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Mozzanica F, Pizzorni N, Eplite A, Ginocchio D, Colombo A, Mora G, Ambrogi F, Warnecke T, Schindler A. Swallowing Characteristics in Patients with Multiple System Atrophy Analyzed Using FEES Examination. Dysphagia 2024; 39:387-397. [PMID: 37733099 PMCID: PMC11127813 DOI: 10.1007/s00455-023-10619-5] [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: 03/07/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023]
Abstract
Patients with multiple system atrophy (MSA) frequently experience dysphagia but only few studies analyzed its characteristics. The aim of this study was to describe the swallowing characteristics in these patients using fiberoptic endoscopic evaluation of swallowing (FEES). In addition, the swallowing abilities in patients with predominantly cerebellar MSA (MSA-C) and predominantly parkinsonian MSA (MSA-P) were compared. Twenty-five patients with MSA (16 MSA-P and 9 MSA-C) were enrolled. Clinical data including age, sex, functional oral intake scale (FOIS) score, body mass index (BMI) and the results of the global disability-unified MSA rating scale (GD-UMSARS) were collected. Three different textures of food (liquid, semisolid, solid) were provided during FEES examination. The characteristics of dysphagia (safety, efficiency, phenotype) and laryngeal movement alterations were analyzed. Delayed pharyngeal phase (92%) and posterior oral incontinence (52%) were the phenotypes more frequently seen. Penetration was more frequent with Liquid (68%), while aspiration occurred only with Liquid (20%). Residues of ingested food were demonstrated both in the pyriform sinus and in the vallecula with all the consistencies. Vocal fold motion impairment was the laryngeal movement alteration most frequently encountered (56%). No significant differences between patients with MSA-P and MSA-C in the dysphagia characteristics and laryngeal movement alterations were found. Patients with MSA frequently experience swallowing impairment and altered laryngeal mobility. Dysphagia characteristics and laryngeal movements alterations seems to be similar in MSA-C and MSA-P.
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Affiliation(s)
- Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- IRCCS Multimedica, Ospedale San Giuseppe, Milan, Italy.
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Angelo Eplite
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniela Ginocchio
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Anna Colombo
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gabriele Mora
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation at the Klinikum Osnabrück, Academic Teaching Hospital of the Westfälische Wilhelms-University of Münster, Osnabrück, Germany
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Yeo MS, Hwang J, Lee HK, Kim SJ, Cho SR. Therapeutic singing-induced swallowing exercise for dysphagia in advanced-stage Parkinson's disease. Front Neurol 2024; 15:1323703. [PMID: 38628693 PMCID: PMC11018993 DOI: 10.3389/fneur.2024.1323703] [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: 10/25/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background With longer life spans and medical advancements, the rising number of patients with advanced-stage Parkinson's disease (PD) warrants attention. Current literature predominantly addresses dementia and fall management in these patients. However, exploring the impact of swallowing function on patients with advanced PD is crucial. Previous research has demonstrated notable enhancements in the quality of life related to voice for participants following a group singing-intervention program. To further elucidate the effect of individual singing-induced swallowing exercises, our study aimed to investigate the quantitative and qualitative effects of therapeutic singing on swallowing function in patients with advanced PD in comparison to a matched usual care control group. The hypothesis of this study is that therapeutic singing-induced swallowing exercises can assist to maintain swallowing function in patients with advanced PD. Methods This prospective matched control study compared the effects of a 6-week therapeutic singing-based swallowing intervention on swallowing function and quality of life in patients with advanced PD. The intervention group received individual sessions with a music therapist and conventional individual physical therapy. The control group received the same standard physical therapy for 6 weeks without music intervention. The primary outcome measure was Video Fluoroscopic Dysphagia Scale (VDS). Results The study revealed that the intervention group maintained swallowing function, whereas the control group experienced deterioration, indicating significant time-dependent changes in Penetration-Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and VDS. Analysis of PAS and NIH-SSS liquid food scores in both groups showed significant time effects. However, the intervention group exhibited no significant differences between the pre- and post-tests, indicating preservation of the swallowing function. VDS of liquid food indicated an interaction effect between time and group in the pharyngeal phase and total scores. The Swallowing-Quality of Life showed significant time-effect improvement in the intervention group. Conclusion Therapeutic singing exercises may help maintain swallowing function in advanced PD patients, potentially enhancing quality of life related to swallowing in those with advanced-stage diseases. Clinical trial registration https://cris.nih.go.kr/cris/search/listDetail.do, identifier KCT0008644.
