK. Are boys with duchenne muscular dystrophy eating more than they need to? Maybe…. Muscle Nerve 2018; 59:277-279. [PMID: 30338857 DOI: 10.1002/mus.26357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/08/2018] [Accepted: 10/14/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Zoe E Davidson
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Natassja K Billich
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.,Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia
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Nutrition in Duchenne muscular dystrophy 16–18 March 2018, Zaandam, the Netherlands. Neuromuscul Disord 2018; 28:680-689. [DOI: 10.1016/j.nmd.2018.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
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40
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Serel Arslan S, Aydın G, Alemdaroğlu İ, Tunca Yılmaz Ö, Karaduman AA. Reliability and validity of the Karaduman Chewing Performance Scale in paediatric neuromuscular diseases: A system for classification of chewing disorders. J Oral Rehabil 2018; 45:526-531. [DOI: 10.1111/joor.12642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 12/30/2022]
Affiliation(s)
- S. Serel Arslan
- Department of Physiotherapy and Rehabilitation; Faculty of Health Sciences; Hacettepe University; Ankara Turkey
| | - G. Aydın
- Department of Physiotherapy and Rehabilitation; Faculty of Health Sciences; Hacettepe University; Ankara Turkey
| | - İ. Alemdaroğlu
- Department of Physiotherapy and Rehabilitation; Faculty of Health Sciences; Hacettepe University; Ankara Turkey
| | - Ö. Tunca Yılmaz
- Department of Physiotherapy and Rehabilitation; Faculty of Health Sciences; Hacettepe University; Ankara Turkey
| | - A. A. Karaduman
- Department of Physiotherapy and Rehabilitation; Faculty of Health Sciences; Hacettepe University; Ankara Turkey
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Lobo-Prat J, Janssen MMHP, Koopman BFJM, Stienen AHA, de Groot IJM. Surface EMG signals in very late-stage of Duchenne muscular dystrophy: a case study. J Neuroeng Rehabil 2017; 14:86. [PMID: 28851391 PMCID: PMC5576133 DOI: 10.1186/s12984-017-0292-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Robotic arm supports aim at improving the quality of life for adults with Duchenne muscular dystrophy (DMD) by augmenting their residual functional abilities. A critical component of robotic arm supports is the control interface, as is it responsible for the human-machine interaction. Our previous studies showed the feasibility of using surface electromyography (sEMG) as a control interface to operate robotic arm supports in adults with DMD (22-24 years-old). However, in the biomedical engineering community there is an often raised skepticism on whether adults with DMD at the last stage of their disease have sEMG signals that can be measured and used for control. Findings In this study sEMG signals from Biceps and Triceps Brachii muscles were measured for the first time in a 37 year-old man with DMD (Brooke 6) that lost his arm function 15 years ago. The sEMG signals were measured during maximal and sub-maximal voluntary isometric contractions and evaluated in terms of signal-to-noise ratio and co-activation ratio. Beyond the profound deterioration of the muscles, we found that sEMG signals from both Biceps and Triceps muscles were measurable in this individual, although with a maximum signal amplitude 100 times lower compared to sEMG from healthy subjects. The participant was able to voluntarily modulate the required level of muscle activation during the sub-maximal voluntary isometric contractions. Despite the low sEMG amplitude and a considerable level of muscle co-activation, simulations of an elbow orthosis using the measured sEMG as driving signal indicated that the sEMG signals of the participant had the potential to provide control of elbow movements. Conclusions To the best of our knowledge this is the first time that sEMG signals from a man with DMD at the last-stage of the disease were measured, analyzed and reported. These findings offer promising perspectives to the use of sEMG as an intuitive and natural control interface for robotic arm supports in adults with DMD until the last stage of the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12984-017-0292-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joan Lobo-Prat
- Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands.
