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Moriyama T, Tokunaga M, Ochi M, Matushima Y, Hori R, Tashima H, Onishi A, Inoue S, Hachisuka A, Itoh H, Saeki S. Negative impact of computed tomography-based low skeletal muscle mass on swallowing recovery in patients with post-stroke dysphagia. Clin Neurol Neurosurg 2023; 229:107760. [PMID: 37156041 DOI: 10.1016/j.clineuro.2023.107760] [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: 03/23/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Dysphagia due to stroke has a high prevalence, and evaluating the swallowing function of dysphagia and promoting oral intake is essential in patients with stroke. The psoas muscle mass index(cm2/height2(m2)), calculated by the psoas muscle area at the L3 level via abdominal computed tomography (CT), can predict the development of dysphagia. However, knowledge about the impact of CT-based skeletal muscle mass on swallowing recovery, remains unknown. Therefore, we investigated whether CT-based low skeletal muscle mass impacted swallowing recovery. METHODS A retrospective cohort study was conducted on patients with post-stroke dysphagia who underwent acute treatments along with a videofluoroscopic swallowing study(VFSS). Swallowing recovery was identified as the improvement of the Functional Oral Intake Scale (FOIS) from the time of VFSS to discharge(observational period: ObPd). The psoas muscle mass index's cut-off values for low skeletal muscle mass were 3.74 cm2/m2 and 2.29 cm2/m2 for men and women respectively. RESULTS There were 53 subjects (36 male, median age 73.9). The median during the ObPd was 26 days, and the median days from onset to admission and admission to VFSS were 0 and 18, respectively. Sixteen patients had low skeletal muscle mass. The median improvement of FOIS during the ObPd was 2, and the median length of hospital stay was 51 days. In the stepwise multiple linear regression analysis for the improvement of FOIS during the ObPd, low skeletal muscle mass (β - 0.245; 95% confidence interval - 2.248 to - 0.127; p = 0.029) was a significant factor, even adjusted for serum albumin at admission, disturbance of consciousness at VFSS, FOIS at VFSS, and aspiration during VFSS. CONCLUSION CT-based low skeletal muscle mass negatively impacted swallowing recovery during the ObPd in patients with post-stroke dysphagia.
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Affiliation(s)
- Toshiyuki Moriyama
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan.
| | - Mizuki Tokunaga
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Mituhiro Ochi
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Yasuyuki Matushima
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Ryoko Hori
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Hiroyuki Tashima
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Atuto Onishi
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Sumire Inoue
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Akiko Hachisuka
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Hideaki Itoh
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
| | - Satoru Saeki
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, School of Medicine, Japan
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Wang Z, Shi Y, Zhang L, Wu L, Fang Q, Huiling L. Nomogram for predicting swallowing recovery in patients after dysphagic stroke. JPEN J Parenter Enteral Nutr 2021; 46:433-442. [PMID: 33834512 DOI: 10.1002/jpen.2115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND To date, variables predicting the recovery of dysphagia in patients after dysphagic stroke have not been well defined. However, despite the difficulties in predicting and understanding the dysphagia recovery trajectory, its significance for stroke care cannot be understated. This study aims to identify the factors for functional swallowing recovery and develop nomograms that predict dysphagia recovery after stroke. METHODS The demographic, neurological, and swallowing characteristics were compared between patients who recovered from dysphagia and those who did not. Then, the factors with P <.1 through comparison were enrolled in the multivariable logistic regression analysis to build a prediction model. A nomogram was also built to provide a quantitative tool. Discrimination, calibration, and clinical usefulness of the prediction model were assessed by using the C index, calibration plot, and decision curve analysis. RESULTS Predictors in the early-phase (T7) prediction nomogram included age, Functional Oral Intake Scale (FOIS), National Institutes of Health Stroke Scale (NHISS), hemispheric stroke, and brainstem stroke on admission. In the middle phase (T14), predictors included age, FOIS, and NHISS on admission. In the late phase (T30), predictors included age, FOIS, NHISS, bilateral stroke, and body mass index on admission. The C index for the day 7, day 14, and day 30 prediction nomograms were 0.847 (95% CI, 0.804-0.884), 0.817 (95% CI, 0.772-0.857), and 0.786 (95% CI, 0.739-0.829). CONCLUSION These novel nomograms predicting dysphagia recovery after ischemic stroke are discriminative and well calibrated and could be used to guide enteral nutrition decision making, rehabilitation plans, and individualized care.