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Affiliation(s)
- Myung Sun Yeo
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Jihye Hwang
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Kyoung Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soo Ji Kim
- Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 Plus Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Republic of Korea
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Liu Y, Hou R, Yu Q, Niu Q. Effect of voice training intervention on swallowing function in patients with head and neck cancer undergoing radiotherapy: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102551. [PMID: 38642524 DOI: 10.1016/j.ejon.2024.102551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/13/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE We aimed to evaluate the effect of voice training in patients with head and neck cancer who were undergoing radiotherapy. METHOD This study used a randomized controlled trial design. IBM SPSS 26.0 was used to randomly divide 74 patients into a control group and an experimental group. The control group followed a swallowing exercises program, and the experimental group additionally received ABCLOVE voice training. Both training programs continued throughout the entire radiotherapy cycle. We compared standardized swallowing assessment (SSA), maximum phonation time (MPT), the Voice Handicap Index-10, and incidence of complications such as difficulty opening the mouth, malnutrition, and aspiration between the two groups at T1 (0 radiotherapy sessions, before radiotherapy), T2 (15-16 radiotherapy sessions, middle of radiotherapy), and T3 (30-32 radiotherapy sessions, end of radiotherapy). RESULTS 70 participants completed this study. Swallowing function and MPT intergroup and interaction effects were statistically significant between the two groups (P < 0.05). At the end of radiotherapy (T3), the SSA score (20.77 ± 1.96) and MPT (10.98 ± 1.75) s in the experimental group were superior to those in the control group (SSA: 22.06 ± 2.38 and MPT: 9.49±1.41 s), with statistical significance (P<0.05). Moreover, the incidence of malnutrition and aspiration in the experimental group was lower than that in the control group (P < 0.05). CONCLUSION Voice training can improve swallowing function and MPT and reduce complications related to swallowing disorders in patients with head and neck cancer.
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Affiliation(s)
- Yan Liu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Ran Hou
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China.
| | - Qinqin Yu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Qiaohong Niu
- Department of Nursing Unit, Shanxi Cancer Hospital, Taiyuan, China
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Hirschwald J, Finnegan L, Hofacker J, Walshe M. Underserved groups in dysphagia intervention trials in Parkinson's disease: A scoping review. Ageing Res Rev 2024; 93:102150. [PMID: 38043779 DOI: 10.1016/j.arr.2023.102150] [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: 10/24/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Underserved groups in Parkinson's disease (PD) intervention studies are well recognised. However, it remains unclear whether these exclusions apply to oropharyngeal dysphagia (OD) intervention studies in PD. The aim of this scoping review was to identify characteristics of included participants and underserved groups in intervention studies in OD in PD. METHODS Six electronic databases and one trial registry were searched without language restrictions. Screening of studies and data extraction were independently conducted by four reviewers. RESULTS Of the 26 studies included, none fully reported the participants' ethnicity. Where data was available, 70% of participants were male with a mean age of 68 years, mean PD duration of 7.26 years, median Hoehn and Yahr stage of 2.5, mild OD and mostly recruited from movement disorders clinics. Underserved groups were younger people (< 50 years), older people (≥ 80 years), women, non-white people, people with severe OD and PD, longer PD duration, other neurological conditions, cognitive impairment/dementia, and depression. CONCLUSIONS Careful consideration of all characteristics of individuals with OD in PD is essential for improving the external validity of studies. This will enhance the generalisability of research findings to the broader PD population, ultimately strengthening the evidence base for OD interventions in PD.
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Affiliation(s)
- Julia Hirschwald
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland.
| | - Lauren Finnegan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Jule Hofacker
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
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Lowit A, Cox J, Loucas M, Grassly J, Egan A, van Brenk F, Hadjivassiliou M. ClearSpeechTogether: a Rater Blinded, Single, Controlled Feasibility Study of Speech Intervention for People with Progressive Ataxia. CEREBELLUM (LONDON, ENGLAND) 2023; 22:865-876. [PMID: 36001243 PMCID: PMC9399979 DOI: 10.1007/s12311-022-01462-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Progressive ataxias frequently lead to speech disorders and consequently impact on communication participation and psychosocial wellbeing. Whilst recent studies demonstrate the potential for improvements in these areas, these treatments generally require intensive input which can reduce acceptability of the approach. A new model of care-ClearSpeechTogether-is proposed which maximises treatment intensity whilst minimising demands on clinician. This study aimed to establish feasibility and accessibility of this approach and at the same time determine the potential benefits and adverse effects on people with progressive ataxias. METHOD This feasibility study targeted people with progressive ataxia and mild-moderate speech and gross motor impairment. ClearSpeechTogether consisted of four individual sessions over 2 weeks followed by 20 patient-led group sessions over 4 weeks. All sessions were provided online. Quantitative and qualitative data were collected for evaluation. RESULTS Nine participants completed treatment. Feasibility and acceptability were high and no adverse effects were reported. Statistical tests found significantly reduced vocal strain, improved reading intelligibility and increased participation and confidence. Participant interviews highlighted the value of group support internalisation of speech strategies and psycho-social wellbeing. DISCUSSION ClearSpeechTogether presented a feasible, acceptable intervention for a small cohort of people with progressive ataxia. It matched or exceeded the outcomes previously reported following individual therapy. Particularly notable was the fact that this could be achieved through patient led practice without the presence of a clinician. Pending confirmation of our results by larger, controlled trials, ClearSpeechTogether could represent an effective approach to manage speech problems in ataxia.