| | - Mariska M H P Janssen
- Department of Rehabilitation, Radboud University Medical Center, Reinier Postlaan 4, Nijmegen, 6500 HB, The Netherlands
| | - Bart F J M Koopman
- Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands
| | - Arno H A Stienen
- Department of Biomechanical Engineering, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Radboud University Medical Center, Reinier Postlaan 4, Nijmegen, 6500 HB, The Netherlands
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van den Engel-Hoek L, Harding C, van Gerven M, Cockerill H. Pediatric feeding and swallowing rehabilitation: An overview. J Pediatr Rehabil Med 2017; 10:95-105. [PMID: 28582882 DOI: 10.3233/prm-170435] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with neurological disabilities frequently have problems with feeding and swallowing. Such problems have a significant impact on the health and well-being of these children and their families. The primary aims in the rehabilitation of pediatric feeding and swallowing disorders are focused on supporting growth, nutrition and hydration, the development of feeding activities, and ensuring safe swallowing with the aim of preventing choking and aspiration pneumonia. Pediatric feeding and swallowing disorders can be divided into four groups: transient, developmental, chronic or progressive.This article provides an overview of the available literature about the rehabilitation of feeding and swallowing disorders in infants and children. Principles of motor control, motor learning and neuroplasticity are discussed for the four groups of children with feeding and swallowing disorders.
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Affiliation(s)
- Lenie van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Celia Harding
- City University, the Royal Free Hospital, London, UK
| | - Marjo van Gerven
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helen Cockerill
- Evelina London Children's Hospital, Guy's and St. Thomas's NHS Foundation Trust, London, UK
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Yamada Y, Kawakami M, Wada A, Otsuka T, Muraoka K, Liu M. A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy. Disabil Rehabil 2017; 40:1421-1425. [PMID: 28288529 DOI: 10.1080/09638288.2017.1298680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Swallowing dysfunction has been reported in Duchenne muscular dystrophy (DMD), but has not been studied in Becker muscular dystrophy (BMD). The aims of this study were to report the characteristics of swallowing dysfunction in BMD compared with DMD. MATERIALS AND METHODS The study participants were 18 patients with BMD and 18 patients with DMD. All the patients were examined using videofluorography during swallowing of 5 mL of fluid. The penetration-aspiration scale (P-A scale) and the videofluorographic dysphagia scale (VDS) were used to evaluate dysphagia. RESULTS Swinyard functional ability stage was not significantly different between the BMD and DMD groups. Rate of aspiration, P-A scale score, and total VDS score did not differ across groups, but the VDS item score for laryngeal elevation was lower in the BMD group than in the DMD group (median scores 4.5 and 9, respectively; p < 0.001). In the BMD group, total VDS score significantly correlated with Swinyard stage (r = 0.78, p < 0.001), but not with age or lung function. CONCLUSION Patients with BMD have swallowing problems similar to those observed in patients with DMD when matched according to physical functional status. These patients should be evaluated and followed-up for the duration of their disease. Implications for rehabiliation Dysphagia is one of the most critical problems in patients with progressive neuromuscular disease but dysphagia in patients with Becker muscular dystrophy (BMD) was not well known. Eighteen patients with BMD and 18 patients with Duchenne muscular dystrophy were examined with videofluorography. Patients with BMD have swallowing problems similar to those observed in patients with DMD.