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Affiliation(s)
- Zhuo Wang
- School of Pharmacy and School of Medicine, Changzhou University, Changzhou, Jiangsu, China
| | - Yixin Shi
- Department of Nursing, Affiliated Hospital of Nanjing Medical University, Changzhou Second People's Hospital, Changzhou, China
| | - Lulu Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lingling Wu
- Department of Rehabilitation, Yancheng City No.1 People's Hospital, Yancheng, Jiangsu, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Li Huiling
- School of Nursing, Medical College of Soochow University, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Pierpoint M, Pillay M. Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2020; 67:e1-e13. [PMID: 32501033 PMCID: PMC7276479 DOI: 10.4102/sajcd.v67i1.625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND South African speech-language therapists are the only health professionals charged with dysphagia rehabilitation. However, registered nurses and doctors are often initial healthcare contact points for post-stroke dysphagia. Notwithstanding service concerns, they do indeed identify and manage post-stroke dysphagia. However, little is known about specifically what they do during these initial clinical encounters. OBJECTIVE To explore how doctors and registered nurses, on initial clinical contact, identify and manage post-stroke dysphagia. METHOD A quantitative descriptive survey design, with non-probability, purposive sampling, was used. Twenty-one registered nurses and four doctors at a private South African hospital self-administered a questionnaire. Univariate analyses were completed by calculating frequency distributions of nurses' and doctors' identification and management practices. RESULTS Most (86%) did not use a formal screening tool. Indicators screened informally included: presence of drooling (84%) or gag reflex (76%), level of alertness (80%) and spontaneous saliva swallow (80%). Participants neglected important indicators like voluntary cough and vocal quality. Management provided included head of bed elevation (96%), speech-language therapist referrals (92%), nasogastric tube insertions (88%), intravenous fluids (84%) and positional adjustments (76%). Alternative management included total parenteral nutrition (52%), syringe feeding (48%), swallow muscle strengthening exercises (56%) and swallow manoeuvres (52%). CONCLUSION Results indicated that doctors and registered nurses under-utilised important dysphagia indicators and used potentially harmful management practices like syringe feeding. Management practices further included out-of-scope methods like dysphagia rehabilitation exercises or manoeuvres. Recommendations include peer dysphagia screening training using formal tools and basic dysphagia management methods to better equip doctors and registered nurses when they clinically engage post-stroke patients.
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Affiliation(s)
- Maggie Pierpoint
- Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Niimi M, Hashimoto G, Hara T, Yamada N, Fujigasaki H, Ide T, Abo M. The 2-Minute Spontaneous Swallowing Screening Predicts Independence on Enteral Feeding in Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2020; 29:104508. [PMID: 31759914 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/16/2019] [Accepted: 10/28/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It is recommended that enteral feeding should be offered to patients with dysphagia estimated to be unable to take adequate diet orally within 7 days of admission after acute stroke, but there is no clear criterion for initiation of enteral feeding. Recent studies have reported that the frequency of spontaneous swallowing is useful in screening for dysphagia in acute stroke. The present study was aimed to investigate whether measurement of frequency of spontaneous swallowing for 2 minutes could predict independence on enteral feeding 1 week after admission in patients with acute stroke. METHODS Patients with acute stroke were subjected. Within 72 hours of stroke onset, the number of swallows for 2 minutes was measured by auscultation. Subsequently, 1-hour frequency of spontaneous swallowing was measured using a laryngeal microphone. Functional Oral Intake Scale (FOIS) was evaluated 1 week after admission. RESULTS Twenty-six out of 40 patients were independent on enteral feeding 1 week after admission based on FOIS. The presence of spontaneous swallowing for 2 minutes had .89 sensitivity, .54 specificity to predict independence on enteral feeding 1 week after admission, whereas the 1-hour frequency of spontaneous swallowing had 1.00 sensitivity, .46 specificity. Logistic regression analysis demonstrated that the presence of spontaneous swallowing for 2 minutes was independent predictor for independence on enteral feeding 1 week after admission, independently of age, sex, and NIHSS. CONCLUSIONS The 2-minute spontaneous swallowing screening predicts independence on enteral feeding 1 week after admission in patients with acute stroke.
