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Yoon TH, Morishita M, Han NM, Park JS. Effect of home-based tongue-strengthening exercise using a portable tool on oropharyngeal muscles in older adults with sarcopenic dysphagia: A randomised controlled study. J Oral Rehabil 2024; 51:2270-2277. [PMID: 39073062 DOI: 10.1111/joor.13818] [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: 06/25/2024] [Revised: 07/12/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Tongue-strengthening exercises may be used at home to strengthen swallowing-related oropharyngeal muscles in community-dwelling older adults with sarcopenic dysphagia; however, evidence of their effectiveness remains unclear. OBJECTIVE This study aimed to investigate the effects of a home-based tongue-strengthening exercise (hTSE) using portable tool on swallowing-related oropharyngeal muscles in community-dwelling older adults with sarcopenic dysphagia. METHODS Forth community-dwelling older adults with sarcopenic dysphagia were enrolled in the study. The participants were randomly assigned to the experimental and control groups. 1-Repetition Maximum (1-RM) of tongue muscle was measured in the experimental group using the Iowa Oral Performance Instrument, and hTSE was performed using a portable tool with an intensity corresponding to approximately 70%-80% of the range based on the 1-RM value (90 times/day, 5 days/week, for 8 weeks). The control group did not perform any tongue exercises. The primary outcome measures were tongue strength and thickness. The secondary outcome measure was suprahyoid muscle strength (digastric and mylohyoid muscles). RESULTS The experimental group showed significantly greater increases in suprahyoid muscle (mylohyoid and digastric) thickness (p = .01 and .011, d = 1.0 and .55), as well as tongue strength and thickness (p < .001 and .029, d = 2.2 and .6) than the control group. CONCLUSION This study confirmed that hTSE using a portable tool is effective in increasing swallowing-related oropharyngeal muscle activity in older adults with sarcopenic dysphagia. Therefore, hTSE is recommended as an inexpensive, safe, and easy-to-use therapy for sarcopenic dysphagia in older adults.
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Affiliation(s)
- Tae-Hyung Yoon
- Department of Occupational Therapy, Dongseo University, Busan, Korea
| | - Motoyoshi Morishita
- Department of Physical Therapy, Faculty of Rehabilitation, Reiwa Health Sciences University, Fukuoka, Japan
| | - Na-Mi Han
- Department of Rehabilitation Medicine, Busan Paik Hospital, Busan, Korea
| | - Ji-Su Park
- Research Institute for Korean Medicine, Pusan National University, Yangsan, Korea
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Shinn EH, Garden AS, Chen M, Basen-Engquist K, Fellman B, Hutcheson K, Morrison WH, Peterson S, Li L. Self-management intervention improves patient adherence to swallowing exercises during radiation for head and neck cancer. Head Neck 2024; 46:2878-2889. [PMID: 38873861 DOI: 10.1002/hed.27832] [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: 05/03/2023] [Revised: 02/02/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND While preventive swallowing exercises reduce the risk of radiation-associated dysphagia in patients with head and neck cancer, strategies are needed to improve patient adherence. METHODS Before radiation, all participants were taught preventive swallowing exercises and randomized to either an adherence intervention or enhanced usual care. During radiation, all participants met twice with a speech pathologist for swallowing assessment and reinforcement of exercises. Intervention participants met weekly with a counselor in-person or by phone. At 6-week post-radiation follow-up, all participants completed a follow-up assessment of self-reported adherence, which was then corroborated with medical record documentation. RESULTS Newly diagnosed pharyngeal and laryngeal cancer patients without distant metastases were randomized (n = 265; 135 to intervention, and 130 to usual care). Intervention participants were more likely to adhere to exercises during radiation compared to the control group (p < 0.0001). CONCLUSION The weekly in-person adherence intervention program significantly increased patient's adherence to preventive swallowing exercises during radiation.
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Affiliation(s)
- Eileen H Shinn
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Minxing Chen
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Kate Hutcheson
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Susan Peterson
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Liang Li
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Ambrocio KR, Aggarwal R, Lacomis D, Zhang X, Garand KLF. Features of Swallowing Function in Sporadic Inclusion Body Myositis: Preliminary Evidence Using Well-Tested Assessment Frameworks. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024:1-12. [PMID: 39392897 DOI: 10.1044/2024_ajslp-24-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
PURPOSE Evidence surrounding swallowing impairment in sporadic inclusion body myositis (IBM) is based on nonstandardized and nonvalidated assessment methods. We investigated (a) IBM's impact on swallowing function and oral intake status using well-tested assessment frameworks; (b) changes in swallowing over time; and (c) age, sex, and swallowing impairment severity's influence on oral intake status. METHOD We conducted a secondary analysis of Modified Barium Swallow Impairment Profile (MBSImP) and Functional Oral Intake Scale (FOIS) data from 13 patients with IBM (seven females; Mage = 60.2 [±13.6] years) and 13 age- and sex-matched healthy controls. We compared MBSImP Overall Impression (OI), Oral Total (OT), Pharyngeal Total (PT), and FOIS scores between groups. Specific to the IBM cohort, we analyzed repeated OT and PT scores and calculated whether age, sex, and OT and PT scores predicted FOIS scores. RESULTS The IBM cohort demonstrated poorer OI scores across six swallowing components than healthy controls (each p < .05). Unlike OT scores (p = .84), PT (p = .033) and FOIS (p < .001) scores were worse in the IBM cohort. Repeated OI scores revealed changes in three swallowing components (each p < .05), but repeated OT (p = .16) and PT (p = .30) scores did not significantly change. Age, sex, and OT and PT scores did not influence FOIS scores (each p > .05). CONCLUSIONS Pharyngeal impairments were most prominent in the IBM cohort, and their oral intake status was adversely affected. Our preliminary data showcase the application of robust assessment methods to investigate swallowing function in IBM, enhancing standardization and comparability across studies. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.27165450.
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Affiliation(s)
- Kevin Renz Ambrocio
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Rohit Aggarwal
- Myositis Center, University of Pittsburgh Medical Center, PA
- Division of Rheumatology and Clinical Immunology, School of Medicine, University of Pittsburgh, PA
| | - David Lacomis
- Muscular Dystrophy Association Care Center, University of Pittsburgh Medical Center, PA
- Division of Neurology and Pathology (Neuropathology), School of Medicine, University of Pittsburgh, PA
| | - Xingyu Zhang
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
| | - Kendrea L Focht Garand
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston (Adjunct affiliation)
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Chua DMN, Choi YY, Chan KMK. Effects of oropharyngeal exercises on the swallowing mechanism of older adults: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:696-713. [PMID: 37529940 DOI: 10.1080/17549507.2023.2221409] [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: 08/03/2023]
Abstract
PURPOSE Age-related changes to the swallowing mechanism, or presbyphagia, may put older adults at a higher risk for developing diseases and dysphagia. Maintaining swallowing functions could help prevent frailty and facilitate healthy ageing. This review summarises and appraises the effects of oropharyngeal exercises on the swallowing functions of healthy older adults without dysphagia. It is hypothesised that these exercises will strengthen and improve the structures and functions of the normal ageing swallow. METHOD This review was reported according to the PRISMA 2020 guidelines. Five electronic databases (Medline, Embase, Cochrane Library, Web of Science, CINAHL) and Google Scholar were searched in June 2021. A rerun was done in January 2023. Study selection, data extraction, and quality assessment were done by two independent raters. RESULT A total of 23 studies were reviewed. Meta-analysis was not conducted due to the heterogenous training protocols and outcomes. Majority (n = 21) had fair quality due to incomplete reporting. Exercises targeting oral structures were implemented the most (n = 15), followed by variations of the head lift (n = 4), and effortful swallow exercise (n = 1). Others implemented combined or multiapproach exercise studies (n = 3). Apart from surface electromyography findings, statistically significant improvements in oral and pharyngeal phase swallowing outcomes such as increased lingual isometric and swallowing pressures, bite force, muscle thickness, hyolaryngeal excursion, and upper oesophageal sphincter opening diameter were reported in 95% of the studies (n = 22). CONCLUSION Collective evidence suggests that strength training for swallowing-related structures leads to increases in structural strength, endurance, and muscle mass. The effects of exercises on overall swallowing efficiency and safety remain unclear. Results should be interpreted with caution due to methodological limitations. Further research should examine the long-term effects of these exercises in preventing frailty and reducing the burden of dysphagia in older adults.
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Affiliation(s)
- Denise Mae N Chua
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Yuen-Yu Choi
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Hong Kong
| | - Karen Man-Kei Chan
- Swallowing Research Laboratory, Faculty of Education, The University of Hong Kong, Hong Kong
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Söyler AK, Kıylıoğlu N, Serel Arslan S, Demir N, Gök M, Ertekin E, Düger T. Do We Know the Long-Term Effects of the Most Popular Traditional Swallow Maneuvers on the Submental Muscles? J Oral Rehabil 2024. [PMID: 39344429 DOI: 10.1111/joor.13862] [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: 09/09/2023] [Revised: 08/19/2024] [Accepted: 09/02/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Various trainings focus on the submental muscles (SMs) for dysphagia rehabilitation because of their importance for swallowing safety and efficiency. According to the current literature, swallow-specific tasks may be optimal exercises for dysphagia. The effortful swallow (ES) and the Masako maneuver (MM) are the most commonly used swallow-specific tasks in the clinical settings for dysphagia for years, but long-term effects for these trainings is insufficient. OBJECTIVES This study aims to investigate and compare the effects of ES and MM on SM activity, strength and thickness. METHODS Thirty-seven healthy adults were randomised to ES, MM and control groups, and ES and MM groups completed 6 weeks of swallowing training. Participants in both training groups performed a total of 120 swallows in each session, while control group did not participate in any swallowing training. Surface electromyography was used to evaluate SM activity, digital dynamometer for SM strength and ultrasonography for SM thickness. RESULTS Both trainings did not change SM activity (p > 0.05), but increased SM strength (p < 0.05). MM increased the thickness of all SM (p < 0.05), and ES increased the thickness of mylohyoid (right, left) and digastric muscle (right) (p < 0.05), and there was no change in all evaluation parameters in the control group (p > 0.05). Also, trainings were not superior to each other in any parameter (p > 0.05). CONCLUSION The results of this study provided new evidence to the literature to show that ES and MM trainings are effective for improving SM strength and thickness. Considering that SM is important in terms of swallowing safety and effectiveness, it is thought that both trainings may be promising by increasing the strength and mass of SM, especially in individuals with reduced SM strength and mass.
