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Umay E, Cankurtaran D, Tezel N, Uz C, Tombak Y, Karaahmet O, Aykin Yigman Z, Celik G, Unlu Akyuz E. Pediatric Dysphagia Risk Screening Instrument (PDRSI) in Children With Cerebral Palsy. Clin Pediatr (Phila) 2024:99228241241901. [PMID: 38591868 DOI: 10.1177/00099228241241901] [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] [Indexed: 04/10/2024]
Abstract
This study aimed to evaluate whether the Pediatric Dysphagia Risk Screening Instrument (PDRSI) was a suitable test for children with cerebral palsy (CP) and assess the instrument's Turkish validity and reliability. One-hundred twenty-six children with CP participated in this study. "Cronbach's alpha (ɑ)," "Cronbach's ɑ when one item is deleted," "inter-item correlation," and "corrected item-to-total correlation" were used to assess internal consistency. In addition, inter-rater agreement tests (Cohen's kappa coefficient) were conducted for reliability. Construct validity was used to assess the validity. Moreover, flexible fiberoptic endoscopic evaluation of the swallowing method was used to describe the receiver operating characteristic curve analysis and calculate the sensitivity and specificity of T-PDRSI. It was found that the PDRSI had adequate validity and reliability. The PDRSI can be used in children with CP as a valid and reliable instrument with high sensitivity and specificity.
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Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Nihal Tezel
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Cuma Uz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Yasemin Tombak
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Ozgur Karaahmet
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Zeynep Aykin Yigman
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
| | - Gulnur Celik
- Physical Medicine and Rehabilitation Clinic, Mamak State Hospital, Ankara, Turkey
| | - Ece Unlu Akyuz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Etlik Integrated Health Campus, Ankara, Turkey
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Kapavarapu PK. Characterization of pharyngeal contractile integral using pharyngeal manometry in children. J Pediatr Gastroenterol Nutr 2024; 78:753-754. [PMID: 38323668 DOI: 10.1002/jpn3.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/14/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Prasanna K Kapavarapu
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Miranda PP, Levy DS, Kieling RR. Aspiration in the First Year of Life and Later Tube Feeding: A Retrospective Cohort from a Low-Income Country. Dysphagia 2023; 38:192-199. [PMID: 35476230 DOI: 10.1007/s00455-022-10450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
The objective of this study is to investigate in infants submitted to videofluoroscopic swallowing study (VFSS) during the first year of life, the association between aspiration and later tube feeding, and to identify potential risk factors related to feeding route outcome. Retrospective cohort study with data from electronic health records was performed. Data were collected from infants < 12 months of age who underwent VFSS during inpatient hospital stay in the period between 2013 and 2018. Patient charts after 24 months of age were reviewed to ascertain the outcome and study factors, including VFSS findings, neonatal data, clinical comorbidities, nutritional status, ICU admissions, and hospital readmissions. Relative risk (RR) for tube feeding was calculated, and a Poisson regression with robust variance was used to identify potential risk factors. VFSS data from 164 patients < 1 year old were retrieved, of whom 112 (68%) contributed with data about feeding route after 2 years of age. Most infants were preterm < 37 weeks (66%), with a median age of 9.28 weeks at the time of the exam. Aspiration occurred in 33% of the patients, with no statistically significant difference between full-term or premature infants (p = 0.173). The relative risk of tube feeding after the age of 2 among infants who aspirated in VFSS was 0.74 (CI 0.25-2.16, p = 0.573). Poisson regression analysis showed that number of hospital readmissions (RR 1.04, 95%CI 1.01-1.07, p = 0.005) and gestational age < 34 weeks (RR 0.26, 95%CI 0.07-0.089, p = 0.032) were associated with later tube feeding. Early VFSS findings have low predictive value regarding later feeding route. Aspiration events should be considered as complementary information for clinical decision.