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Affiliation(s)
- Masachika Niimi
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan.
| | - Gentaro Hashimoto
- Department of Rehabilitation Medicine, Tokyo Metropolitan Bokutoh Hospital, Sumida-Ku, Tokyo, Japan
| | - Takatoshi Hara
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Hiroto Fujigasaki
- Department of Internal Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Sumida-Ku, Tokyo, Japan
| | - Takafumi Ide
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Sumida-Ku, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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Sakamoto M, Watanabe Y, Edahiro A, Motokawa K, Shirobe M, Hirano H, Ito K, Kanehisa Y, Yamada R, Yoshihara A. Self-Feeding Ability as a Predictor of Mortality Japanese Nursing Home Residents: A Two-Year Longitudinal Study. J Nutr Health Aging 2019; 23:157-164. [PMID: 30697625 DOI: 10.1007/s12603-018-1125-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To examine the ability of different elements of the Self-Feeding Assessment Tool for Elderly with Dementia (SFED) to predict mortality risk in nursing home residents. DESIGN AND SETTING Data from 387 residents in five nursing homes for the elderly in Japan were obtained using a baseline survey. This measure's ability to predict mortality risk was examined over a two-year observation period. Participants and Measurement: Demographic information (sex, age, height, weight, medical history) on 387 initial participants was gathered. A total of 10 individuals were excluded from the analysis because of the inability to eat by mouth at baseline, while 36 were excluded owing to missing mortality data during the observation period. The resulting 341 residents were divided into a death group or survival group according to whether they were still alive after two-year observation period. In addition to basic information and the SFED, the baseline survey included the Barthel Index (BI), Clinical Dementia Rating (CDR), and Mini Nutritional Assessment-Short Form (MNA®-SF). The ability of SFED to predict time-to-event mortality was examined using Cox proportional hazards regression analysis, including other measures associated with mortality as confounding variables. RESULTS In total, 129 participants (37.8%) died during the observation period, and their mean SFED score was significantly lower than that of surviving ones (11.1 ± 6.7 vs. 15.0 ± 5.6, P<0.001). SFED score was significantly associated with two-year mortality in the Cox proportional hazards regression analysis after adjusting for sex, age, medical history, BI, CDR, and MNA®-SF (hazard ratio = 0.941, 95% confidence interval = 0.898-0.985, P = 0.010). Additionally, three SFED categories were significantly associated with mortality risk: movement ("able to eat without dropping food"), concentration ("able to maintain attention to meal"), and safety ("able to swallow without choking, with no change in vocal quality after eating"). CONCLUSIONS Self-feeding ability as measured by SFED score was associated with long-term mortality in elderly living in nursing homes. Accordingly, adjusting feeding assistance based on regular SFED-based assessments may help maintain self-feeding ability and enhance quality of life in this population, as well as providing evidence for end-of-life care options and greatly improving care quality.
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Affiliation(s)
- M Sakamoto
- Yutaka Watanabe, Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan,
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Chun YM, Chun MH, Do KH, Choi SJ. Clinical Predictors of Oro-esophageal Tube Feeding Success in Brain Injury Patients With Dysphagia. Ann Rehabil Med 2017; 41:769-775. [PMID: 29201815 PMCID: PMC5698663 DOI: 10.5535/arm.2017.41.5.769] [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: 11/30/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022] Open
Abstract
Objective To identify possible clinical predictors of intermittent oro-esophageal (OE) tube feeding success, and evaluate the clinical factors associated with OE tube treatment. Methods A total of 135 dysphagic patients were reviewed, who received OE tube treatment and were hospitalized in the department of rehabilitation medicine between January 2005 and December 2014. The 76 eligible cases enrolled were divided into two groups, based on the OE tube training success. Clinical factors assessed included age, cause of brain lesion, gag reflex, cognitive function and reasons for OE tube training failure. Results Of the 76 cases enrolled, 56 study patients were assigned to the success group, with the remaining 20 in the failure group. There were significant differences between these two groups in terms of age, gag reflex, ability to follow commands, and the score of Korean version of Mini-Mental Status Examination (K-MMSE). Location of the brain lesion showed a borderline significance. Multivariable analysis using logistic regression revealed that age, cause of brain lesion, gag reflex, and K-MMSE were the main predictors of OE tube training success. Conclusion A younger age, impaired gag reflex and higher cognitive function (specifically a K-MMSE score ≥19.5) are associated with an increased probability of OE tube training success in dysphagic patients.