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Affiliation(s)
- Ayşe Kübra Söyler
- Faculty of Health Science, Physiotherapy and Rehabilitation, Aydın Adnan Menderes University, Aydın, Turkey
| | - Nefati Kıylıoğlu
- Department of Neurology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Mustafa Gök
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Ersen Ertekin
- Department of Radiology, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Tülin Düger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Murray KL, Wong SM, Kamarunas E. Short-term cortical activation changes associated with postural compensation in swallowing. Exp Brain Res 2024:10.1007/s00221-024-06928-2. [PMID: 39320437 DOI: 10.1007/s00221-024-06928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024]
Abstract
Compensatory strategies used to treat dysphagia, like the chin-down and chin-up positions, are often employed by speech-language pathologists to enhance swallowing safety. However, their effects on cortical neural responses remain unclear. This study aimed to investigate the cortical hemodynamic responses to swallowing across three head positions -chin-down, chin-neutral, and chin-up - using functional near-infrared spectroscopy (fNIRS) in the bilateral precentral and postcentral gyrus regions of interest. Twenty-six healthy adults completed 32 swallows of 5 ml water in each head position. Results revealed short-term cortical activation increases for chin-up swallows compared to both chin-neutral (mean difference = 1.2, SE = 0.18, p = .048) and chin-down swallows (mean difference = 0.76, SE = 0.18, p = .009). These findings suggest that postural changes during swallowing induce immediate neural adaptations in people without swallowing difficulty. These modifications likely reflect the necessary sensory and neuromuscular adaptations required for safe swallowing in different head positions, with less hyolaryngeal movement needed for a chin-down swallow and more movement needed for a chin-up swallow. While challenging swallow conditions, like the chin-up, may offer promising therapeutic potential, caution is warranted considering the associated safety risk, and further investigation is needed. This study provides insights into the immediate effects of head positions on cortical activity during swallowing and highlights avenues for future research in dysphagia rehabilitation.
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Affiliation(s)
- Kelsey L Murray
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA.
| | - Seng Mun Wong
- Speech Therapy Department, Singapore General Hospital, Singapore, Singapore
| | - Erin Kamarunas
- Communication Sciences and Disorders, James Madison University, Harrisonburg, VA, USA
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Calvache C, Castillo-Triana N, Aguirre FD, Leguízamo P, Rojas S, Valenzuela P, Piedrahita MM, Ardila MDPR, Pérez DVB. Integration of Dysphagia Therapy Techniques into Voice Rehabilitation: Design and Content Validation of a Cross-Therapy Protocol. J Voice 2024:S0892-1997(24)00235-2. [PMID: 39244386 DOI: 10.1016/j.jvoice.2024.07.024] [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: 03/13/2024] [Revised: 06/06/2024] [Accepted: 07/22/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The intricate relationship between swallowing and phonation, sharing anatomical and physiological substrates, underscores a clinical demand for integrated therapeutic approaches. Existing interventions often address these functions in isolation, overlooking their interconnected dynamics. OBJECTIVE To design and validate a cross-therapy protocol incorporating dysphagia therapy techniques (maneuvers/exercises) into voice rehabilitation. This protocol aims to exploit the shared biomechanical components of swallowing and phonation to improve both functions simultaneously in patients with underlying hypofunctional laryngeal pathology. METHODS A descriptive research design was employed, consisting of three phases: a comprehensive literature review and expert discussions in a German seminar format to conceptualize the protocol; detailed analysis and categorization of swallowing maneuvers/exercises; and content validation by a panel of seven experts through a structured evaluation instrument. The process integrated motor learning and exercise physiology principles to ensure the protocol's clinical applicability and theoretical coherence. RESULTS The developed cross-therapy protocol incorporates four core swallowing therapy techniques to voice therapy procedures. Selected swallowing therapy techniques target laryngeal excursion and vocal fold closure because they are critical components of swallowing and phonation. Expert validation yielded a Content Validity Coefficient exceeding 0.90 for most items, indicating high consensus on the protocol's relevance, clarity, and applicability. Adjustments were made based on feedback, enhancing the protocol's precision and user-friendliness. CONCLUSION We present a novel, evidence-based therapy protocol for voice and swallowing difficulties resulting from hypofunctional laryngeal pathology. Its development marks a significant step toward bridging the gap between swallowing and voice therapy. Future empirical studies are needed to assess its effectiveness in clinical settings.
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Affiliation(s)
- Carlos Calvache
- Corporación Universitaria Iberoamericana, Department Communication Sciences and Disorders, Bogotá, Colombia; Vocology Research, Vocology Center, Bogotá, Colombia.
| | - Nicolás Castillo-Triana
- Corporación Universitaria Iberoamericana, Department Communication Sciences and Disorders, Bogotá, Colombia
| | - Fernando Delprado Aguirre
- Vocology Research, Vocology Center, Bogotá, Colombia; Fundación Universitaria María Cano, Speech Therapy Program, Medellín, Colombia
| | - Paola Leguízamo
- Escuela Colombiana de Rehabilitación, Speech Therapy Program, Bogotá, Colombia
| | - Sandra Rojas
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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Wang L, Ren P, Cui PC, Liang LP, Zhao QQ, Zhao DQ. Swallowing rehabilitation of patients undergoing T-tube implantation for the treatment of laryngotracheal stenosis. Head Neck 2024. [PMID: 38943309 DOI: 10.1002/hed.27848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 07/01/2024] Open
Abstract
OBJECTIVE Patients with laryngotracheal stenosis (LTS) often have dysphagia after laryngotracheal reconstruction with T-tube insertion, which affects the quality of life. The purpose of this study is to observe the effect of swallowing rehabilitation therapy on the improvement of quality of life in patients of otolaryngology-head and neck surgery with dysphagia undergoing T-tube implantation treatment through longitudinal study. METHODS Thirty-eight patients with LTS who experienced dysphagia after laryngotracheal reconstruction and T-tube implantation were recruited. All patients received swallowing rehabilitation therapy. The assessment of swallowing function was performed using the 10-item Eating Assessment Tool (EAT-10), the 30 mL water swallow test (WST), and flexible endoscopic evaluation of swallow (FEES). RESULTS After swallowing rehabilitation therapy, timing of swallowing, grade of dysphagia, performance on FEES and 30 mL WST, and EAT-10 score all improved. Thirty-eight patients successfully transitioned to oral feeding and were able to remove their nasogastric tubes without experiencing any complications, including aspiration pneumonia. CONCLUSION For patients with LTS who experienced dysphagia after laryngotracheal reconstruction and T-tube implantation, swallowing rehabilitation therapy could improve swallowing function of the patients, so as to reduce the potential harm caused by the pain and complications of surgery experienced by patients.
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Affiliation(s)
- Lu Wang
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Pan Ren
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Peng-Cheng Cui
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Le-Ping Liang
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Qian-Qian Zhao
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
| | - Da-Qing Zhao
- Department of Otolaryngology - Head and Neck Surgery, The Second Affiliated Hospital of the Air Force Medical University, Xi'an, China
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Dallal-York J, Troche MS. Hypotussic cough in persons with dysphagia: biobehavioral interventions and pathways to clinical implementation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1394110. [PMID: 38933659 PMCID: PMC11199739 DOI: 10.3389/fresc.2024.1394110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
Cough is a powerful, protective expulsive behavior that assists in maintaining respiratory health by clearing foreign material, pathogens, and mucus from the airways. Therefore, cough is critical to survival in both health and disease. Importantly, cough protects the airways and lungs from both antegrade (e.g., food, liquid, saliva) and retrograde (e.g., bile, gastric acid) aspirate contents. Aspiration is often the result of impaired swallowing (dysphagia), which allows oral and/or gastric contents to enter the lung, especially in individuals who also have cough dysfunction (dystussia). Cough hyposensitivity, downregulation, or desensitization- collectively referred to as hypotussia- is common in individuals with dysphagia, and increases the likelihood that aspirated material will reach the lung. The consequence of hypotussia with reduced airway clearance can include respiratory tract infection, chronic inflammation, and long-term damage to the lung parenchyma. Despite the clear implications for health, the problem of managing hypotussia in individuals with dysphagia is frequently overlooked. Here, we provide an overview of the current interventions and treatment approaches for hypotussic cough. We synthesize the available literature to summarize research findings that advance our understanding of these interventions, as well as current gaps in knowledge. Further, we highlight pragmatic resources to increase awareness of hypotussic cough interventions and provide support for the clinical implementation of evidence-based treatments. In culmination, we discuss potential innovations and future directions for hypotussic cough research.
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Affiliation(s)
- Justine Dallal-York
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
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Choy J, Pourkazemi F, Bogaardt H, Anderson C, Chai SY, Pebdani RN. "One of the biggest grey areas": A focus group study exploring dosage of swallowing exercises from speech-language pathologist perspectives. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:445-456. [PMID: 37652163 DOI: 10.1080/17549507.2023.2240038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Purpose: To explore the perspectives and practices of speech-language pathologists on dosage of swallowing exercises in stroke rehabilitation.Method: Online focus groups involved 20 speech-language pathologists working in various settings across Australia. Focus group data were recorded, deidentified, and analysed using inductive thematic analysis guided by an interpretivist phenomenological approach.Result: Analysis resulted in four main themes: (1) "Getting the most bang for your buck": Importance of dosage in swallowing, (2) "No patient is identical": Personalising swallowing exercise dosage to the patient, (3) "You've got what you should do, and then what you can do": Gap between recommendations and practical application, and (4) "Not much guidance out there about dosage": More research needed to guide dosage. Speech-language pathologists agreed that dosage was theoretically important for swallowing exercises, but practical application of dosage was impacted by patient factors, limited access to resources, and lack of research-based guidelines.Conclusion: Speech-language pathologists reported trying to provide optimal care despite multiple barriers to prescribing dosages of swallowing exercises in practice. Personalising exercise dosage to the patient, creative clinician strategies, improved and equitable access to resources, and research-based guidelines on swallowing exercise dosages are needed to address these barriers.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- HammondCare Braeside Hospital, Prairiewood, NSW, Australia
- Royal Rehab, Ryde, NSW, Australia
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Hans Bogaardt
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, Prairiewood, NSW, Australia
- Nepean Hospital, Kingswood, NSW, Australia
| | - Shing Yee Chai
- HammondCare Braeside Hospital, Prairiewood, NSW, Australia
| | - Roxanna N Pebdani
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
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Borges AFM, Taveira KVM, Eduardo JYM, Cavalcanti RVA. Orofacial and cervical myofunctional intervention programmes for older adults: A scoping review. Gerodontology 2024; 41:183-199. [PMID: 37847803 DOI: 10.1111/ger.12719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Senescent stomatognathic systems undergo anatomical changes that are not always compensated by physiology due to associated factors such as poorly fitted dentures, dental changes, and clinical conditions that trigger sarcopenia. When these conditions are not properly addressed, they can lead to nutritional deficiencies. Hence, this study aimed to map orofacial and cervical myofunctional intervention programmes for older adults, evaluate the current research in this area, and formulate suggestions for further investigation. METHODS Scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and grey literature databases were systematically searched. Studies addressing therapeutic programmes, myofunctional exercises, and their influence on the stomatognathic system of older adults were included. Studies with populations younger than 60 years, residing in long-term care facilities, homes, or hospital care, and with associated comorbidities were excluded, as well as secondary studies. RESULTS A total of 3098 studies were retrieved. After applying the eligibility criteria, nine studies were eligible for this review. The nine studies were published in English between 2008 and 2021 in the United States, Japan, and South Korea. The participants' mean ages ranged from 64 to 81 years, with a preponderance of females. Six of the studies divided the sample into intervention and control groups. Two studies referred to programmes to promote oral function through facial expression and tongue muscle exercises, salivary gland massage, and swallowing biomechanics. Seven studies report the positive influence of myofunctional exercises on the stomatognathic system. CONCLUSION The mapping concluded that therapeutic programmes, including educational actions, help prevent orofacial myofunctional disorders, and improve the functionality of the stomatognathic system.