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Affiliation(s)
- Priscilla Poliseni Miranda
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Deborah Salle Levy
- Speech and Language Pathology Service, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos Street, 2350 - Room 1045, Porto Alegre, Rio Grande do Sul, 90035-903, Brazil
- Department of Health and Human Communication, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Renata Rocha Kieling
- Graduate Program in Child and Adolescent, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
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Dysphagia Management in Children: Implementation and Perspectives of Flexible Endoscopic Evaluation of Swallowing (FEES). CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121857. [PMID: 36553301 PMCID: PMC9776403 DOI: 10.3390/children9121857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
Dysphagia is any impairment of swallowing that compromises the safety, efficiency, or adequacy of nutritional or liquid intake. It is common in children, especially in some clinical populations, and may result in failure to thrive and respiratory problems due to pulmonary aspiration. Swallowing disorders have a severe impact on children's health, growth, and development, and on the quality of life of the child and family. Clinical evaluation cannot validly predict aspiration, which is mostly silent. A team management approach is advocated, including instrumental swallowing assessments. FEES has been proven to be safe and valid and is increasingly used in children of all ages. It allows the identification of structural abnormalities, assessment of the child's diet with real-life food and liquids while the child holds the optimal or preferred position, examination during breastfeeding, and assessment of fatigue and treatment strategies. FEES is carried out following a protocol that comprises three parts: the evaluation of the anatomical and physiological parameters of swallowing, testing of food and liquids of a range of different consistencies, and evaluation of treatment methods. Pediatric FEES involves adaptations for infants, and special considerations about readiness for nutritive trials and the infant's ability to sustain a coordinated feeding pattern. Varying consistencies and volumes of food or liquids are tried. Care of the dysphagic child involves team work. FEES, as a part of the assessment and management of dysphagia, enables the evaluation of the safety, efficiency, and adequacy of oral food and liquid intake. Future perspectives include standardized training in clinical FEES protocols to ensure clinical competency of the pediatric FESS team members and the development and validation of standardized examination and interpretation protocols for pediatric FEES.
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Ariji Y, Gotoh M, Fukuda M, Watanabe S, Nagao T, Katsumata A, Ariji E. A preliminary deep learning study on automatic segmentation of contrast-enhanced bolus in videofluorography of swallowing. Sci Rep 2022; 12:18754. [PMID: 36335226 PMCID: PMC9637105 DOI: 10.1038/s41598-022-21530-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Although videofluorography (VFG) is an effective tool for evaluating swallowing functions, its accurate evaluation requires considerable time and effort. This study aimed to create a deep learning model for automated bolus segmentation on VFG images of patients with healthy swallowing and dysphagia using the artificial intelligence deep learning segmentation method, and to assess the performance of the method. VFG images of 72 swallowing of 12 patients were continuously converted into 15 static images per second. In total, 3910 images were arbitrarily assigned to the training, validation, test 1, and test 2 datasets. In the training and validation datasets, images of colored bolus areas were prepared, along with original images. Using a U-Net neural network, a trained model was created after 500 epochs of training. The test datasets were applied to the trained model, and the performances of automatic segmentation (Jaccard index, Sørensen-Dice coefficient, and sensitivity) were calculated. All performance values for the segmentation of the test 1 and 2 datasets were high, exceeding 0.9. Using an artificial intelligence deep learning segmentation method, we automatically segmented the bolus areas on VFG images; our method exhibited high performance. This model also allowed assessment of aspiration and laryngeal invasion.