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Affiliation(s)
- Yuka Yamada
- a Department of Rehabilitation Medicine , National Higashisaitama Hospital , Saitama , Japan.,b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Michiyuki Kawakami
- b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Ayako Wada
- a Department of Rehabilitation Medicine , National Higashisaitama Hospital , Saitama , Japan.,b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Tomoyoshi Otsuka
- a Department of Rehabilitation Medicine , National Higashisaitama Hospital , Saitama , Japan.,b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Kaori Muraoka
- b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
| | - Meigen Liu
- b Department of Rehabilitation Medicine , Keio University School of Medicine , Tokyo , Japan
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Van Den Engel-Hoek L, Lagarde M, Van Alfen N. Ultrasound of oral and masticatory muscles: Why every neuromuscular swallow team should have an ultrasound machine. Clin Anat 2017; 30:183-193. [DOI: 10.1002/ca.22818] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Lenie Van Den Engel-Hoek
- Department of Rehabilitation; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
| | - Marloes Lagarde
- Department of Rehabilitation; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
| | - Nens Van Alfen
- Department of Neurology; Donders Centre for Neuroscience, Radboud University Medical Center; Nijmegen The Netherlands
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Nesmith AP, Wagner MA, Pasqualini FS, O'Connor BB, Pincus MJ, August PR, Parker KK. A human in vitro model of Duchenne muscular dystrophy muscle formation and contractility. J Cell Biol 2016; 215:47-56. [PMID: 27697929 PMCID: PMC5057287 DOI: 10.1083/jcb.201603111] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/23/2016] [Indexed: 12/17/2022] Open
Abstract
Tongue weakness, like all weakness in Duchenne muscular dystrophy (DMD), occurs as a result of contraction-induced muscle damage and deficient muscular repair. Although membrane fragility is known to potentiate injury in DMD, whether muscle stem cells are implicated in deficient muscular repair remains unclear. We hypothesized that DMD myoblasts are less sensitive to cues in the extracellular matrix designed to potentiate structure-function relationships of healthy muscle. To test this hypothesis, we drew inspiration from the tongue and engineered contractile human muscle tissues on thin films. On this platform, DMD myoblasts formed fewer and smaller myotubes and exhibited impaired polarization of the cell nucleus and contractile cytoskeleton when compared with healthy cells. These structural aberrations were reflected in their functional behavior, as engineered tongues from DMD myoblasts failed to achieve the same contractile strength as healthy tongue structures. These data suggest that dystrophic muscle may fail to organize with respect to extracellular cues necessary to potentiate adaptive growth and remodeling.
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Affiliation(s)
- Alexander P Nesmith
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering and Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Matthew A Wagner
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering and Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Francesco S Pasqualini
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering and Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Blakely B O'Connor
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering and Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Mark J Pincus
- Sanofi U.S.-Tucson Innovation Center, Oro Valley, AZ 85755
| | - Paul R August
- Sanofi U.S.-Tucson Innovation Center, Oro Valley, AZ 85755
| | - Kevin Kit Parker
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering and Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
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Gochicoa-Rangel L, Vargas MH, Alonso-Gómez JL, Rodríguez-Moreno L, Martínez-Briseño D, Baños-Mejía O, Torre-Bouscoulet L. Respiratory impedance in patients with Duchenne muscular dystrophy. Pediatr Pulmonol 2016; 51:1072-1079. [PMID: 27129130 DOI: 10.1002/ppul.23434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 01/09/2016] [Accepted: 02/23/2016] [Indexed: 12/27/2022]
Abstract
UNLABELLED Impulse oscillometry (IOS) evaluates non-effort-dependent respiratory mechanics, and thus it may be useful to evaluate patients with Duchenne muscular dystrophy (DMD). OBJECTIVES We aimed (1) to describe the behavior of IOS parameters in patients with DMD, and compare it to those from a control group; (2) to determine whether resistances and reactances differ in relation to the severity of DMD; and (3) to compare IOS parameters with spirometry and maximal inspiratory (MIP) and expiratory (MEP) pressures. METHODS Children and adolescents (<20 years old) with biopsy-confirmed DMD and age-paired subjects were cross-sectionally evaluated. All results were transformed to z scores with respect to the healthy subjects (reference population). RESULTS Anthropometric characteristics did not differ between the 31 patients and 69 controls included in the study. Compared with controls, patients with DMD had higher IOS resistances and lower reactances. As expected, FEV1 and FVC were lower in patients and always declined as age increased. By contrast, MIP and MEP were lower-than-normal in youngest patients, tended to improve around puberty initiation, and declined thereafter. In general, there was a poor correlation between IOS parameters and spirometric variables or respiratory pressures, excepting for X20 Hz, which had an inverse correlation with FEV1 . Interestingly, IOS resistances were higher in patients with less disability (lower Vignos score; better FVC), but tended to be normalized in advanced stages of the disease. CONCLUSION This study showed that IOS is feasible in children and adolescents with DMD and yields information about respiratory function not achievable with the usual forced techniques. Pediatr Pulmonol. 2016;51:1072-1079. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080, México DF, México.,Centro de Evaluación del Paciente Asmático Infantil, Centro Médico Santa Teresa, Texcoco, Estado de México, México
| | - Mario H Vargas
- Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", México DF, México
| | - José Luis Alonso-Gómez
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080, México DF, México
| | - Luis Rodríguez-Moreno
- Centro de Evaluación del Paciente Asmático Infantil, Centro Médico Santa Teresa, Texcoco, Estado de México, México
| | - David Martínez-Briseño
- Departamento de Epidemiología y Ciencias Sociales en Salud, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", México DF, México
| | - Omar Baños-Mejía
- Departamento de Rehabilitación Pulmonar, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", México DF, México
| | - Luis Torre-Bouscoulet
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080, México DF, México.