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Affiliation(s)
- Allya Francisca Marques Borges
- Associated Postgraduate Program in Speech, Language and Hearing Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Research Group Studies in Orofacial Motricity and Oropharyngeal Dysphagia at Federal University of Rio Grande do Norte, Natal, Brazil
| | - Karinna Veríssimo Meira Taveira
- Department of Morphology, Center of Biosciences, Associated Postgraduate Program in Speech, Language and Hearing Sciences, Permanent Researcher of the Research Group Studies in Orofacial Motricity and Oropharyngeal Dysphagia, Federal University of Rio Grande do Norte, Natal, Brazil
- Center for Advanced Studies in Systematic Review and Meta-Analysis (NARSM), Multicenter Study Group, Brazil
| | | | - Renata Veiga Andersen Cavalcanti
- Department of Speech, Language and Hearing Sciences, Permanent Researcher of the Research Group Studies in Orofacial Motricity and Oropharyngeal Dysphagia, Federal University of Rio Grande do Norte, Natal, Brazil
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Oh JC. Effect of Visual Biofeedback Obtained Using the Iowa Oral Performance Instrument on the Suprahyoid Muscle Activation Level During Effortful Swallowing Maneuver. Dysphagia 2024; 39:433-443. [PMID: 37936019 DOI: 10.1007/s00455-023-10627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
Effortful swallowing (ES) is a maneuver prescribed for patients who experience pharyngeal residues after swallowing owing to weakness of the tongue and pharyngeal constrictor muscles. ES can increase the pharyngeal contraction force by intentionally increasing the degree of effort during swallowing. However, the effect is limited as the nature of swallowing makes it difficult to maintain a constant high-effort level. The aim of this study was to assess the effect of visual feedback, delivered by the Iowa Oral Performance Instrument (IOPI), a tongue pressure measurement device on ES maneuver effort. Overall, 34 healthy adults performed five sets of ten ES, once every 10 s. The ES maneuver was conducted under two conditions, ES with and without IOPI biofeedback in a crossover design. IOPI biofeedback was provided at 80% of the maximum posterior oral tongue pressure. The suprahyoid muscle activation level was assessed using surface electromyography during the ES maneuver. The mean suprahyoid muscle activation levels in all sets for which IOPI biofeedback was provided were significantly higher than those during ES maneuver without biofeedback (p < 0.05). IOPI biofeedback can help maintain the ES maneuver target effort, utilizing a constantly high swallowing pressure potentially promoting better pharyngeal pressures and muscle strength.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, 298 Daesung-ro, Cheongwon-gu, Cheongju, Chungcheongbuk-do, 28503, Republic of Korea.
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13
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Wu Y, Guo K, Chu Y, Wang Z, Yang H, Zhang J. Advancements and Challenges in Non-Invasive Sensor Technologies for Swallowing Assessment: A Review. Bioengineering (Basel) 2024; 11:430. [PMID: 38790297 PMCID: PMC11118896 DOI: 10.3390/bioengineering11050430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Dysphagia is a pervasive health issue that impacts diverse demographic groups worldwide, particularly the elderly, stroke survivors, and those suffering from neurological disorders. This condition poses substantial health risks, including malnutrition, respiratory complications, and increased mortality. Additionally, it exacerbates economic burdens by extending hospital stays and escalating healthcare costs. Given that this disorder is frequently underestimated in vulnerable populations, there is an urgent need for enhanced diagnostic and therapeutic strategies. Traditional diagnostic tools such as the videofluoroscopic swallowing study (VFSS) and flexible endoscopic evaluation of swallowing (FEES) require interpretation by clinical experts and may lead to complications. In contrast, non-invasive sensors offer a more comfortable and convenient approach for assessing swallowing function. This review systematically examines recent advancements in non-invasive swallowing function detection devices, focusing on the validation of the device designs and their implementation in clinical practice. Moreover, this review discusses the swallowing process and the associated biomechanics, providing a theoretical foundation for the technologies discussed. It is hoped that this comprehensive overview will facilitate a paradigm shift in swallowing assessments, steering the development of technologies towards more accessible and accurate diagnostic tools, thereby improving patient care and treatment outcomes.
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Affiliation(s)
- Yuwen Wu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Kai Guo
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Yuyi Chu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
| | - Zhisen Wang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Hongbo Yang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
| | - Juzhong Zhang
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou 215163, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China
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14
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Paim ÉD, Sugueno LA, Martins VB, Zanella VG, Macagnan FE. Electrical Stimulation for Treatment of Dysphagia Post Head Neck Cancer: A Systematic Review and Meta-Analysis. Int Arch Otorhinolaryngol 2024; 28:e339-e349. [PMID: 38618607 PMCID: PMC11008950 DOI: 10.1055/s-0043-1761175] [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: 06/15/2022] [Accepted: 11/13/2022] [Indexed: 04/16/2024] Open
Abstract
Introduction Dysphagia induced by radiotherapy in the head and neck region comprises a challenging scenario and sometimes difficult rehabilitation due to the severity of the adverse effects. Some resources such as electrical stimulation have emerged as an alternative to complement the therapeutic process, but there is still no consensus on its use. Objective The purpose of the present study was to evaluate, through a meta-analysis, the effect of electrical stimulation on the rehabilitation of dysphagia generated after head and neck cancer treatment. Data Synthesis Four randomized controlled trials with a total of 146 participants were included. The age of the participants was 58.37 ± 1.8 years old and there was a predominance of males. The time to start the intervention ranged from 50.96 ± 40.12 months after cancer treatment. The intervention showed great heterogeneity regarding the positioning of the electrodes, parameters, duration of the stimulus, number of sessions, and intensity. No difference was identified in the following aspects: oral transit time, hyoid elevation, penetration and/or aspiration after electrostimulation. The quality of the evidence ranged from very low to moderate and high risk of bias. Conclusion In this meta-analysis, we found weak evidence for small and moderate swallowing benefits in patients after radiotherapy for head and neck cancer in short-term clinical trials.
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Affiliation(s)
- Émille Dalbem Paim
- Speech Therapy Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Lica Arakawa Sugueno
- Graduate Program in Human Communication, Faculdade de Ciências Médicas da Santa Casa de São Paulo, SP, Brazil
| | - Vera Beatris Martins
- Speech Therapy Department, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Virgilio Gonzales Zanella
- Head and Neck Surgery Department, Hospital Santa Rita, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Fabricio Edler Macagnan
- Graduate Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
- Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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15
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Baudelet M, Van den Steen L, Duprez F, Goeleven A, Nuyts S, Nevens D, Vandenbruaene C, Massonet H, Vergauwen A, Vauterin T, Verstraete H, Wouters K, Vanderveken O, De Bodt M, Van Nuffelen G. Prophylactic Swallowing Therapy During Head-and-Neck Cancer Radiotherapy: Effect of Service-Delivery Mode and Overall Adherence Level on Swallowing Function and Muscle Strength-the PRESTO Trial. Dysphagia 2024; 39:267-281. [PMID: 37550571 PMCID: PMC10957706 DOI: 10.1007/s00455-023-10609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM's (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75- group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM's and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75-. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE.Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018-retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.
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Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, University Hospital Ghent, 9000, Ghent, Belgium.
- Department of ENT, University Hospital Ghent, 9000 Ghent, Belgium.
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, University Hospital Ghent, 9000, Ghent, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
| | - Ann Goeleven
- Department of Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Louvain, Belgium
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, KU Leuven, Louvain, Belgium
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
- Iridium Network, Antwerp, Belgium
| | | | - Hanne Massonet
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Louvain, Belgium
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, KU Leuven, Louvain, Belgium
| | - Alice Vergauwen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | | | - Hilde Verstraete
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
- Iridium Network, Antwerp, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
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16
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Yaşaroğlu ÖF, Serel Arslan S, Cengiz E, Alıcı R, Demir N, Oğuz B, Düger T. Swallowing kinematics and submental muscles activation during a newly designed maneuver called Mouth Open Swallowing Maneuver: A comparative study. PLoS One 2024; 19:e0299845. [PMID: 38527058 PMCID: PMC10962842 DOI: 10.1371/journal.pone.0299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024] Open
Abstract
The aim of this study was to design a new maneuver called the Mouth Open Swallowing Maneuver (MOSM), and to compare swallowing kinematics and submental muscles activation (SMA) between MOSM and two current approaches used in dysphagia rehabilitation. Fifty healthy volunteers were asked to perform three repetitions of dry swallowing (DS) (control task), the MOSM, the Mendelsohn Maneuver (MM), and the Tongue-Hold Maneuver (THM) during videofluoroscopic swallowing study accompanied with simultaneous SMA recording. Swallowing kinematics were measured by frame-by-frame analysis on hyolaryngeal movement using ImageJ. Swallowing with maximum hyolaryngeal movement and SMA during these tasks was used for comparative analysis. Vertical movement of the hyoid during the MOSM was significantly greater than those observed during the DS and the THM (p<0.001, p<0.001). Horizontal movement of the hyoid during DS and the THM was significantly greater than that observed during the MM (p = 0.001, p = 0.001). Vertical movement of the larynx during the MOSM was significantly greater than those observed during DS, MM, and THM (p<0.001). There was no significant difference between tasks in horizontal movement of the larynx (p = 0.785). SMA during the THM was significantly greater than that observed during MOSM (p = 0.002). No significant difference was found between other tasks in terms of SMA (p>0.05). The MOSM as a newly designed maneuver was significantly superior to other maneuvers in increasing vertical hyolaryngeal movement. The THM has as much effect on hyolaryngeal movement as the MM. In this study, the MOSM was shown to be effective in increasing hyolaryngeal movement. ClinicalTrials.gov Protocol Registration and Results System (PRS); the clinical trial registration number (NCT05579041).
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Affiliation(s)
- Ömer Faruk Yaşaroğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Emre Cengiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Rabia Alıcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Berna Oğuz
- Department of Radiology, Hacettepe University Hospitals, Ankara, Türkiye
| | - Tülin Düger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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17
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Oh JC. Changes in the Activation Level of the Floor of the Mouth Muscles during Pressing and Swallowing Tasks According to the Degree of Tongue Pressure. Dysphagia 2024:10.1007/s00455-024-10691-5. [PMID: 38466426 DOI: 10.1007/s00455-024-10691-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024]
Abstract
The suprahyoid muscles play an important role in protecting the airway by elevating both the hyoid bone and larynx superior-anteriorly during swallowing. However, providing systematic external resistance when performing exercises to improve suprahyoid muscle strength is practically difficult. This study attempted to confirm whether systematic resistance can be provided to the suprahyoid muscles using the Iowa Oral Performance Instrument (IOPI)-a representative tongue pressure measurement device. Thirty-one healthy adults participated in this study (20.6 ± 0.96 y, 19 females). The participants performed 16 exercise tasks using the IOPI three times each in random order (Anterior/posterior tongue × pressing/swallowing task × 40/60/80/100% maximum tongue pressure). Furthermore, the floor of the mouth (FOM) muscle activity during exercise was simultaneously measured using surface electromyography. During the pressing task, there were significant differences in FOM maximal muscle activity among the four exercise intensities for both the anterior and posterior oral tongue. For the swallowing task, a significant difference was found in FOM muscle activity among the four exercise intensities for the anterior tongue. For the posterior tongue, significant differences were identified among all conditions except for the comparison between 80% and 100% maximum tongue pressure. Significant correlations between the degree of tongue pressure and maximal FOM muscle activity were found in both the pressing and swallowing tasks at the anterior and posterior oral tongue. Overall, these results indicate that objective and systematic external resistance can be applied using the IOPI-a standard tongue pressure measurement device-during the program to improve suprahyoid muscle function.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, 298 Daesung-ro, Cheongwon-gu, Cheongju, Chungcheongbuk-do, 28503, Republic of Korea.