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Affiliation(s)
- Yoshiko Ariji
- grid.411253.00000 0001 2189 9594Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651 Japan ,grid.412378.b0000 0001 1088 0812Department of Oral Radiology, School of Dentistry, Osaka Dental University, Osaka, Japan
| | - Masakazu Gotoh
- grid.411253.00000 0001 2189 9594Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651 Japan
| | - Motoki Fukuda
- grid.411253.00000 0001 2189 9594Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651 Japan
| | - Satoshi Watanabe
- grid.411253.00000 0001 2189 9594Department of Maxillofacial Surgery, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
| | - Toru Nagao
- grid.411253.00000 0001 2189 9594Department of Maxillofacial Surgery, Aichi-Gakuin University School of Dentistry, Nagoya, Japan
| | - Akitoshi Katsumata
- grid.411456.30000 0000 9220 8466Department of Oral Radiology, Asahi University School of Dentistry, Mizuho, Japan
| | - Eiichiro Ariji
- grid.411253.00000 0001 2189 9594Department of Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry, 2-11 Suemori-dori, Chikusa-ku, Nagoya, 464-8651 Japan
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Umay E, Eyigor S, Giray E, Karadag Saygi E, Karadag B, Durmus Kocaaslan N, Yuksel D, Demir AM, Tutar E, Tikiz C, Gurcay E, Unlu Z, Celik P, Unlu Akyuz E, Mengu G, Bengisu S, Alicura S, Unver N, Yekteusaklari N, Uz C, Cikili Uytun M, Bagcier F, Tarihci E, Akaltun MS, Ayranci Sucakli I, Cankurtaran D, Aykın Z, Aydın R, Nazli F. Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts. World J Pediatr 2022; 18:715-724. [PMID: 35821340 DOI: 10.1007/s12519-022-00584-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. METHODS This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). RESULTS In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. CONCLUSIONS This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.
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Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey.
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospıtal, Istanbul, Turkey
| | - Evrim Karadag Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatric Pulmonology, Marmara University, Istanbul, Turkey
| | - Nihal Durmus Kocaaslan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Marmara University, Istanbul, Turkey
| | - Deniz Yuksel
- Department of Pediatric Neurology, University of Health Sciences, Ankara Dr Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Arzu Meltem Demir
- Department of Pediatric Gastroenterology, Ankara City Hospital, Ankara, Turkey
| | - Engin Tutar
- Department of Pediatric Gastroenterology, Marmara University, Ankara, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Eda Gurcay
- University of Health Sciences Turkey, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Pelin Celik
- Department of Developmental Pediatric, Ankara City Hospital, Ankara, Turkey
| | - Ece Unlu Akyuz
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Guven Mengu
- Department of Western Languages and Literatures, Ankara Haci Bayram Veli University, English Language and Literature Division, Ankara, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Uskudar University, Istanbul, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Necati Unver
- Department of Otolaryngology, Head and Neck Surgery, Marmara University, Istanbul, Turkey
| | - Nida Yekteusaklari
- Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey
| | - Cuma Uz
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Merve Cikili Uytun
- Department of Child and Adolescent Psychiatry, Ankara University, Ankara, Turkey
| | - Fatih Bagcier
- Department of Physical Medicine and Rehabilitation, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Elif Tarihci
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey
| | - Iclal Ayranci Sucakli
- University of Health Sciences Turkey, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey
| | - Damla Cankurtaran
- Department of Physical Medicine and Rehabilitation Ankara, University of Health Sciences Turkey, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Istanbul, Turkey
| | - Zeynep Aykın
- Ministry of Health, Mamak Public Hospital, Ankara, Turkey
| | - Resa Aydın
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Fatma Nazli
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Kirikkale, Turkey
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Ullal TV, Marks SL, Belafsky PC, Conklin JL, Pandolfino JE. A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans. Front Vet Sci 2022; 9:889331. [PMID: 35754550 PMCID: PMC9228035 DOI: 10.3389/fvets.2022.889331] [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: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022] Open
Abstract
Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.