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Goselink RJM, Schreuder THA, Mul K, Voermans NC, Pelsma M, de Groot IJM, van Alfen N, Franck B, Theelen T, Lemmers RJ, Mah JK, van der Maarel SM, van Engelen BG, Erasmus CE. Facioscapulohumeral dystrophy in children: design of a prospective, observational study on natural history, predictors and clinical impact (iFocus FSHD). BMC Neurol 2016; 16:138. [PMID: 27530735 PMCID: PMC4988042 DOI: 10.1186/s12883-016-0664-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/04/2016] [Indexed: 12/19/2022] Open
Abstract
Background Facioscapulohumeral muscular dystrophy (FSHD; OMIM 158900 & 158901) is a progressive skeletal muscle dystrophy, characterized by an autosomal dominant inheritance pattern. One of the major unsolved questions in FSHD is the marked clinical heterogeneity, ranging from asymptomatic individuals to severely affected patients with an early onset. An estimated 10 % of FSHD patients have an early onset (onset before 10 years of age) and are traditionally classified as infantile FSHD. This subgroup is regarded as severely affected and extra-muscular symptoms, such as hearing loss and retinopathy, are frequently described. However, information on the prevalence, natural history and clinical management of early onset FSHD is currently lacking, thereby hampering adequate patient counselling and management. Therefore, a population-based prospective cohort study on FSHD in children is highly needed. Methods/design This explorative study aims to recruit all children (aged 0–17 years) with a genetically confirmed diagnosis of FSHD in The Netherlands. The children will be assessed at baseline and at 2-year follow-up. The general aim of the study is the description of the clinical features and genetic characteristics of this paediatric cohort. The primary outcome is the motor function as measured by the Motor Function Measure. Secondary outcomes include quantitative and qualitative description of the clinical phenotype, muscle imaging, genotyping and prevalence estimations. The ultimate objective will be a thorough description of the natural history, predictors of disease severity and quality of life in children with FSHD. Discussion The results of this population-based study are vital for adequate patient management and clinical trial-readiness. Furthermore, this study is expected to provide additional insight in the epigenetic and environmental disease modifying factors. In addition to improve counselling, this could contribute to unravelling the aetiology of FSHD. Trial registration clinicaltrials.gov NCT02625662.
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Affiliation(s)
- Rianne J M Goselink
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Tim H A Schreuder
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maaike Pelsma
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Department of Rehabilitation, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas Franck
- Department of Clinical audiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas Theelen
- Department of Op Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard J Lemmers
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean K Mah
- Department of Paediatric Neurology, Alberta Children's Hospital, Calgary, Canada
| | | | - Baziel G van Engelen
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Neurology, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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48
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Janssen MMHP, Hendriks JCM, Geurts ACH, de Groot IJM. Variables associated with upper extremity function in patients with Duchenne muscular dystrophy. J Neurol 2016; 263:1810-8. [PMID: 27314968 PMCID: PMC5010825 DOI: 10.1007/s00415-016-8193-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/18/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023]
Abstract
Preserving upper extremity (UE) function in patients with Duchenne muscular dystrophy (DMD) is extremely important as it is related to independence and quality of life. For clinical decision making, knowledge of variables associated with UE function is necessary. This knowledge is, however, limited. Therefore, this study aims to gain more insight into the variables associated with UE function in DMD. Data from an international web-based questionnaire on UE function, obtained from 213 DMD patients, were used. Six dependent variables regarding UE function were used in multivariable linear regression analyses. In addition, 26 independent variables regarding patient characteristics, medication, therapy, supportive aids, pain, stiffness and participation were used. Twelve independent variables showed a significant relation to UE function. Variables with a negative relation to UE function were: later disease stage, occurrence of scoliosis, higher age, use of UE splints, more frequent stiffness complaints, more limitations due to stiffness, more frequent elbow pain, and having physical therapy. A positive relation with UE function was seen for going to school or work, use of corticosteroids, higher BMI, and higher age at diagnosis. These variables explained 56–81 % of the variation of the different measures of UE function. Knowledge of variables associated with UE function is very important in the clinical management of DMD patients. The results of this study suggest that corticosteroid use and participation in school and work related activities are positively related to UE function in DMD patients, as well as reducing pain and stiffness and preventing scoliosis.