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18
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Shinn EH, Garden AS, Peterson SK, Leupi DJ, Chen M, Blau R, Becerra L, Rafeedi T, Ramirez J, Rodriquez D, VanFossen F, Zehner S, Mercier PP, Wang J, Hutcheson K, Hanna E, Lipomi DJ. Iterative Patient Testing of a Stimuli-Responsive Swallowing Activity Sensor to Promote Extended User Engagement During the First Year After Radiation: Multiphase Remote and In-Person Observational Cohort Study. JMIR Cancer 2024; 10:e47359. [PMID: 38416544 PMCID: PMC10938225 DOI: 10.2196/47359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Frequent sensor-assisted monitoring of changes in swallowing function may help improve detection of radiation-associated dysphagia before it becomes permanent. While our group has prototyped an epidermal strain/surface electromyography sensor that can detect minute changes in swallowing muscle movement, it is unknown whether patients with head and neck cancer would be willing to wear such a device at home after radiation for several months. OBJECTIVE We iteratively assessed patients' design preferences and perceived barriers to long-term use of the prototype sensor. METHODS In study 1 (questionnaire only), survivors of pharyngeal cancer who were 3-5 years post treatment and part of a larger prospective study were asked their design preferences for a hypothetical throat sensor and rated their willingness to use the sensor at home during the first year after radiation. In studies 2 and 3 (iterative user testing), patients with and survivors of head and neck cancer attending visits at MD Anderson's Head and Neck Cancer Center were recruited for two rounds of on-throat testing with prototype sensors while completing a series of swallowing tasks. Afterward, participants were asked about their willingness to use the sensor during the first year post radiation. In study 2, patients also rated the sensor's ease of use and comfort, whereas in study 3, preferences were elicited regarding haptic feedback. RESULTS The majority of respondents in study 1 (116/138, 84%) were willing to wear the sensor 9 months after radiation, and participant willingness rates were similar in studies 2 (10/14, 71.4%) and 3 (12/14, 85.7%). The most prevalent reasons for participants' unwillingness to wear the sensor were 9 months being excessive, unwanted increase in responsibility, and feeling self-conscious. Across all three studies, the sensor's ability to detect developing dysphagia increased willingness the most compared to its appearance and ability to increase adherence to preventive speech pathology exercises. Direct haptic signaling was also rated highly, especially to indicate correct sensor placement and swallowing exercise performance. CONCLUSIONS Patients and survivors were receptive to the idea of wearing a personalized risk sensor for an extended period during the first year after radiation, although this may have been limited to well-educated non-Hispanic participants. A significant minority of patients expressed concern with various aspects of the sensor's burden and its appearance. TRIAL REGISTRATION ClinicalTrials.gov NCT03010150; https://clinicaltrials.gov/study/NCT03010150.
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Affiliation(s)
- Eileen H Shinn
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Susan K Peterson
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Dylan J Leupi
- Department of Chemistry and Biochemistry, College of Science, University of Notre Dame, South Bend, IN, United States
| | - Minxing Chen
- Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Rachel Blau
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Laura Becerra
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, United States
| | - Tarek Rafeedi
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Julian Ramirez
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Daniel Rodriquez
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Finley VanFossen
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Sydney Zehner
- Department of Behavioral Science, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Patrick P Mercier
- Department of Electrical and Computer Engineering, University of California, San Diego, CA, United States
| | - Joseph Wang
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
| | - Kate Hutcheson
- Department of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Ehab Hanna
- Department of Head and Neck Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, United States
| | - Darren J Lipomi
- Department of Nano and Chemical Engineering, University of California, San Diego, CA, United States
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19
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Bascuñana-Ambrós H, Renom-Guiteras M, Nadal-Castells MJ, Beranuy-Rodríguez M, Perrot-González JC, Ramirez-Mirabal E, Trejo-Omeñaca A, Monguet-Fierro JM. Swallowing muscle training for oropharyngeal dysphagia: A non-inferiority study of online versus face-to-face therapy. J Telemed Telecare 2024; 30:116-120. [PMID: 34355589 DOI: 10.1177/1357633x211035033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study is to show the non-inferiority of the telemedicine therapy versus face-to-face using the exercise therapy of oropharyngeal muscles in 183 patients treated consecutively from 2010 to 2020. METHOD We conducted a retrospective study comparing two dysphagia treatment groups: online versus face-to-face. Patients were distributed in a non-random way but according to patient's preferences. All patients followed the same pathway and were evaluated at the beginning and at the end of the study using the dysphagia outcome and severity scale and the functional oral intake scale. A non-inferiority analysis approximation was done with delta = 1 in both variables. RESULTS Within a total of 183 patients, 114 (62.3%) used the online treatment and 69 (37.7%) the face-to-face one. The main cause of dysphagia was neurological in the total sample (60.7%) and within both groups. When we evaluate the clinical response, we find that both groups improved regardless of the type of therapy. The confidence interval of the difference between the beginning and the end of treatment did not reach the inferior limit of the delta defined, therefore supporting the no inferiority of online versus presential. DISCUSSION This study shows the no inferiority of the online therapy versus the face-to-face one for the oropharyngeal training of the swallow muscles.
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Affiliation(s)
| | - Marta Renom-Guiteras
- Physical Medicine and Rehabilitation Department, Sant Pau University Hospital, Spain
| | | | | | | | - Eliot Ramirez-Mirabal
- Physical Medicine and Rehabilitation Department, Sant Pau University Hospital, Spain
| | - Alex Trejo-Omeñaca
- Department of Engineering and Information Systems, Universitat Politècnica de Catalunya, Barcelona Tech, Spain
| | - Josep Maria Monguet-Fierro
- Department of Engineering and Information Systems, Universitat Politècnica de Catalunya, Barcelona Tech, Spain
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20
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Ueha R, Cotaoco C, Kondo K, Yamasoba T. Management and Treatment for Dysphagia in Neurodegenerative Disorders. J Clin Med 2023; 13:156. [PMID: 38202163 PMCID: PMC10779554 DOI: 10.3390/jcm13010156] [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: 11/21/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Patients with neurodegenerative disorders (NDDs) often experience functional dysphagia, which may involve dysfunction in a specific phase of swallowing or in the entire process. This review outlines the approach to dysphagia in the setting of NDDs. Distinguishing the etiology of dysphagia can be difficult, and it is important to always look out for signs pointing to NDD as the cause. Thorough diagnostic work-up is essential, and it includes a comprehensive history and physical examination, alongside swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, and high-resolution manometry. Management requires a multidisciplinary approach with a treatment plan tailored to each patient. This involves dietary guidance, swallowing rehabilitation, and surgery in cases in which improvement with rehabilitation is inadequate. Surgery may involve altering certain pharyngolaryngeal structures to facilitate swallowing and reduce the risk of aspiration (swallowing improvement surgery) or separating the airway and digestive tract while sacrificing laryngeal function, with the main goal of preventing aspiration (aspiration prevention surgery). Proper management stems from recognizing the impact of these disorders on swallowing and consistently finding ways to improve the quality of life of patients.
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Affiliation(s)
- Rumi Ueha
- Swallowing Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
| | - Carmel Cotaoco
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
- Ear Nose Throat Head and Neck Surgery Institute, The Medical City, Metro Manila 1600, Philippines
| | - Kenji Kondo
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan; (C.C.); (K.K.); (T.Y.)
- Tokyo Teishin Hospital, Tokyo 102-0071, Japan
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21
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Szynkiewicz SH, Drulia T, Griffin L, Mulheren R, Murray KL, Lee T, Kamarunas E. Flexibility for Intensity Dosing in Lingual Resistance Exercises: A Large Randomized Clinical Trial in Typically Aging Adults as Proof of Principle. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:3021-3035. [PMID: 37850842 DOI: 10.1044/2023_ajslp-23-00113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE The objective of this study was to determine the effect of intensity dosing during tongue exercise on tongue pressure generation, adherence, and perceived effort. DESIGN This was a five-site, prospective, randomized clinical trial. Outcome measures were obtained across multiple baselines, biweekly during exercise, and 4-weeks post-intervention. SETTING The general community at each study site. PARTICIPANTS Typically aging adults between 55-82 years of age with no history of neurological or swallowing disorders. Eighty-four volunteers completed the study. INTERVENTIONS Participants were randomly assigned to one of four exercise groups: (a) maximum intensity/no biofeedback, (b) progressive intensity/no biofeedback, (c) maximum intensity/biofeedback, and (d) progressive intensity/biofeedback. Half of the participants completed a maintenance exercise program. OUTCOME MEASURES Maximum isometric pressure (MIP), regular effort saliva swallow pressure, adherence, and the Borg Rating of Perceived Exertion Scale. RESULTS All exercise protocols were efficacious for gains in MIP (large effect sizes; Cohen's d). Group 3 made gains in regular effort saliva swallow pressure (medium effect size). There was a significant change in perceived exertion for regular effort saliva swallow pressure at 8 weeks. Tongue pressure gains were maintained at 1 month, regardless of maintenance group status. Mean adherence across groups was high. CONCLUSIONS All groups improved pressure generation. Intensity dosing differences did not affect strength gains, adherence, or detraining. Regular effort saliva swallow pressure may be most responsive to maximum intensity with biofeedback. The findings suggest flexibility in approach to tongue exercise protocols. Tongue muscles may differ from limb muscles in terms of dose response and neuroplasticity principles.
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Affiliation(s)
- Sarah H Szynkiewicz
- Department of Communication Sciences and Disorders, Samford University, Birmingham, AL
| | - Teresa Drulia
- Davies School of Communication Sciences and Disorders, Texas Christian University, Fort Worth
| | - Lindsay Griffin
- Department of Communication Sciences and Disorders, Emerson College, Boston, MA
| | - Rachel Mulheren
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Kelsey L Murray
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Theresa Lee
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Erin Kamarunas
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
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Ball L, Meteyard L, Powell RJ. Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists. Eur Arch Otorhinolaryngol 2023; 280:5101-5114. [PMID: 37543958 DOI: 10.1007/s00405-023-08153-z] [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: 06/04/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors. METHOD In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy. RESULTS Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity DISCUSSION: Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).
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Affiliation(s)
- Laura Ball
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
| | - Lotte Meteyard
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Roy J Powell
- NIHR Research Design Service-SW, Exeter, UK
- University of Exeter Medical School, Exeter, UK
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23
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Fonseca NDF, Motta AR, de Freitas FC, Nonato MR, Francelino EM, Furlan RMMM. The effects of lingual training: a systematic review with meta-analysis. Codas 2023; 35:e20210324. [PMID: 37610923 PMCID: PMC10449095 DOI: 10.1590/2317-1782/20232021324pt] [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: 12/21/2021] [Accepted: 09/14/2022] [Indexed: 08/25/2023] Open
Abstract
PURPOSE To assess the effectiveness of myotherapy exercises in increasing tongue pressure and strength. A secondary aim was to analyze the exercise types, training parameters, and functional results. RESEARCH STRATEGIES This systematic literature review was based on the Prisma protocol guidelines. SELECTION CRITERIA The review included clinical trials that assessed the effects of tongue muscle training, with no restriction on the language or year of publication. DATA ANALYSIS The steps included eliminating duplicates; reading abstracts and excluding studies that did not meet the inclusion criteria; reading selected articles in full text, extracting important data, and gathering them in a table; and meta-analysis, using the inverse variance method. The methodological quality of the studies was assessed with the Joanna Briggs Institute's tool. The quality of evidence was assessed with the Grading System of Recommendations Assessment, Development and Evaluation. RESULTS The meta-analysis indicated a significant increase in maximum anterior and posterior pressure as an effect of training. The most performed exercise was tongue pressure against the palate. However, training parameters varied between studies, and whether exercises alone led to functional improvement cannot be stated. The quality of the evidence was considered low. CONCLUSION Myotherapy exercises increased anterior and posterior tongue pressure in adults, but the quality of this evidence is low. The studies used various exercise types and training parameters. It cannot be stated whether exercises alone led to functional improvement.