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Affiliation(s)
- Tarini V Ullal
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Stanley L Marks
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Peter C Belafsky
- Department of Otolaryngology, Center for Voice and Swallowing, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jeffrey L Conklin
- The Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UCLA Robert G. Kardashian Center for Esophageal Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John E Pandolfino
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Miles A, Dharmarathna I, Fuller L, Jardine M, Allen J. Developing a Protocol for Quantitative Analysis of Liquid Swallowing in Children. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1244-1263. [PMID: 35302872 DOI: 10.1044/2021_ajslp-20-00337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Objective measures in videofluoroscopic swallow studies (VFSSs) can quantify swallow biomechanics. There are a wide array of validated measures studied in infants, children, and adults. There is a need for a pediatric VFSS protocol that consists of a small number of vital, time efficient, and clinically relevant measures. In this study, we aimed to establish a standard protocol for quantitative VFSS analysis in children. METHOD Protocol development began with a systematic literature review, which identified 22 quantitative and eight descriptive measures available in the literature. A pediatric VFSS database of 553 children was collected using a standardized VFSS protocol. Studies were evaluated using the 30 previously reported measures covering displacement and timing parameters as well as penetration-aspiration and residue. Measures were tested for rater reliability and internal consistency. Measures meeting acceptable values for protocol inclusion were included in the final protocol (Cronbach's alpha > .53). RESULTS Interrater and intrarater reliability of 17 measures met acceptable reliability levels. During internal consistency testing, we removed six further measures based on Cronbach's alpha levels indicating that two or more measures were equivalent in measuring the same aspect of swallow biomechanics in children. A VFSS protocol of reliable, valid, and obtainable objective quantitative (n = 6) and descriptive measures (n = 3) with separate protocols for young infants (≤ 9 months) and older children was established. CONCLUSIONS A standardized quantitative VFSS protocol for children has been developed to suit two age groups (≤ 9 and > 9 months old). Consistent VFSS administration and reporting support assessment over time and across disease groups. Future research should focus on how this information can be used by clinicians to produce individualized treatment plans for children with swallowing impairment.
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Affiliation(s)
- Anna Miles
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Isuru Dharmarathna
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Laura Fuller
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Marie Jardine
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, New Zealand
| | - Jacqui Allen
- Department of Surgery, The University of Auckland, New Zealand
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Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers. An Pediatr (Barc) 2022; 96:431-440. [DOI: 10.1016/j.anpede.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
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Viviers M, Edwards L, Asir M, Hibberd J, Rowe R, Phillips S, Thomas V, Keesing M, Sugar A, Allen J. Enhanced rapid review of the applicability of ultrasound in the assessment of sucking, swallowing and laryngeal function in the paediatric population. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:422-440. [PMID: 35060665 DOI: 10.1111/1460-6984.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/26/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has renewed interest in the use of ultrasound (US) amongst dysphagia-trained clinicians working with infants and children. US is a portable, minimally intrusive tool which carries reduced risk of aerosol-generation provoked by other instrumental swallowing assessment tools such as fibreoptic endoscopic evaluation of swallowing (FEES). For this reason, US could be a valuable addition to the dysphagia assessment toolkit. A recently published rapid review of US evidence for the assessment of swallowing and laryngeal function in the adult population provided a framework for this neonatal and paediatric review. AIMS This enhanced rapid review aimed to establish the applicability of US as an instrumental assessment tool for sucking, swallowing and laryngeal function in the neonatal and paediatric populations. METHODS & PROCEDURES A rapid review of six electronic databases was conducted to identify articles using US to assess sucking, swallowing or laryngeal function in the selected populations, compared with varied reference tests. Abstract screening was completed according to pre-defined inclusion/exclusion criteria with 10% of articles assessed by a second screener. Data was extracted from the included studies using a pre-developed form. A modified QUADAS-2 tool was used to assess study quality. Results from the included studies were summarised and grouped into sucking, swallowing and laryngeal function data. OUTCOMES & RESULTS Twelve studies using US in the assessment of swallowing and/or laryngeal function met inclusion criteria. No studies using US for assessment of sucking met the inclusion criteria. All were peer-reviewed, primary studies across a range of clinical populations and with a wide geographical spread. Five studies had an overall low risk of bias. Seven studies had at least one domain where risk of bias was judged as high. All studies had high applicability. The two studies assessing swallowing differed in terms of aims and use of US. The studies assessing laryngeal function predominately investigated vocal fold movement and laryngeal pathology. Sensitivity and specificity data were provided or calculated from raw data for nine of the laryngeal function studies (respective ranges of 75%-100% and 80%-100%). CONCLUSIONS & IMPLICATIONS Emerging evidence exists to support the use of US as adjunct to clinical assessment of swallowing and laryngeal function in the neonatal and paediatric population. A paucity of evidence to support use of US in the assessment of sucking exists. Further research is needed to establish evidence-based assessment and analysis protocols as well as development of paediatric data.