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Affiliation(s)
- Anja Lowit
- School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, Scotland.
| | - Jessica Cox
- School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, Scotland
| | - Melissa Loucas
- School of Psychology and Clinical Language Sciences, Earley Gate, University of Reading, RG6 6AL, Reading, England
| | - Jennifer Grassly
- University College London, Chandler House, 2 Wakefield Street, London, WC1N 1PF, England
| | - Aisling Egan
- School of Psychological Sciences and Health, Strathclyde University, 40 George St, Glasgow, G1 1QE, Scotland
| | - Frits van Brenk
- Department of Languages, Literature and Communication, Utrecht University, Trans 10, 3512 JK, Utrecht, Netherlands
| | - Marios Hadjivassiliou
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Rd, Sheffield, S10 2JF, England
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Hirschwald J, Hofacker J, Duncan S, Walshe M. Swallowing outcomes in dysphagia interventions in Parkinson's disease: a scoping review. BMJ Evid Based Med 2023; 28:111-118. [PMID: 36368883 PMCID: PMC10086282 DOI: 10.1136/bmjebm-2022-112082] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To identify all outcomes, their definitions, outcome measurement instruments (OMIs), timepoints and frequency of measurement applied in clinical trials in oropharyngeal dysphagia (OD) interventions in Parkinson's disease (PD). This scoping review is the first stage of a larger project establishing a core outcome set for dysphagia interventions in Parkinson's disease (COS-DIP). DESIGN Scoping review. METHODS Six electronic databases and one trial registry were searched without language restrictions until March 2022. Bibliography lists of included studies were also reviewed. Study screening and data extraction were conducted independently by two reviewers using Covidence. The scoping review protocol is registered and published (http://hdl.handle.net/2262/97652). RESULTS 19 studies with 134 outcomes were included. Trial outcomes were mapped to a recommended taxonomy for COSs and merged. 39 outcomes were identified. The most frequently measured were general swallowing-related outcomes, global quality-of-life outcomes and swallowing-related perceived health status outcomes. The applied outcomes, their definitions, OMIs, timepoints and frequency of measurement showed a high variability across all studies. CONCLUSIONS The high variability of outcomes emphasises the need for an agreed standardised COS. This will inform clinical trial design in OD in PD, increase the quality of OD trials in PD and facilitate synthesising and comparing study results to reach conclusion on the safety and effectiveness of OD interventions in PD. It will not prevent or restrict researchers from examining other outcomes. TRIAL REGISTRATION NUMBER The COS-DIP study, including the scoping review, was registered prospectively with the Core Outcome Measures in Effectiveness Trials Database on 24 September 2021 (www.comet-initiative.org, registration number: 1942).
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Affiliation(s)
- Julia Hirschwald
- Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jule Hofacker
- Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Sallyanne Duncan
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Margaret Walshe
- Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
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Niu C, Zhou W, Wang H, Zhang Y, Cai J, Lu N, Wang Y. The effect of voice training interventions on patients with oropharyngeal dysphagia: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:973-984. [PMID: 36342516 PMCID: PMC9899714 DOI: 10.1007/s00405-022-07719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Voice training has been proposed as an intervention to improve swallowing function in patients with dysphagia. However, little is known about the effects of voice training on swallowing physiology. OBJECTIVES This systematic review investigates the effect of voice training on the swallowing function of patients with oropharyngeal dysphagia and provides the theoretical basis for improving the swallowing function and life quality of patients with oropharyngeal dysphagia. DATA SOURCES A systematic review using a narrative synthesis approach of all published studies was sought with no date restrictions. Five electronic databases (EMBASE, PubMed, CINAHL, Web of Science, and The Cochrane Library) were searched from inception to April 2022. STUDY SELECTION Eight studies were included. Two researchers screened the literature according to inclusion and exclusion criteria, extracted data, and carried out quality control according to the Cochrane handbook5.1.0. Data were analyzed narratively and descriptively. CONCLUSIONS In general, statistically significant positive therapy effects were found. Voice training improves the oral and pharyngeal stages of swallowing in patients with neurological causes of dysphagia, such as stroke, and in patients with non-neurological causes of dysphagia, such as head and neck cancer. However, the current literature is limited and further primary research is required to provide more evidence to support voice training intervention in dysphagia. Future studies could further refine the content of voice training interventions, increase the number of patients enrolled, assess the long-term effects of voice training interventions and add associated assessments of the quality of life after treatment.