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Silva JO, Giglio LD, Trawitzki LVV. Effects of tongue strengthening exercises in healthy adults and elderly: an integrative literature review. Codas 2023; 35:e20210213. [PMID: 37283365 DOI: 10.1590/2317-1782/20232021213pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 04/27/2022] [Indexed: 06/08/2023] Open
Abstract
PURPOSE To summarize and discuss the scientific literature on the effects of tongue strengthening exercises on healthy adults and elderly people. RESEARCH STRATEGIES We searched two online databases, PubMed and Web of Science. SELECTION CRITERIA Studies with evidence of interventions in tongues strengthening exercises in healthy individuals over 18 years of age. DATA ANALYSIS Study objectives, design, participants, interventions, gain in the percentage of tongue strength. RESULTS Sixteen studies were included. There was an increase in tongue strength after strengthening training in healthy adults and elderly people. This strength was maintained after a short period of detraining. We could not compare the results between age groups due to the different methodological designs. We found that the approach of a less intense training protocol was more effective in gaining tongue strength in the elderly. CONCLUSION Tongue strength training proved effective in increasing tongue strength in healthy individuals of different age groups. The benefits reported for the elderly corresponded to the reversal of the progressive loss of strength and muscle mass caused by aging. These findings must be interpreted with caution considering the number of studies on the elderly and their methodological variability.
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Affiliation(s)
- Juliana Oliveira Silva
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil
| | - Lucia Dantas Giglio
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil
| | - Luciana Vitaliano Voi Trawitzki
- Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Faculdade de Medicina de Ribeirão Preto - FMRP, Universidade de São Paulo - USP - Ribeirão Preto (SP), Brasil
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25
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Tavakoli S, Poorjavad M, Taheri N, Ghasisin L, Etemadifar M, Memarian A. Neuromuscular Electrical Stimulation in Conjunction with Conventional Swallowing Therapy in the Treatment of Dysphagia Caused by Multiple Sclerosis: A Single-Case Experimental Design. Folia Phoniatr Logop 2023; 75:350-362. [PMID: 37231810 DOI: 10.1159/000531062] [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: 09/08/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Dysphagia as a consequence of multiple sclerosis (MS) puts individuals at higher risk of dehydration, malnutrition, and aspiration pneumonia. This study intended to investigate the effects of a combined program of neuromuscular electrical stimulation (NMES) and conventional swallowing therapy to improve swallow safety and efficiency, oral intake, and physical, emotional, and functional impacts of dysphagia in people with dysphagia and MS. METHODS In this single-case experimental study with ABA design, two participants with dysphagia caused by MS underwent 12 sessions therapy during 6 weeks following a baseline of 4 evaluation sessions. They were evaluated 4 more times in the follow-up phase after therapy sessions. Scores of Mann Assessment of Swallowing Ability (MASA), DYsphagia in MUltiple Sclerosis (DYMUS), and timed test of swallowing capacity were obtained at baseline, during treatment, and in the follow-up phases. The Dysphagia Outcome and Severity Scale (DOSS) based on videofluoroscopic swallow studies, Persian-Dysphagia Handicap Index (Persian-DHI), and Functional Oral Intake Scale (FOIS) were also completed before and after treatment. Visual analysis and percentage of nonoverlapping data were calculated. RESULTS MASA, DYMUS, FOIS, and DHI scores indicated significant improvement in both participants. Although the scores of the timed test of swallowing capacity in participant 1 (B.N.) and DOSS in participant 2 (M.A.) showed no changes, considerable improvements including reducing the amount of residue and the number of swallows required to clear bolus were seen in the posttreatment videofluoroscopic records of both participants. CONCLUSION NMES in conjunction with conventional dysphagia therapy based on motor learning principles could improve the swallowing function and decrease disabling effects of dysphagia on different aspects of life in participants with dysphagia caused by MS.
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Affiliation(s)
- Shadi Tavakoli
- Speech Therapy Department, Rehabilitation School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marziyeh Poorjavad
- Speech Therapy Department, Rehabilitation School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Navid Taheri
- Physical Therapy Department, Rehabilitation School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Ghasisin
- Communication Disorders Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Etemadifar
- Professor of Neurology, Medicine School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Asefeh Memarian
- School of Rehabilitation Science, Faculty of Health Science, University of Ottawa, Ottawa, Ontario, Canada
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26
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Cheng PC, Kao YC, Lo WC, Cheng PW, Wu CY, Hsieh CH, Shueng PW, Wang CT, Liao LJ. Speech and Swallowing Rehabilitation Potentially Decreases Body Weight Loss and Improves Survival in Head and Neck Cancer Survivors. Dysphagia 2023; 38:641-649. [PMID: 35819528 DOI: 10.1007/s00455-022-10493-7] [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: 02/12/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
This retrospective observational cohort study aims to assess the outcomes and associated factors in head and neck cancer (HNC) survivors with dysphagia, and to investigate the relationship between outcomes and speech and swallowing rehabilitation (SSR). We enrolled patients who were diagnosed with HNC between October 2016 and July 2018; we included 393 patients who developed dysphagia after definite treatment and were referred to speech-language pathologists (SLPs). We then classified patients into groups according to whether they received SSR. We used the clinical variables-including age, sex, site of malignancy, cancer stage, treatment modality, SSR, initial ECOG score, initial KPS, initial body weight (BW), and initial BMI-to evaluate the association between the percentage of BW change and overall survival (OS). There were 152 (39%) and 241 (61%) patients who received and did not receive SSR, respectively. In multivariate linear regression, SSR was significantly associated with percentage change in BW at 3 months post-treatment. Having SSR was positively associated with the percentage change in BW and decreased the BW loss [β coefficient (95% CIs) = 2.53 (0.92 to 4.14)] compared to having no SSR. In the multivariate Cox regression, SSR was an independent factor for OS. Compared to no SSR, the hazard ratio (95% CIs) for patients who received SSR was 0.48 (0.31 to 0.74). SSR helps to avoid BW loss and increases overall survival. HNC patients who develop dysphagia after treatment should be encouraged to participate in SSR.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Yih-Chia Kao
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
| | - Chia-Yun Wu
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Oncology and Hematology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Hsi Hsieh
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan.
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.
- Medical Engineering Office, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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28
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Ebersole BM, McMillan H, Hutcheson K. Evaluation and Management of Speech and Swallowing Issues in RFS. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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29
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of swallowing exercises in stroke rehabilitation: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:1017-1045. [PMID: 36471047 PMCID: PMC9899761 DOI: 10.1007/s00405-022-07735-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/29/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the dosages of swallowing exercises reported in intervention studies on post-stroke dysphagia through systematic review. METHODS Five electronic databases were searched from inception until February 2022 with reference tracing of included studies. Studies were included, where adults with post-stroke dysphagia received rehabilitative, behavioural swallowing exercises, pre/post outcomes were reported, and intervention dosage was described in detail, including frequency, intensity, time, and type of exercise. Two reviewers independently screened studies and rated quality using ASHA Levels of Evidence tool. Data was tabulated and narratively described. RESULTS 54 studies were included with a total 1501 participants. Studies included 28 randomised controlled trials, 8 non-randomised controlled trials, 12 pre/post studies, 3 retrospective case controls and 3 case studies. Results showed inconsistent reporting of intervention dosage, with intensity the least consistently reported dosage component. While swallowing intervention was most commonly provided five times per week for four weeks, there was a wide breadth of type, frequency, intensity and duration of swallowing exercises reported. Dosage under-reporting and variation was particularly observed in "standard care" co-interventions or control groups. Study strengths included following PRISMA guidelines, providing a comprehensive review of swallowing exercise methodology and dosages, and including non-English studies. The limitation was lack of meta-analysis due to the heterogeneity of included studies. CONCLUSIONS Dosages of swallowing exercises are inconsistently reported and vary significantly in post-stroke dysphagia studies. Results indicate the need for consistent and comprehensive dosage reporting in dysphagia studies, and for further research into evidence-based principles to optimise swallowing exercise dosages. SYSTEMATIC REVIEW REGISTRATION NUMBER 131294.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- HammondCare Braeside Hospital, Sydney, NSW, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Hans Bogaardt
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Allied Health Science and Practice, The University of Adelaide, Adelaide, SA, Australia
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30
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Christmann MK, Gonçalves DDS, Cielo CA. Finger Kazoo Intensive Short-term Vocal Therapy: Vocal and Aerodynamic Measurements in Female Teachers. J Voice 2022:S0892-1997(22)00352-6. [PMID: 36517329 DOI: 10.1016/j.jvoice.2022.11.003] [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: 08/16/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE to verify the effect after short-term intensive therapy with the Finger Kazoo technique on vocal and aerodynamic measures of dysphonic female teachers. METHOD blind randomized clinical trial. Fifteen female teachers without structural disorders of vocal folds and nine with vocal nodules participated in the study groups. Yet, nine female teachers without structural disorders and eight with vocal nodules in the control groups. The following variables were measured pre and post-therapy: minimum and maximum fundamental frequency: forced vital capacity; simple phonic coefficient; compound phonic coefficient; ratio between maximum phonation time of /a/ and expected maximum phonation time. RESULTS no statistical significance was observed in the intra and intergroup analyses in any of the measures. CONCLUSION in this group of female teachers, it was not possible to show a positive effect of short-term and intensive therapy with the Finger Kazoo technique on the vocal measures of minimum and maximum fundamental frequency, forced vital capacity, simple phonic coefficient, compound phonic coefficient, and the relationship between maximum phonation time of /a/ and expected maximum phonation time.