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Affiliation(s)
- Mari Viviers
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Maya Asir
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Rebecca Rowe
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sophie Phillips
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Melissa Keesing
- Nelson Marlborough District Health Board, Nelson, New Zealand
| | - Analou Sugar
- Chelsea and Westminster Hospital, Chelsea & Westminster Hospital Foundation Trust, London, UK
| | - Jodi Allen
- The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Zang J, Kiehn S, Flügel T, Koseki JC, Nießen A, Kim SH, Pflug C, Nienstedt JC. Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research. Dysphagia 2022; 37:1822-1838. [PMID: 35430715 PMCID: PMC9643173 DOI: 10.1007/s00455-022-10446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date. OBJECTIVE This systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome. METHODS Included were all studies reporting a pediatric FEES protocol for children aged 0-18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form. RESULTS In total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared. DISCUSSION None of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Saskia Kiehn
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susan Hyoungeun Kim
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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12
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Ortiz Pérez P, Valero Arredondo I, Torcuato Rubio E, Rosa López A, García-Herrera Taillifer P, Navas-López VM. [Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00219-8. [PMID: 34257061 DOI: 10.1016/j.anpedi.2021.06.009] [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: 02/25/2021] [Revised: 05/04/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (DOF) without proper evaluation can be underdiagnosed in certain groups of the pediatric population. Meeting the needs of these patients can lead to an overload of their caregivers. OBJECTIVES To describe the epidemiological and clinical characteristics of the patients evaluated after starting a monographic DOF clinic (C-DOF) and study whether there are changes at the nutritional level, as well as the burden and impact that caregivers find on quality of life related to health (HRQOL). MATERIAL AND METHODS Descriptive observational study of patients evaluated in a C-DOF from its start-up. To evaluate HRQOL, an ad hoc survey adapted from the Swallowing Quality of Life Questionnaire of the adult population was designed. RESULTS 103 patients were evaluated, 85.4% presenting some neurological disease. A videofluoroscopic study was performed in 51 patients (49.5%), reporting combined alterations in both the oral and pharyngeal phases in 64.7% of them. There was a directly proportional correlation between the severity of the DOF and the presence of aspirations, as well as with the patient's motor impairment. Regarding the anthropometric evaluation, there was a trend toward improvement in weight z-score (+0.14 SD), height (+0.17 SD) and BMI (+0.16 SD). Out of 46.2% of the caregivers reported that the DOF problem interfered negatively in the basic activities of daily life. The increase in HRQOL, after the evaluation in the monographic DOF clinic, was statistically significant overall. CONCLUSIONS The monographic DOF clinic provided specialized care, impacting positively at the nutritional status of patients, as well as perceived changes in HRQOL, with a probable impact on caregivers.