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Affiliation(s)
- Mariska M H P Janssen
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands.
| | - Jan C M Hendriks
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC, Nijmegen, The Netherlands
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49
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van den Engel-Hoek L, de Groot IJM, Sie LT, van Bruggen HW, de Groot SAF, Erasmus CE, van Alfen N. Dystrophic changes in masticatory muscles related chewing problems and malocclusions in Duchenne muscular dystrophy. Neuromuscul Disord 2016; 26:354-60. [PMID: 27132120 DOI: 10.1016/j.nmd.2016.03.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 03/23/2016] [Accepted: 03/31/2016] [Indexed: 12/28/2022]
Abstract
Dysphagia in Duchenne muscular dystrophy (DMD) worsens with age, with increasingly effortful mastication. The aims of this study were to describe mastication problems in consecutive stages in a group of patients with DMD and to determine related pathophysiological aspects of masticatory muscle structure, tongue thickness, bite force and dental characteristics. Data from 72 patients with DMD (4.3 to 28.0 years), divided into four clinical stages, were collected in a cross sectional study. Problems with mastication and the need for food adaptations, in combination with increased echogenicity of the masseter muscle, were already found in the early stages of the disease. A high percentage of open bites and cross bites were found, especially in the later stages. Tongue hypertrophy also increased over time. Increased dysfunction, reflected by increasingly abnormal echogenicity, of the masseter muscle and reduced occlusal contacts (anterior and posterior open bites) were mainly responsible for the hampered chewing. In all, this study shows the increasing involvement of various elements of the masticatory system in progressive Duchenne muscular dystrophy. To prevent choking and also nutritional deficiency, early detection of chewing problems by asking about feeding and mastication problems, as well as asking about food adaptations made, is essential and can lead to timely intervention.
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Affiliation(s)
- L van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - I J M de Groot
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L T Sie
- Department of Pediatric Neurology, Juliana Children's Hospital/Haga Teaching Hospital, The Hague, The Netherlands
| | - H W van Bruggen
- Department of Cariology, Endodontology & Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - S A F de Groot
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C E Erasmus
- Donders Centre for Neuroscience, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N van Alfen
- Donders Centre for Neuroscience, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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50
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Umemoto G, Furuya H, Arahata H, Sugahara M, Sakai M, Tsuboi Y. Relationship between tongue thickness and tongue pressure in neuromuscular disorders. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ncn3.12058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- George Umemoto
- Department of Oral and Maxillofacial Surgery Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Hirokazu Furuya
- Department of Neurology Faculty of Medicine Kochi University Kochi Japan
| | - Hajime Arahata
- Department of Neurology Neuro‐Muscular Center National Omuta Hospital Fukuoka Japan
| | - Miwa Sugahara
- Department of Neurology Neuro‐Muscular Center National Omuta Hospital Fukuoka Japan
| | - Mitsuaki Sakai
- Department of Rehabilitation Neuro‐Muscular Center National Omuta Hospital Fukuoka Japan
| | - Yoshio Tsuboi
- Department of Neurology Faculty of Medicine Fukuoka University Fukuoka Japan
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