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Affiliation(s)
- Mara Keli Christmann
- Speech Therapy Departament, Voice Laboratory Voz, Federal University of Santa Maria, RS, Brazil; Universidade do Vale do Itajaí (UNIVALI), Itajaí, SC, Brazil; Associação Educacional Luterana Bom Jesus (IELUSC), Joinville, SC, Brazil
| | | | - Carla Aparecida Cielo
- Speech Therapy Departament, Voice Laboratory Voz, Federal University of Santa Maria, RS, Brazil
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Tan SW, Wu A, Cheng LJ, Wong SH, Lau Y, Lau ST. The Effectiveness of Transcranial Stimulation in Improving Swallowing Outcomes in Adults with Poststroke Dysphagia: A Systematic Review and Meta-analysis. Dysphagia 2022; 37:1796-1813. [PMID: 35430717 DOI: 10.1007/s00455-022-10424-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Transcranial stimulation has been proposed as an alternative rehabilitation therapy for adults with post-stroke dysphagia (PSD). This systematic review sought to determine the effectiveness of transcranial stimulation in patients with post-stroke dysphagia to improve swallowing function. From inception to January 3, 2021, an extensive search was conducted in PubMed, EMBASE, Cochrane, CINAHL, and Scopus, Web of Science. The randomized controlled trials (RCTs) included studies in adults aged 18 years and older who suffered from post-stroke dysphagia. Using Hedges' g as effect size, meta-analyses were conducted using random-effects models. To investigate potential sources of heterogeneity, subgroup analyses, and multivariable meta-regression analyses were conducted. Sixteen RCTs were included in this review, and 13 RCTs were used for meta-analysis. The meta-analysis showed that a large effect size in improving swallowing function after repetitive Transcranial Magnetic Stimulation (g = - 0.86, 95% CI - 1.57, - 0.16) and medium effect size in Transcranial Direct Current Stimulation (g = - 0.61, 95% CI - 1.04, - 0.17) at post-intervention, respectively. Subgroup and meta-regression analysis indicated that stimulation of the esophagus cortical area and middle-aged adults had a greater effect on swallowing function. The overall certainty of evidence assessed using the GRADE approach was low. Despite the positive results, transcranial stimulation requires additional research to reach definitive conclusions about the optimal stimulation protocol and to achieve the greatest benefit. Future trials should be more rigorous and include a larger sample size to demonstrate the efficacy of transcranial stimulation. Transcranial stimulation enables a more efficacious approach to dysphagia mitigation in PSD rehabilitation.
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Affiliation(s)
- Shu Wen Tan
- National Healthcare Group, Department of Nursing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Anping Wu
- National Healthcare Group, Department of Nursing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sai Ho Wong
- Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Clinical Research Centre, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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32
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Massonet H, Goeleven A, Van den Steen L, Vergauwen A, Baudelet M, Van Haesendonck G, Vanderveken O, Bollen H, van der Molen L, Duprez F, Tomassen P, Nuyts S, Van Nuffelen G. Home-based intensive treatment of chronic radiation-associated dysphagia in head and neck cancer survivors (HIT-CRAD trial). Trials 2022; 23:893. [PMID: 36273210 PMCID: PMC9587548 DOI: 10.1186/s13063-022-06832-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Chronic radiation-associated dysphagia (C-RAD) is considered to be one of the most severe functional impairments in head and neck cancer survivors treated with radiation (RT) or chemoradiation (CRT). Given the major impact of these late toxicities on patients’ health and quality of life, there is a strong need for evidence-based dysphagia management. Although studies report the benefit of strengthening exercises, transference of changes in muscle strength to changes in swallowing function often remains limited. Therefore, combining isolated strengthening exercises with functional training in patients with C-RAD may lead to greater functional gains. Methods This 3-arm multicenter randomized trial aims to compare the efficacy and possible detraining effects of mere strengthening exercises (group 1) with a combination of strengthening exercises and functional swallowing therapy (group 2) and non-invasive brain stimulation added to that combination (group 3) in 105 patients with C-RAD. Patients will be evaluated before and during therapy and 4 weeks after the last therapy session by means of swallowing-related and strength measures and quality of life questionnaires. Discussion Overall, this innovative RCT is expected to provide new insights into the rehabilitation of C-RAD to optimize post-treatment swallowing function. Trial registration International Standard Randomized Controlled Trials Number (ISRCTN) registry ID ISRCTN57028065. Registration was accepted on 15 July 2021.
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Affiliation(s)
- Hanne Massonet
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology - Delgutology, KU Leuven, Leuven, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. .,Department of Head and Neck Surgery, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium. .,Department of ENT, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium.
| | - Ann Goeleven
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology - Delgutology, KU Leuven, Leuven, Belgium.,Department of Head and Neck Surgery, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium.,Department of ENT, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Alice Vergauwen
- Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gilles Van Haesendonck
- Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Olivier Vanderveken
- Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Heleen Bollen
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Humanities, University of Amsterdam, Amsterdam, The Netherlands
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Sandra Nuyts
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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Baudelet M, Duprez F, Van den Steen L, Nuyts S, Nevens D, Goeleven A, Vandenbruaene C, Massonet H, Vergauwen A, Bollen H, Deschuymer S, Wouters K, Peeters M, Van Laer C, Mariën S, Van den Brekel M, van der Molen L, Vauterin T, van Dinther J, Verstraete H, Hutsebaut I, Meersschout S, Vanderveken O, De Bodt M, Van Nuffelen G. Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial. Dysphagia 2022; 38:886-895. [PMID: 36121560 PMCID: PMC9484351 DOI: 10.1007/s00455-022-10513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022]
Abstract
Background Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence. Methods A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. Results Adherence and evolution of adherence over time was significantly different between the three groups (p < .001). Adherence rates decreased in all three groups during the 4 training weeks (p < .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. Conclusions PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. Trial Registration Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.
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Affiliation(s)
- Margot Baudelet
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium. .,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Fréderic Duprez
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
| | - Sandra Nuyts
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | - Ann Goeleven
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Hanne Massonet
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Heleen Bollen
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,KU Leuven, Louvain, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Steven Mariën
- Antwerp University Hospital, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Joost van Dinther
- Department of ENT-HNS, European Institute for ORL-HNS, Sint-Augustinus Hospital, GZA, Antwerp, Belgium
| | - Hilde Verstraete
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | | | | | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
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Expanding Rehabilitation Options for Dysphagia: Skill-Based Swallowing Training. Dysphagia 2022; 38:756-767. [PMID: 36097215 PMCID: PMC10182941 DOI: 10.1007/s00455-022-10516-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
Abstract
Over the past four decades, our understanding of swallowing neural control has expanded dramatically. However, until recently, advances in rehabilitation approaches for dysphagia have not kept pace, with a persistent focussing on strengthening peripheral muscle. This approach is no doubt very appropriate for some if not many of our patients. But what if the dysphagia is not due to muscles weakness? The purpose of this clinical manuscript is to reflect on where we have been, where we are now and perhaps where we need to go in terms of our understanding of swallowing motor control and rehabilitation of motor control impairments. This compilation is presented to clinicians in the hope that suggesting approaches "outside the box" will inspire clinicians to focus their attention "inside the box" to ultimately improve rehabilitation and long-term outcomes for patients with dysphagia.
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Nanto T, Ono T, Hori K, Murakami K, Uchiyama Y, Maeda Y, Domen K. The Effects of Tongue Elevation using a Weighted Plastic Bottle on the Tongue Pressure and Activity of Suprahyoid Muscles. J Oral Rehabil 2022; 49:1041-1048. [PMID: 36029125 DOI: 10.1111/joor.13365] [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: 10/04/2021] [Revised: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND A rise in tongue pressure coincides with an increase in the suprahyoid muscles activity. OBJECTIVES The aim was to investigate the effects of holding a weighted plastic bottle on tongue pressure and the suprahyoid muscles activity. METHODS Eighteen participants (8 men and 10 women; mean age 42 ± 16 years) participated in this study. All participants had no history of speech, language, hearing, or swallowing disorders and no tooth loss, and they did not require dentures. Healthy participants held gauzes connected with a plastic bottle with increasing resistive loads of 0 g, 250 g, 500 g, and 750 g, between their palate and tongue. The maximum tongue pressure and average tongue pressure were measured during a 5-second hold. The average tongue pressure was defined as the mean tongue-pressure data in each task. The suprahyoid muscles activity was measured using the electromyogram (EMG). The root mean square of the EMG signals measured while lifting different loads and while performing the head lifting exercises were compared. All variables were examined using the Friedman's test and Wilcoxon signed-rank test. RESULTS The maximum tongue pressure (p < .05) and average tongue pressure values (p < .05) increased gradually in the anterior-median region with increasing resistive loads, and the root mean square amplitudes for 250 g, 500 g, and 750 g were not significant compared to head lifting exercises. CONCLUSION These results indicated that Plastic bottle holding could be a potential strength-training tool for the tongue and the suprahyoid muscles.
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Affiliation(s)
- Tomoki Nanto
- Department of Rehabilitation, Hyogo College of Medicine Hospital, Nishinomiya, Japan.,Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Niigata University Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics, Niigata University Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuhiro Murakami
- Division of Comprehensive Prosthodontics, Niigata University Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshinobu Maeda
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Lindh MG, Selander E, Kukka AJ. Swallowing difficulties in adolescents: A case report and suggestion of treatment model. Clin Case Rep 2022; 10:e6097. [PMID: 35979385 PMCID: PMC9366933 DOI: 10.1002/ccr3.6097] [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: 10/02/2021] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022] Open
Abstract
Dysphagia or difficulty swallowing in childhood necessitates multi-disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work-up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.
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Affiliation(s)
- Margareta Gonzalez Lindh
- Department of NeuroscienceUppsala UniversityUppsalaSweden
- Centre for Research & DevelopmentGävleSweden
| | | | - Antti Juhani Kukka
- Department of PediatricsRegion GävleborgSweden
- Uppsala Global Health Research on Implementation and Sustainability, Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
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Li WY, Jin H, Zou Y, Huang H, Wei Z, Kang J, Xue Y, Wang W. The Different Effect of Tongue Motor Task Training (TTT) and Strength Training (ST) on the Modulation of Genioglossus Corticomotor Excitability and upper airway stability in Rats. Sleep 2022; 45:6648555. [PMID: 35867628 DOI: 10.1093/sleep/zsac170] [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: 05/15/2022] [Revised: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES the mechanical efficiency of upper airway (UA) muscles are pivotal in maintaining UA stability. We aimed to investigate if different tongue training approaches could differently induce signs of neuroplastic in the corticomotor pathways and upper airway stability changes. METHODS 36 Sprague-Dawley rats were trained daily for eight weeks to lick an isotonic force-sensing disc at targeting forces using 30-50% of maximal achieved lick force (MALF) for tongue task training (TTT) or targeting force set above 50%, 60% and 70% of MALF progressively for tongue strength training (TST). Corticomotor excitability was dynamically assessed by GG response to transcortical magnetic stimulation (TMS) at different sessions. GG EMG activity, GG ultrastructure and myosin heavy chain (MHC), UA dynamics were assessed after eight weeks. RESULTS After 4 weeks, GG TMS latencies decreased in both tongue training groups when compared with the control group (p<0.05) and this excitability was more stable in TTT group. After 8 weeks, both GG TMS response and EMG activity revealed increased excitability in TTT and TST groups. The apoptotic pathological morphology changes of GG ultrastructure were observed in TST group, but not TTT. Percentage of GG MHC type I fibers in TST group was higher than the control and TTT groups (p<0.05). The UA Pcrit decreased significantly in TTT group (p<0.05) and tend to decrease in TST group (p=0.09). CONCLUSION TTT could improve the UA stability and induce the neuroplastic changes more efficiently without training-induced muscle injury, while TST revealed a fatigue-resistance change in GG.