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Affiliation(s)
- Pilar Ortiz Pérez
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España.
| | - Inés Valero Arredondo
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
| | - Encarnación Torcuato Rubio
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
| | - Andrés Rosa López
- Sección de Radiología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España
| | | | - Víctor Manuel Navas-López
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
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Dharmarathna I, Miles A, Allen J. Predicting penetration-aspiration through quantitative swallow measures of children: a videofluoroscopic study. Eur Arch Otorhinolaryngol 2021; 278:1907-1916. [PMID: 33564910 DOI: 10.1007/s00405-021-06629-4] [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: 09/02/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Quantitative measures have improved the reliability and accuracy in interpretation and reporting of videofluoroscopy (VFSS). Associations between quantitative VFSS measures and swallow safety in children are not widely reported. The ability to predict aspiration in children, even if not observed during brief VFSS, will improve diagnostic reporting and potentially reduce the need for extended radiation time. The aims of this study were to determine associations between quantitative fluoroscopic swallow measures and penetration-aspiration and to predict likelihood of penetration-aspiration. METHODS We selected videofluoroscopic data of 553 children from a pediatric hospital database for this single-center retrospective observational study. A standard protocol of VFSS administration was used and data were recorded at 30 frames-per-second. A set of quantitative and descriptive swallow measures was obtained using a specialized software with satisfactory inter-rater and intra-rater reliability. Binomial logistic regression with backward likelihood ratio was conducted, while controlling for age, gender, and etiology. RESULTS We found bolus clearance ratio (BCR), pharyngeal constriction ratio (PCR), duration to hyoid maximal elevation (Hdur), and total pharyngeal transit time (TPT) to be predictive of penetration-aspiration in children. PCR was the most predictive of penetration-aspiration in children (61.5%). Risk of aspiration was more than 100 times, when BCR = ≥ 0.1, TPT = ≥ 2 s, Hdur = > 1 s or PCR = ≥ 0.2 (p < 0.05 for all measures). CONCLUSION The results confirm the potential of objective quantitative swallow measures in predicting the risk of aspiration in children with dysphagia. These parameters provide predictive measures of aspiration risk that are clinically useful in identifying children of concern, even if no aspiration is observed during VFSS.
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Affiliation(s)
- Isuru Dharmarathna
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, Building 507, Level 2 (B.065), 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand. .,Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
| | - Anna Miles
- Speech Science, School of Psychology, Faculty of Science, The University of Auckland, Building 507, Level 2 (B.065), 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand
| | - Jacqui Allen
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Allen J, Dewan K, Herbert H, Randall DR, Starmer H, Stein E. Aspects of the assessment and management of pharyngoesophageal dysphagia. Ann N Y Acad Sci 2020; 1482:5-15. [PMID: 32794195 DOI: 10.1111/nyas.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023]
Abstract
Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive system may be affected. A thorough assessment from the oral cavity to the stomach will provide physiologic information that enables specific targeted management plans to be devised. Although the swallow trajectory bridges anatomic areas, there has previously been a tendency to compartmentalize assessment and treatment by arbitrary anatomic boundaries. It is now clear that this approach fails to appreciate the complexity of swallow mechanics and that systems (oral, pharyngeal, esophageal, and pulmonary) are intertwined and codependent. Swallowing specialists from different backgrounds and with complementary skill sets form a multidisciplinary team that can provide insight and address multiple areas of management. With the advent of new tools for instrumental evaluation, such as manometry, targeted rehabilitative strategies can be informed by physiology, increased in precision and breadth, and assessed quantitatively. Surgical approaches have evolved toward endoscopic techniques, and food technology is expanding options in dietary management. The multidisciplinary team is core to managing this varied and often neglected patient population. This review is for clinicians treating swallowing disorders and will explore the selected aspects of the assessment and management of pharyngoesophageal swallowing disorders.
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Affiliation(s)
- Jacqueline Allen
- Department of Surgery, the University of Auckland, Auckland, New Zealand
| | - Karuna Dewan
- Division of Otolaryngology, Stanford University, Stanford, California
| | - Hayley Herbert
- Department of Otolaryngology, University of Western Australia, Perth, Western Australia, Australia
| | - Derrick R Randall
- Division of Otolaryngology, the University of Calgary, Calgary, Alberta, Canada
| | - Heather Starmer
- Division of Otolaryngology, Stanford University, Stanford, California
| | - Ellen Stein
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical School, Baltimore, Maryland
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