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Afsharzadeh M, Mirmosayyeb O, Vaheb S, Shaygannejad A, Maracy M, Shaygannejad V. Dysphagia in neuromyelitis optica spectrum disorder and multiple sclerosis: A comparison of frequency, severity, and effects on quality of life. Mult Scler Relat Disord 2024; 87:105640. [PMID: 38692153 DOI: 10.1016/j.msard.2024.105640] [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: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/20/2024] [Indexed: 05/03/2024]
Abstract
OVERVIEW Dysphagia has been previously discussed as a potential life-threatening condition secondary to chronic neurological diseases such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, its impact on the quality of life (QoL) of patients with NMOSD has never been studied before. This study aims to determine the frequency of dysphagia and its impact on QoL in NMOSD patients in comparison with MS people and healthy individuals. METHODS Seventy-five MS and sixty-five NMOSD patients with an expanded disability status scale (EDSS) score ≥ 3.5 in addition to 106 healthy controls were enrolled in this cross-sectional study. All the participants completed the self-report dysphagia in MS (DYMUS) and 36-item short-form health survey (SF-36) questionnaires. In case of positive answers to at least one of the questions in DYMUS, they were asked to fill out the dysphagia handicap index (DHI) questionnaire. RESULTS The frequency of dysphagia in NMOSD, MS, and control groups was 61.54 %, 72.97 %, and 27 %, respectively. Patients with swallowing problems had reduced scores across different swallowing-related QoL domains compared to non-dysphagic patients (p < 0.05). NMOSD (1, IQR [0-3.5]) and MS patients (2, IQR [0-4]) had a significantly higher median total DYMUS score than control (0, IQR [0-1]) (p < 0.01). However, there was no discernible difference between the two patient groups. NMOSD had the highest mean total DHI score (21.22 ± 21), followed by MS (15.25 ± 18.94) and control (7.08 ± 5.12). A significant correlation was seen in the NMOSD group between the DHI total score and the SF-36 total score (r = 0.62, p < 0.05). The DHI and SF-36 subscales showed a strong association as well. The overall SF-36 scores in both the control and MS groups was not significantly correlated with DHI. The generalized linear model analysis showed that the NMOSD group's age (p-value = 0.005), EDSS (p-value < 0.001), and total DYMUS score (p-value = 0.018) significantly affected overall health status. CONCLUSION The presence of dysphagia significantly impacts the QoL in NMOSD patients, particularly in aspects related to swallowing. These findings underscore the critical need for diligent dysphagia screening and emphasize the importance of educating both caregivers and NMOSD patients about managing this challenging symptom.
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Affiliation(s)
- Mahshad Afsharzadeh
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Vaheb
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aysa Shaygannejad
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammadreza Maracy
- Department of Epidemiology and Biostatistics School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Vahid Shaygannejad
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Li K, Fu C, Xie Z, Zhang J, Zhang C, Li R, Gao C, Wang J, Xue C, Zhang Y, Deng W. The impact of physical therapy on dysphagia in neurological diseases: a review. Front Hum Neurosci 2024; 18:1404398. [PMID: 38903410 PMCID: PMC11187312 DOI: 10.3389/fnhum.2024.1404398] [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: 03/28/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.
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Affiliation(s)
- Kun Li
- Shandong Daizhuang Hospital, Jining, China
| | - Cuiyuan Fu
- Shandong Daizhuang Hospital, Jining, China
| | - Zhen Xie
- Shandong Daizhuang Hospital, Jining, China
| | - Jiajia Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | | | - Rui Li
- Shandong Daizhuang Hospital, Jining, China
| | | | | | - Chuang Xue
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Wei Deng
- Affiliated Mental Health Center and Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Liangzhu Laboratory, MOE Frontier Science Center for Brain Science and Brain-machine Integration, State Key Laboratory of Brain-Machine Intelligence, Zhejiang University, Hangzhou, China
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Seifelnasr A, Ding P, Si X, Biondi A, Xi J. Oropharyngeal swallowing hydrodynamics of thin and mildly thick liquids in an anatomically accurate throat-epiglottis model. Sci Rep 2024; 14:11945. [PMID: 38789468 PMCID: PMC11126673 DOI: 10.1038/s41598-024-60422-x] [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: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Understanding the mechanisms underlying dysphagia is crucial in devising effective, etiology-centered interventions. However, current clinical assessment and treatment of dysphagia are still more symptom-focused due to our limited understanding of the sophisticated symptom-etiology associations causing swallowing disorders. This study aimed to elucidate the mechanisms giving rise to penetration flows into the laryngeal vestibule that results in aspirations with varying symptoms. Methods: Anatomically accurate, transparent throat models were prepared with a 45° down flapped epiglottis to simulate the instant of laryngeal closure during swallowing. Fluid bolus dynamics were visualized with fluorescent dye from lateral, rear, front, and endoscopic directions to capture key hydrodynamic features leading to aspiration. Three influencing factors, fluid consistency, liquid dispensing site, and dispensing speed, were systemically evaluated on their roles in liquid aspirations. Results: Three aspiration mechanisms were identified, with liquid bolus entering the airway through (a) the interarytenoid notch (notch overflow), (b) cuneiform tubercle recesses (recess overflow), and (c) off-edge flow underneath the epiglottis (off-edge capillary flow). Of the three factors considered, liquid viscosity has the most significant impact on aspiration rate, followed by the liquid dispensing site and the dispensing speed. Water had one order of magnitude higher aspiration risks than 1% w/v methyl cellulose solution, a mildly thick liquid. Anterior dispensing had higher chances for aspiration than posterior oropharyngeal dispensing for both liquids and dispensing speeds considered. The effects of dispending speed varied. A lower speed increased aspiration for anterior-dispensed liquids due to increased off-edge capillary flows, while it significantly reduced aspiration for posterior-dispensed liquids due to reduced notch overflows. Visualizing swallowing hydrodynamics from multiple orientations facilitates detailed site-specific inspections of aspiration mechanisms.