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Affiliation(s)
- Yoon Mok Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hee Do
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Su Jin Choi
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
BACKGROUND Stroke is the leading cause of mortality and disability worldwide. Important sequels are frequent, including dysphagia and communication disorders. OBJECTIVE to determine the prevalence of dysphagia and communication disorders following stroke, and to identify if communication disorders can predict dysphagia. METHODS Thirty-one prospective and consecutive patients were admitted to the Otolaryngology-Dysphagia Outpatient Clinic with diagnosis of ischemic or hemorrhagic stroke. Stroke was confirmed by computed tomography or magnetic resonance imaging, and medical evaluation. All patients had a swallowing and communication evaluation. We compared patients with and without dysphagia, and established the co-occurrence among dysphagia and communication disorders. RESULTS Twenty-five patients presented dysphagia. Aphasia occurred in 32.3% of the patients; dysarthria in 45.2%. Dysphagia and aphasia co-occurred in 29% of the population; dysphagia and dysarthria in 45.2%; the three conditions co-occurred in 22.6%. Dysarthria was a predictor of dysphagia, and it was associated with the presence of oral stage problems. CONCLUSIONS A comprehensive evaluation of dysphagia, aphasia, and dysarthria are important to improve clinical outcome following stroke. The identification of dysarthria as a predictor of dysphagia can help identify risk for dysphagia in stroke and assist in the therapeutic process of swallowing problems.
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Oba S, Tohara H, Nakane A, Tomita M, Minakuchi S, Uematsu H. Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia. Odontology 2016; 105:96-102. [DOI: 10.1007/s10266-016-0238-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/12/2016] [Indexed: 11/24/2022]
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Ribeiro PW, Cola PC, Gatto AR, da Silva RG, Luvizutto GJ, Braga GP, Schelp AO, de Arruda Henry MAC, Bazan R. Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2088-94. [PMID: 26187787 DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/23/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The present study aimed to evaluate the relation between the National Institutes of Health Stroke Scale (NIHSS) score and the presence of laryngeal penetration and/or laryngotracheal aspiration in ischemic stroke patients and to verify what factors are predictors of the occurrence of pneumonia in the evaluated patients. METHODS This was an observational study of ischemic stroke in the acute or subacute phases. Neurologic examination included anamnesis, Bamford classification, and application of the NIHSS. Speech therapy evaluation was carried out after clinical stabilization of the patient, and all individuals who were considered dysphagic were sent for examination by means of videofluoroscopic recordings. The parameters observed in the objective examination were the presence of laryngeal penetration and/or laryngotracheal aspiration. The pneumonia data were obtained in accordance with local protocols, which were based on international guidelines. The relation of laryngeal penetration and laryngotracheal aspiration with the NIHSS score was assessed by the Mann-Whitney U test, and predictors for the occurrence of pneumonia were analyzed by multiple logistic regression using semiautomatic backward selection. Significance was set at P less than .05. RESULTS The relations between laryngeal penetration and the NIHSS score and between laryngotracheal aspiration and the NIHSS score were not statistically significant. The predictors for pneumonia occurrence in the ischemic stroke patients with a clinical diagnosis of dysphagia were age (P = .002; odds ratio [OR], 1.12) and NIHSS score (P = .04; OR, 1.17), whereas laryngeal penetration of liquid (P = .065; OR, 3.70) tended to correlate with pneumonia but not significantly. CONCLUSIONS There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity.
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Affiliation(s)
- Priscila W Ribeiro
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil.