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Affiliation(s)
- Wen-Yang Li
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Hongyu Jin
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Ying Zou
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Hong Huang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Zhijing Wei
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Jian Kang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
| | - Yixue Xue
- Neurobiology department, College of Life Science, China Medical University, Shenyang, China
| | - Wei Wang
- Respiratory and critical care department, the First Hospital of China Medical University, Shenyang, China
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38
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Effects of Tongue-Strengthening Exercise on Tongue Strength Reserve and Detraining Effects among Healthy Adults: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116878. [PMID: 35682461 PMCID: PMC9180874 DOI: 10.3390/ijerph19116878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/10/2022]
Abstract
Introduction: Tongue strength reserve is the difference between the maximum isometric pressure (MIP) and swallowing pressure of the tongue. People with decreased tongue strength reserve may have a higher risk of presbyphagia or dysphagia. Thus, this study explored the effects of tongue strengthening exercise (TSE) on tongue strength reserve and detraining effects in healthy adults. Materials and Methods: In total, 102 healthy volunteers without any reported history of speech or swallowing deficits were recruited and assigned to experimental (n = 50) and control groups (n = 52). Exercises in the experimental group consisted of compressing an air-filled bulb between the tongue and hard palate for 30 min a day, 5 days a week, for 8 weeks. Thereafter, the experimental group underwent a 4-week detraining period. Results: Following the TSE training, posterior tongue strength reserve (F = 4.92, p = 0.029) of the experimental group was significantly higher than that of the control group. No significant detraining effects were observed on the MIP and swallowing pressure from 4 weeks after the completion of TSE training. Conclusions: According to the study results, TSE may be an effective approach for improving swallowing function.
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Fukuoka T, Ono T, Hori K, Kariyasu M. Effects of Tongue-Strengthening Exercise on Tongue Strength and Effortful Swallowing Pressure in Young Healthy Adults: A Pilot Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1686-1696. [PMID: 35363546 DOI: 10.1044/2022_jslhr-21-00331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the effects of tongue-strengthening exercise (TSE) on tongue strength and effortful swallowing pressure in young healthy adults. METHOD Thirteen young healthy volunteers (six men, seven women; M age = 20.5 ± 0.5 years) performed 8 weeks of isometric TSE 3 days per week. A tongue pressure measurement device was used to measure maximum isometric tongue pressure (MITP) and conduct the TSE, and a tactile sensor system attached to the hard palate was used to measure effortful swallowing pressure. MITP and effortful swallowing pressure were measured at baseline, after 4 and 8 weeks of training, and at 4 and 8 weeks after the last training session to examine the detraining effects. RESULTS The results indicated that both MITP and effortful swallowing pressure increased significantly from baseline to 8 weeks after training. Although the improved MITP significantly decreased at 4 and 8 weeks after training cessation, no detraining effect was observed for effortful swallowing pressure. CONCLUSIONS TSE is an effective method for increasing tongue pressure in wide tongue-palate contact areas during effortful swallow. The effortful swallowing pressure gained with TSE appears to be maintained for at least eight nontraining weeks.
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Affiliation(s)
- Tatsuyuki Fukuoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Japan
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Kazuhiro Hori
- Division of Comprehensive Prosthodontics, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Japan
| | - Makoto Kariyasu
- Human Communication Science Laboratories, Nobeoka, Japan
- Institute of Junwa Rehabilitation Foundation, Miyazaki, Japan
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He K, Wu L, Huang Y, Chen Q, Qiu B, Liang K, Ma R. Efficacy and Safety of Transcranial Direct Current Stimulation on Post-Stroke Dysphagia: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:2297. [PMID: 35566421 PMCID: PMC9102865 DOI: 10.3390/jcm11092297] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/14/2022] [Accepted: 04/14/2022] [Indexed: 12/12/2022] Open
Abstract
Dysphagia is one of the most common symptoms in patients after stroke onset, which has multiple unfavorable effects on quality of life and functional recovery. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation that is widely used to improve deglutition function. Recently, some studies have confirmed that tDCS enhances deglutition function after stroke. However, the number of evaluation indexes used in those studies was small, and the number of trials included was limited. Most importantly, the optimal stimulation protocol is still uncertain and the safety of tDCS has not been reviewed. Therefore, we conducted a systematic review and meta-analysis to address these shortcomings. METHODS Seven databases were searched entirely, including Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wan-fang database, and the Chinese Scientific Journals Database (VIP) from inception to 31 December 2021. Two reviewers independently evaluated the eligibility of retrieved data according to the selection criteria and assessed the methodological quality of the studies using the Cochrane risk of bias tool. Outcomes, measures, and indicators used in this study included the dysphagia outcome and severity scale (DOSS), modified Mann assessment of swallowing ability (MMASA), functional oral intake scale (FOIS), functional dysphagia scale (FDS), and Kubota's water-drinking test (KWDT). Sensitivity and subgroup analyses were performed to evaluate the intervention effect more specifically. RESULTS Fifteen trials with a total of 787 participants (394 subjects in the tDCS groups were treated with true tDCS, and 393 subjects in the control groups were wait-listed or treated with sham tDCS) involving tDCS for dysphagia after stroke and were included in the meta-analysis. Results of this meta-analysis confirmed that tDCS had a positive effect on post-stroke dysphagia. Subgroup analyses revealed that bilateral and high-intensity stimulation with tDCS had a more significant impact on post-stroke dysphagia. Furthermore, no adverse events occurred during the application of tDCS for post-stroke dysphagia. CONCLUSION tDCS can promote the recovery of deglutition function in patients with dysphagia after stroke. In addition, bilateral stimulation and high-intensity stimulation may have better effects. However, the safety evidence for tDCS and post-stroke dysphagia is insufficient.
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Affiliation(s)
- Kelin He
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Lei Wu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
| | - Yi Huang
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Qinqin Chen
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Bei Qiu
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
| | - Kang Liang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
| | - Ruijie Ma
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou 310005, China; (K.H.); (L.W.); (K.L.)
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou 310053, China; (Y.H.); (Q.C.); (B.Q.)
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Effect of CrossFit Training on Physical Fitness of Kickboxers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084526. [PMID: 35457394 PMCID: PMC9030818 DOI: 10.3390/ijerph19084526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 02/05/2023]
Abstract
Background: Kickboxing is a combat sport that is complex in technique, tactics, and movement structure, and requires an adequate level of motor skills as a foundation for activities during competitions. General physical fitness, defined as the effect of the externalization of motor skills, is the basis for athletic training regardless of the sport. The aim of this study was to determine the effect of modified training based on the principles of CrossFit on the development of general physical fitness in a group of kickboxers compared to a control group. Methods: The study was experimental in nature and was conducted in a group of 60 kickboxers, divided into experimental and control groups. Participants were selected by purposive sampling, and the criteria were training experience, sports skill level (minimum class 1 athletes), and consent to participate in the experiment. The intervention in the study group involved the introduction of CrossFit-based training into a conventional kickboxing training program. General and special physical fitness of the athletes were diagnosed. Results: Statistically significant differences were found in general fitness in terms of abdominal strength (p < 0.001), pull-ups (p < 0.001), dynamometric measurement of handgrip force (p < 0.001) (kg), clap push-ups (p < 0.001), standing long jump (p < 0.001), shuttle run (p < 0.001), sit-and-reach (p < 0.001), and tapping (p < 0.001). Furthermore, changes in special fitness were also demonstrated for the special kickboxing fitness test (SKFT) (p < 0.02), the total number of punches (p < 0.001), punching speed (p < 0.001), and hip turning speed (p < 0.001). There was also a correlation between characteristics of general fitness and special fitness (p < 0.001). Conclusions: The experimental training program based on the principles of CrossFit training had a positive effect on the general and special kickboxing physical fitness.
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Julier R, Benfield JK. A qualitative exploration of how oral trials are used in dysphagia management in one inpatient hospital. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:340-351. [PMID: 35092338 DOI: 10.1111/1460-6984.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The lack of high-quality evidence to support specific treatment approaches has been widely documented in the existing literature, with evidence suggesting speech and language therapists (SLTs) frequently rely on experience and expert opinion to inform treatment. One approach that is commonly used within dysphagia management, in spite of a lack of existing evidence to support its efficacy, is the use of oral trials, otherwise known as swallow trials or tasters. This approach involves offering specified, limited amounts of oral diet or fluids for those at risk of aspiration or choking if full amounts are taken orally and may be recommended for rehabilitation or quality of life. METHODS & PROCEDURES A total of nine SLTs working in one acute hospital volunteered to participate in focus groups in order to discuss their experience and clinical reasoning for using oral trials within one inpatient hospital setting in the UK. The objectives of this study were (1) to explore how oral trials are used within one inpatient hospital; (2) to consider the barriers and facilitators to the approach; and (3) to consider why this approach may be favoured over other evidenced dysphagia therapies. A grounded theory approach was used to guide data analysis, using two independent coders to identify themes within the focus groups. OUTCOMES & RESULTS Analysis of data revealed the following themes: (1) delivering oral trials requires 'a whole team approach'; (2) SLTs vary recommendations based on patient and environmental factors; and (3) oral trials as a holistic approach. CONCLUSIONS & IMPLICATIONS The use of oral trials was considered by SLTs to be a holistic and flexible approach which can be adapted to a range of patient and environmental factors. Although clinical experience guided rationale, an understanding of the principles of neuroplasticity and swallow physiology was also integral to the approach. Further research is warranted to investigate the use and efficacy of oral trials across the SLT community and within specific patient groups and different environments.
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Affiliation(s)
- Rebecca Julier
- Department of Speech and Language Therapy, Royal Derby Hospital, Derbyshire Community Health Services, Derby, UK
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Jacqueline K Benfield
- Department of Speech and Language Therapy, Royal Derby Hospital, Derbyshire Community Health Services, Derby, UK
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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Bengtsson L, Dotevall H, Sjögreen L, Ragnemalm L, Tuomi L. Effects of oral screen exercise on orofacial and pharyngeal activity: An exploratory study using videofluoroscopy and surface electromyography in healthy adults. Clin Exp Dent Res 2022; 8:519-528. [PMID: 35106972 PMCID: PMC9033549 DOI: 10.1002/cre2.538] [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: 06/28/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/12/2022] Open
Abstract
Objective The oral screen is a device commonly used for treatment of orofacial disorders. The objective of this exploratory study was to examine the effect of oral screen exercise on the muscle activity in the lips, submental complex, masseter muscle, and kinematic activity of the tongue base, soft palate, pharynx, and larynx in healthy adults. This was compared with the kinematic activity during a dry swallow. It was hypothesized that not only the lip musculature but also other structures in the oral and pharyngeal cavities are activated while using an oral screen device. Method Ten healthy subjects used an oral screen during examination with videofluoroscopy and surface electromyography (EMG). Three different instructions for oral screen application and a dry swallow were examined. Results The lip muscles showed the highest activity during oral screen exercise. The other muscle groups were activated to a lesser degree. The pattern of activation differed between individuals. Compared with a dry swallow, the range of motion of the tongue base, posterior pharyngeal wall, and the larynx was significantly smaller during oral screen activation. No major differences were found between three different instructions. Conclusion This study indicates that the lips and submental complex and, to a lesser degree, oral, pharyngeal, and laryngeal structures are activated with the oral screen, but the pattern of activation varied between individuals. In comparison to the activity during a dry swallow, range of motion during oral screen exercise is small.