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Affiliation(s)
- Chunyan Niu
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Wenyan Zhou
- Changshu Second People's Hospital, Changshu, 215500, China
| | - Haifang Wang
- Department of Nursing, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Yingying Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
| | - Jianzheng Cai
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Nini Lu
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yalan Wang
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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Dumican M, Watts C, Drulia T, Zhang Y. Dysphagia Presentation, Airway Invasion, and Gender Differences in a Clinically Based Sample of People with Parkinson's Disease. Dysphagia 2023; 38:353-366. [PMID: 35809095 DOI: 10.1007/s00455-022-10472-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/28/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia in People with Parkinson's Disease (PWPD) is expected to occur in most individuals. The manifestation of dysphagia and its salient swallow dysfunction characteristics leading to decreased airway safety are not well understood. The aim of this study was to quantify dysphagia presentation and severity, examine contributors to airway invasion, and explore gender differences in dysphagia manifestation in PWPD. 60 PWPD in clinical, healthcare settings underwent a Videofluoroscopic Swallow Study (VFSS) after referral for complaints of dysphagia. VFSS records and videos were analyzed to obtain dysphagia diagnosis, Videofluoroscopic Dysphagia Scale (VDS) scores, laryngeal vestibule kinematic timings, and Penetration-Aspiration Scale scores. Frequencies of VDS component and PAS scores were examined. MANOVA and logistic regression analyses were used to identify predictors of penetration and aspiration. Pharyngeal stage dysphagia was prevalent throughout PWPD and presented more frequently than oral stage dysphagia. Pharyngeal residue was a significant predictor for aspiration events. Laryngeal vestibule closure reaction time (LVCrt) and duration time (LVCd) were significant predictors of airway invasion, as were bolus consistency and volume. LVCrt, LVCd, and pharyngeal stage VDS scores were significantly altered in men compared to women in PWPD. A broad clinical sample of PWPD displayed atypical frequencies of airway invasion and frequent atypical scores of oral and pharyngeal stage physiologies. Thicker and smaller bolus consistencies significantly reduced the odds of airway invasion. Men and women presented with significantly different swallow physiology including prolonged LVCrt, LVCd, and more frequent atypical scores of pharyngeal residue and laryngeal elevation.Journal instruction requires a country for affiliations; however, these are missing in affiliation [1, 2]. Please verify if the provided country are correct and amend if necessary.Yes, USA is correct as the provided country.
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Affiliation(s)
- Matthew Dumican
- Western Michigan University, 1903 W Michigan Ave, Kalamazoo, MI, 46008, USA.
| | - Christopher Watts
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
| | - Teresa Drulia
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
| | - Yan Zhang
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
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Namasivayam-MacDonald A, Rapley M, Stewart J, Webster E, Quon C, Rogus-Pulia N. Impact of Dysphagia Rehabilitation in Adults on Swallowing Physiology Measured With Videofluoroscopy: A Mapping Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2195-2228. [PMID: 35868298 PMCID: PMC9907451 DOI: 10.1044/2022_ajslp-21-00342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE The research aims of this review were to (a) map swallowing rehabilitation approaches to specific swallowing impairments using the Modified Barium Swallow Impairment Profile (MBSImP) to develop evidence maps, (b) match desired rehabilitation treatment targets to treatment approaches, and (c) identify gaps in the literature and highlight which rehabilitation approaches require further investigation to support accurate mapping of interventions to physiologic change. METHOD A mapping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review extension framework. The databases searched were CINAHL, Ovid Medline, and Ovid Embase. Data extracted included swallowing rehabilitation approach details via the Rehabilitation Treatment Specification System framework, study characteristics, and resulting change in swallowing physiology. The resulting change in swallowing physiology was mapped onto MBSImP components, where applicable, and effect sizes were reported where data were available. Extracted data were summarized in the form of evidence maps. RESULTS Forty-three unique articles met the inclusion criteria for this review and were divided into single-approach and multi-approach exercise studies. Within single-approach studies, 13 different exercise approaches were investigated, and 117 outcome measures could be mapped to MBSImP components. Within multi-approach studies, 13 different combinations of exercise approaches were investigated and 60 outcome measures could be mapped to MBSImP components. CONCLUSIONS This review supports speech-language pathologists in incorporating current best evidence into their practice, as it found there is potential for improvement in many MBSImP components by using rehabilitative exercises. In the future, more intervention studies are needed to ensure that recommended rehabilitation approaches are beneficial for improving the targeted swallowing physiology.