| | - Paula C Cola
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Ana R Gatto
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Roberta G da Silva
- Department of Phonoaudiology, School of Philosophy and Sciences, Marília, Brazil
| | - Gustavo J Luvizutto
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Gabriel P Braga
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Arthur O Schelp
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Maria A C de Arruda Henry
- Department of Surgery, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
| | - Rodrigo Bazan
- Neurology Service, Botucatu School of Medicine, University Estadual Paulista Júlio de Mesquita Filho, São Paulo, Brazil
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Momosaki R, Yasunaga H, Matsui H, Horiguchi H, Fushimi K, Abo M. Predictive factors for oral intake after aspiration pneumonia in older adults. Geriatr Gerontol Int 2015; 16:556-60. [DOI: 10.1111/ggi.12506] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Ryo Momosaki
- Department of Rehabilitation Medicine; The Jikei University School of Medicine; Tokyo Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Hiromasa Horiguchi
- Department of Clinical Data Management and Research; Clinical Research Center, National Hospital Organization Headquarters; Tokyo Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics; Tokyo Medical and Dental University Graduate School of Medicine; Tokyo Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine; The Jikei University School of Medicine; Tokyo Japan
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Mituuti CT, Bianco VC, Bentim CG, de Andrade EC, Rubo JH, Berretin-Felix G. Influence of oral health condition on swallowing and oral intake level for patients affected by chronic stroke. Clin Interv Aging 2014; 10:29-35. [PMID: 25565784 PMCID: PMC4279671 DOI: 10.2147/cia.s62314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND According to the literature, the occurrence of dysphagia is high in cases of stroke, and its severity can be enhanced by loss of teeth and the use of poorly fitting prostheses. OBJECTIVE To verify that the status of oral health influences the level of oral intake and the degree of swallowing dysfunction in elderly patients with stroke in chronic phase. METHODS Thirty elderly individuals affected by stroke in chronic phase participated. All subjects underwent assessment of their oral condition, with classification from the Functional Oral Intake Scale (FOIS) and nasoendoscopic swallowing assessment to classify the degree of dysphagia. The statistical analysis examined a heterogeneous group (HG, n=30) and two groups designated by the affected body part, right (RHG, n=8) and left (LHG, n=11), excluding totally dentate or edentulous individuals without rehabilitation with more than one episode of stroke. RESULTS There was a negative correlation between the need for replacement prostheses and the FOIS scale for the HG (P=0.02) and RHG (P=0.01). Differences in FOIS between types of prostheses of the upper dental arch in the LHG (P=0.01) and lower dental arch in the RHG (P=0.04). A negative correlation was found between the number of teeth present and the degree of dysfunction in swallowing liquid in the LHG (P=0.05). There were differences in the performance in swallowing solids between individuals without prosthesis and those with partial prosthesis in the inferior dental arch (P=0.04) for the HG. CONCLUSION The need for replacement prostheses, type of prostheses, and the number of teeth of elderly patients poststroke in chronic phase showed an association with the level of oral intake and the degree of oropharyngeal dysphagia.
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Affiliation(s)
- Cláudia T Mituuti
- Speech Language and Hearing Department, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil
| | - Vinicius C Bianco
- Department of Prosthodontics, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil
| | | | - Eduardo C de Andrade
- Speech Language and Hearing Department, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil
| | - José H Rubo
- Department of Prosthodontics, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil
| | - Giédre Berretin-Felix
- Speech Language and Hearing Department, Bauru School of Dentistry/University of São Paulo, Bauru, Brazil
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Nakajima M, Inatomi Y, Yonehara T, Hashimoto Y, Hirano T. Acquisition of oral intake in severely dysphagic patients with acute stroke: A single-center, observational study involving a database of 4972 consecutive stroke patients. J Neurol Sci 2012; 323:56-60. [DOI: 10.1016/j.jns.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 08/01/2012] [Accepted: 08/08/2012] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE It remains unclear which patients with acute stroke need percutaneous endoscopic gastrostomy (PEG) placement and when it should be performed. The aim of this study was to identify the predictors for oral intake 6 months after onset in stroke patients. METHODS Data were obtained from a prospectively registered database of 738 acute ischemic stroke patients both with and without a history of stroke. Patients who survived for 6 months and replied to a questionnaire were divided into two groups: those with oral intake 6 months after onset and those without. Predictors for oral intake 6 months after onset were analyzed. RESULTS Forty-five patients died during their hospital stay, 145 did not reply to the questionnaire, and 23 died during follow-up. Of the residual 525 patients, 485 (92.4%) had oral intake after 6 months. On multivariate analysis, modified Rankin Scale score 0 before admission (OR 2.70, 95% CI 1.10-6.61) and National Institutes of Health Stroke Scale (NIHSS) score ≤9 on day 10 (OR 21.12, 95% CI 5.04-88.39) were independent predictors for oral intake after 6 months, while NIHSS score on admission was not. CONCLUSION Clinicians should be cautious about PEG placement for stroke patients who were independent prior to their stroke and whose stroke severity decreases 10 days after admission, because their swallowing dysfunction may improve within a brief period.
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Affiliation(s)
- Makoto Nakajima
- Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Japan.
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