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Affiliation(s)
- Lisa Bengtsson
- Region Västra Götaland, Public Dental Service, Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Dotevall
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lotta Sjögreen
- Region Västra Götaland, Public Dental Service, Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Gothenburg, Sweden
| | - Lena Ragnemalm
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Tuomi L, Dotevall H, Bergquist H, Petersson K, Andersson M, Finizia C. The effect of the Shaker head‐lift exercise on swallowing function following treatment for head and neck cancer: Results from a randomized, controlled trial with videofluoroscopic evaluation. Head Neck 2022; 44:862-875. [PMID: 35068016 PMCID: PMC9306707 DOI: 10.1002/hed.26982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/28/2021] [Accepted: 01/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Dysphagia is common following treatment for head and neck cancer (HNC) and intervention to improve swallowing function is warranted. This study aimed to evaluate the efficacy of the Shaker head‐lift exercise (HLE) to improve dysphagia in HNC patients. Methods Patients treated for HNC with radiochemotherapy and with subsequent dysphagia were randomly assigned to intervention (HLE, n = 25) and control (standard dysphagia management, n = 27) groups. Videofluoroscopic evaluation of penetration‐aspiration, initiation, residue, movement of selected structures, and self‐perceived swallowing function, before and after 8 weeks of treatment, were compared. Results Although adherence to training was high, no statistically significant differences in objectively measured swallowing function between the groups or within‐group changes were found. Self‐perceived swallowing function improved in the intervention group. Conclusions In this HNC population, neither HLE nor standard dysphagia management improved objectively measured swallowing function as evaluated after 8 weeks. Future research focusing on finding effective interventions for dysphagia is warranted.
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Affiliation(s)
- Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Hans Dotevall
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Henrik Bergquist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Kerstin Petersson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
| | - Mats Andersson
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Stockholm Sweden
- Department of Abdominal Radiology Karolinska University Hospital Stockholm Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery Region Västra Götaland, Sahlgrenska University Hospital Gothenburg Sweden
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Gillman A, Hayes M, Sheaf G, Walshe M, Reynolds JV, Regan J. Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review. BMC Cancer 2022; 22:53. [PMID: 35012495 PMCID: PMC8751332 DOI: 10.1186/s12885-021-09155-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. METHODS Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. RESULTS Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have 'serious' to 'critical' risk of bias. CONCLUSIONS This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.
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Affiliation(s)
- Anna Gillman
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - Michelle Hayes
- Speech and Language Therapy Department, St James' Hospital, James' Street, Dublin 8, D08 NHY1, Ireland
| | - Greg Sheaf
- The Library of Trinity College Dublin, Dublin 2, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland
| | - John V Reynolds
- Department of Surgery, St James' Hospital, James' Street, Dublin 8, D08 NHY1, Ireland
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, 7-9 South Leinster Street, Dublin 2, Ireland.
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Ueda R, Umetani K, Konishi F, Mori A, Nagai T, Asakura H, Funaki J, Abe K, Asakura T. Characterization of palatability and ease of deglutition of the five basic tastes by partial least squares regression analysis using myoelectric potential parameters of the submental muscle. FOOD SCIENCE AND TECHNOLOGY RESEARCH 2022. [DOI: 10.3136/fstr.fstr-d-21-00209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Reiko Ueda
- Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Kana Umetani
- Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | | | - Anju Mori
- Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Toshitada Nagai
- Department of Applied Biological Science, Takasaki University of Health and Welfare
| | - Hiroko Asakura
- Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Junko Funaki
- International College of Arts and Sciences, Fukuoka Women's University
| | - Keiko Abe
- Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Tomiko Asakura
- Graduate School of Agricultural and Life Sciences, The University of Tokyo
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Dick S, Thomas J, McMillan J, Davis K, Miles A. Swallowing rehabilitation following spinal injury: A case series. J Spinal Cord Med 2022; 45:65-75. [PMID: 32441589 PMCID: PMC8890526 DOI: 10.1080/10790268.2020.1762828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context/objective: Swallowing difficulties (dysphagia) are well recognized after spinal injury. There are no published rehabilitation efficacy studies to date. This study explored viability and outcomes of swallowing rehabilitation programs for four patients with persisting dysphagia.Design: Prospective, quantitative experimental longitudinal case series.Setting: Spinal rehabilitation unit or patients' homes.Interventions: Four patients engaged in a 6-week (3×weekly) individualized progressive rehabilitation program.Outcome measures: Objective videofluoroscopic measures of timing and displacement and a validated self-reported questionnaire - the Eating Assessment Tool (EAT-10) were taken pre-therapy, immediately post-therapy and EAT-10 was repeated at 3 months. Feeling and fatigue scale scores were taken before and after each therapy session.Results: Patients (63, 67 yr, 67 yr, 76 yr; 3 male) had varying spinal diagnoses (2 traumatic, all involving the C-spine) and length of dysphagia (6 weeks, 6 weeks, 12 weeks, 10 yr). Common physiological impairments across all patients were: reduced maximum hyoid displacement, reduced pharyngeal constriction and reduced pharyngoesophageal segment maximum opening. Therapy programs were well received with 100% compliance. Participants made quantitative improvements in their videofluoroscopic measures of timing and displacement. Three out of four participants were able to have their percutaneous endoscopic gastrostomies (PEG) removed. EAT-10 scores significantly improved for all patients (P < .001). Poor upper limb function and restricted neck flexion prohibited some exercises.Conclusions: For many patients following spinal injury, dysphagia resolves during the acute phase of post-surgery recovery. For some, significant pharyngeal impairments persist. This case series demonstrates potential to regain functional swallowing following a 6-week tailored rehabilitation program. High-quality research exploring efficacy of rehabilitation programs are warranted.
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Affiliation(s)
- Shaolyn Dick
- Speech Science, University of Auckland, Auckland, New Zealand
| | - Jess Thomas
- Speech Science, University of Auckland, Auckland, New Zealand
| | | | - Kelly Davis
- Counties Manukau Health, Auckland, New Zealand
| | - Anna Miles
- Speech Science, University of Auckland, Auckland, New Zealand,Correspondence to: Anna Miles, Speech Science, School of Psychology, The University of Auckland, Tamaki Campus, Private Bag 92019, Auckland, New Zealand; Ph: +64 9 923 8177.
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El Nagar R, AL-Nemr A, Abdelazeim F. Effect of oromotor exercises on feeding in children with cerebral palsy: systematic review. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Feeding problems are prevalent in children with cerebral palsy (CP). Oromotor exercises (OME) should be started as soon as possible to enhance chewing and drooling. Oromotor exercises consist of active exercises, passive exercises, and sensory stimulation. The purpose of this review is to evaluate the effectiveness of oromotor exercises on feeding, chewing, and drooling in children with CP.
Body
The American Academy for Cerebral Palsy and Developmental Medicine and Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology were used to conduct a systematic review. Four databases (PubMed, Cochrane Library, PEDro, and Google Scholar) were searched; this review includes seven articles, participants were 173 participants ranging in age from 18 months to 18 years. Articles were assessed according to their level of evidence and quality assessment was done by AACPDM, PEDro scale, and JBI scale. Due to the heterogeneity across included studies, descriptive analysis was performed on all of them. Primary outcomes were chewing and drooling. Results showed the effectiveness of OME in improving drooling, but with weak evidence while not effective in improving chewing.
Conclusion
High-quality studies are required to develop a firm judgment on the influence of oromotor exercises on feeding. The current level of evidence to support the effectiveness of oromotor exercises in children with CP is currently insufficient.
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Healthy Women and Men Do Not Show Differences in Tongue Strength and Regular Effort Saliva Swallows as Assessed by Piezo-Resistive Sensors: Results from a Reproducibility Study. Dysphagia 2021; 37:1217-1225. [PMID: 34779910 DOI: 10.1007/s00455-021-10381-6] [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: 04/01/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
The aim of this study was to establish the reproducibility of tongue strength measurements in healthy women and men during maximum anterior isometric pressure (MAIP) and regular effort saliva swallows (RESS). In this cross-sectional study, 30 healthy young adults were required to push with the tip of the tongue on a piezo-resistive sensor glued to the hard palate, immediately above the central incisor line. Tongue pressures exerted on the sensor during MAIP and spontaneous RESS were recorded. Participants underwent a retest procedure within the same session to verify the reproducibility of measurements, as determined by intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Complete data were obtained from 30 subjects (15 women, 15 men; mean age 31.4 ± 7.8 years; mean weight 61.3 ± 9.4 kg). Compared to women, men showed a trend for generating larger MAIP (p = 0.06; d = 0.71) and RESS (p = 0.07; d = 0.69). After normalizing to body weight, height, and body mass index (BMI), such trends disappeared. At retest, MAIP and RESS proved stable and highly reliable (all ICCs ≥ 0.93) in men and women but associated to moderate variability as for SEM and MDC, with MAIP estimates associated to smaller SEM and MDC (SEM ranging 7.4-14.2%; MDC 18.6-20.9%) than RESS (SEM ranging 20.4-38.5%; MDC 52.5-55.6%). Piezo-resistive pressure sensors allow clinicians and researchers to perform reproducible measurements of tongue muscle performance. However, if therapeutic interventions are administered, measurement variability in tongue performance should be considered when appraising their clinical efficacy, especially for those populations who display impaired performance and may not be capable to generate high and stable forces. No gender-based differences emerged in the motor tasks tested.
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Nordio S, Arcara G, Berta G, Dellai A, Brisotto C, Koch I, Cazzador D, Aspidistria M, Ventura L, Turolla A, D'Imperio D, Battel I. Biofeedback as an Adjunctive Treatment for Post-stroke Dysphagia: A Pilot-Randomized Controlled Trial. Dysphagia 2021; 37:1207-1216. [PMID: 34767083 DOI: 10.1007/s00455-021-10385-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Post-stroke dysphagia affects almost half of the survivors and severely influences quality of life, thus becoming swallowing rehabilitation of paramount importance. However, there is little adequate evidence on which the best rehabilitative strategy can be. Surface electromyography (sEMG) allows for recording swallowing muscles' activity and provides real time visual feedback, as a biofeedback adjunctive technique to improve treatment outcome. This study aimed to analyze the effectiveness of biofeedback rehabilitation of swallowing through sEMG compared to standard techniques, in post-stroke dysphagia. METHODS A pilot-randomized controlled trial included 17 patients diagnosed with post-stroke dysphagia. Nine underwent sEMG-biofeedback rehabilitation; seven controls were submitted to control treatment, one dropout. The primary outcome was the functional oral intake scale (FOIS), secondary outcomes was pharyngeal clearance and safe swallowing, assessed through fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS FOIS improved in all patients, regardless of treatment. sEMG-biofeedback rehabilitation led to improvements of the pharyngeal clearance and swallowing safety. The rehabilitative effects appeared stable at 2-months follow-up. CONCLUSIONS The application of biofeedback based on sEMG in post-stroke dysphagia patients resulted in an effective rehabilitative technique, in particular for pharyngeal clearance improvements and safe swallowing, thus reducing the risk of aspiration and malnutrition.
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Affiliation(s)
- Sara Nordio
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy.
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Giulia Berta
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Angela Dellai
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Camilla Brisotto
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Isabella Koch
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Diego Cazzador
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padua, Via Giustiniani 5, 35128, Padua, Italy.,Section of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Marta Aspidistria
- Department of Statistical Sciences, University of Padua, Via Cesare Battisti 241, 35121, Padua, Italy
| | - Laura Ventura
- Department of Statistical Sciences, University of Padua, Via Cesare Battisti 241, 35121, Padua, Italy
| | - Andrea Turolla
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Daniela D'Imperio
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Irene Battel
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 3 Serenissima, Ospedale Civile di Venezia, Castello, 6667, Venice, Italy.,Department of Clinical Speech & Language Studies, Trinity College, University of Dublin, College Green, Dublin 2, Ireland
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