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Affiliation(s)
| | - Megan Rapley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Josephine Stewart
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Eryn Webster
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Christina Quon
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Rogus-Pulia
- Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
- Geriatric Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI
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Abstract
Multiple system atrophy (MSA) is a rare neurodegenerative disease that is characterized by neuronal loss and gliosis in multiple areas of the central nervous system including striatonigral, olivopontocerebellar and central autonomic structures. Oligodendroglial cytoplasmic inclusions containing misfolded and aggregated α-synuclein are the histopathological hallmark of MSA. A firm clinical diagnosis requires the presence of autonomic dysfunction in combination with parkinsonism that responds poorly to levodopa and/or cerebellar ataxia. Clinical diagnostic accuracy is suboptimal in early disease because of phenotypic overlaps with Parkinson disease or other types of degenerative parkinsonism as well as with other cerebellar disorders. The symptomatic management of MSA requires a complex multimodal approach to compensate for autonomic failure, alleviate parkinsonism and cerebellar ataxia and associated disabilities. None of the available treatments significantly slows the aggressive course of MSA. Despite several failed trials in the past, a robust pipeline of putative disease-modifying agents, along with progress towards early diagnosis and the development of sensitive diagnostic and progression biomarkers for MSA, offer new hope for patients.
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Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T, Shigematsu T, Oshima F, Mori T, Ogawa N, Nishioka S, Momosaki R, Yamada M, Ogawa S. Prevalence of Hoarseness and Its Association with Severity of Dysphagia in Patients with Sarcopenic Dysphagia. J Nutr Health Aging 2022; 26:266-271. [PMID: 35297470 PMCID: PMC8883003 DOI: 10.1007/s12603-022-1754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/15/2022] [Indexed: 10/29/2022]
Abstract
OBJECTIVES To investigate the prevalence of hoarseness and its association with the severity of dysphagia in patients with sarcopenic dysphagia. DESIGN Cross-sectional study using the Japanese sarcopenic dysphagia database. SETTING 19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team. PARTICIPANTS 287 patients with sarcopenic dysphagia, aged 20 years and older. MEASUREMENTS Sarcopenic dysphagia was diagnosed using a reliable and validated diagnostic algorithm for the condition. The presence and characteristics of hoarseness classified as breathy, rough, asthenic, and strained were assessed. The prevalence of hoarseness and the relationship between hoarseness and Food Intake LEVEL Scale (FILS) were examined. Order logistic regression analysis adjusted for age, sex, naso-gastric tube, and handgrip strength was used to examine the relationship between hoarseness and FILS at baseline and at follow-up. RESULTS The mean age was 83 ± 10 years. Seventy-four (26%) patients had hoarseness, while 32 (11%), 20 (7%), 22 (8%), and 0 (0%) patients had breathy, rough, asthenic, and strained hoarseness, respectively. Median FILS at the initial evaluation was 7 (interquartile range, 5-8). Hoarseness (β=0.747, 95% confidence intervals= 0.229, 1.265, p=0.005), age, sex, naso-gastric tube, and handgrip strength were associated independently with baseline FILS, while hoarseness (β=0.213, 95% confidence intervals= -0.324, 0.750, p=0.438) was not associated independently with the FILS at follow-up. CONCLUSIONS Hoarseness was associated with the severity of dysphagia at baseline, however not a prognostic factor for sarcopenic dysphagia. Resistance training of swallowing and respiratory muscles and voice training as part of rehabilitation nutrition might be useful for treating sarcopenic dysphagia.
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Affiliation(s)
- H Wakabayashi
- Hidetaka Wakabayashi, MD, PhD, Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, Japan. Code; 162-0054, Tel: +81-3-3353-8111, Fax: +81-3-5269-7639, E-mail:
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