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Affiliation(s)
- Amr Seifelnasr
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA
| | - Peng Ding
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave, Cleveland, OH, 44195, USA
| | - Xiuhua Si
- Department of Mechanical Engineering, California Baptist University, 8432 Magnolia Ave, Riverside, CA, 92504, USA
| | - Andres Biondi
- Department of Electrical and Computer Engineering, University of Massachusetts, 1 University Ave., Lowell, MA, 01854, USA
| | - Jinxiang Xi
- Department of Biomedical Engineering, University of Massachusetts, 1 University Ave., Falmouth Hall 302I, Lowell, MA, 01854, USA.
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Trevizan-Baú P, Stanić D, Furuya WI, Dhingra RR, Dutschmann M. Neuroanatomical frameworks for volitional control of breathing and orofacial behaviors. Respir Physiol Neurobiol 2024; 323:104227. [PMID: 38295924 DOI: 10.1016/j.resp.2024.104227] [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: 12/07/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/16/2024]
Abstract
Breathing is the only vital function that can be volitionally controlled. However, a detailed understanding how volitional (cortical) motor commands can transform vital breathing activity into adaptive breathing patterns that accommodate orofacial behaviors such as swallowing, vocalization or sniffing remains to be developed. Recent neuroanatomical tract tracing studies have identified patterns and origins of descending forebrain projections that target brain nuclei involved in laryngeal adductor function which is critically involved in orofacial behavior. These nuclei include the midbrain periaqueductal gray and nuclei of the respiratory rhythm and pattern generating network in the brainstem, specifically including the pontine Kölliker-Fuse nucleus and the pre-Bötzinger complex in the medulla oblongata. This review discusses the functional implications of the forebrain-brainstem anatomical connectivity that could underlie the volitional control and coordination of orofacial behaviors with breathing.
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Affiliation(s)
- Pedro Trevizan-Baú
- The Florey Institute, University of Melbourne, Victoria, Australia; Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Davor Stanić
- The Florey Institute, University of Melbourne, Victoria, Australia
| | - Werner I Furuya
- The Florey Institute, University of Melbourne, Victoria, Australia
| | - Rishi R Dhingra
- The Florey Institute, University of Melbourne, Victoria, Australia; Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mathias Dutschmann
- The Florey Institute, University of Melbourne, Victoria, Australia; Division of Pulmonary, Critical Care and Sleep Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Hino H, Suzuki T, Maekawa K, Ita R, Sasa A, Kulvanich S, Takei E, Magara J, Tsujimura T, Inoue M. Effect of bolus property on swallowing dynamics in patients with dysphagia. J Oral Rehabil 2024. [PMID: 38685709 DOI: 10.1111/joor.13709] [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: 01/13/2023] [Revised: 02/20/2024] [Accepted: 04/12/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture-modified food for patients with dysphagia. OBJECTIVES The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy. MATERIALS AND METHODS A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide (Jelly) and jelly made of pectin (Reset gel). Outcome measures of videofluoroscopic images, bolus transit time and hyoid movements were compared. RESULTS The frequency of chewing movements was highest for Jelly, followed by Reset gel and Thick liquid. While the probability of oral residue was the highest for Reset gel, pharyngeal residue after swallowing was high for Thick liquid as compared to Jelly and Reset gel. Oral transit time and pharyngeal transit time for Thick liquid were significantly smaller than that for Jelly and Reset gel. Pharyngeal delay time was significantly smaller for Thick liquid than that for Jelly and Reset gel. There was no difference in hyoid elevation time and hyoid movement time among the conditions. CONCLUSION Mildly thick liquid material may be optimal for patients with primarily oral motor function impairment and jelly, such as Reset gel, may be more suitable for patients with primarily pharyngeal motor function impairment or oral and pharyngeal coordinative motor function decline.
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Affiliation(s)
- Haruka Hino
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Taku Suzuki
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kazuya Maekawa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Reiko Ita
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Anna Sasa
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sirima Kulvanich
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Community Dentistry & Gerodontology, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Eri Takei
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takanori Tsujimura
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Chandran SK, Doucet M. Neurogenic Dysphagia. Otolaryngol Clin North Am 2024:S0030-6665(24)00037-9. [PMID: 38575486 DOI: 10.1016/j.otc.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This article provides an overview of neurogenic dysphagia, describing the evaluation and management of swallowing dysfunction in various neurologic diseases. The article will focus on stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis.
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Affiliation(s)
- Swapna K Chandran
- Department of Otolaryngology, Head and Neck Surgery and Communicative Disorders, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA.
| | - Manon Doucet
- Department of Otolaryngology, Head and Neck Surgery and Communicative Disorders, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA
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Adams-Mitchell CJ, Smith WR, Wilkie DJ. Dysphagia in patients with sickle cell disease: An understudied problem. J Natl Med Assoc 2024; 116:126-130. [PMID: 38262892 DOI: 10.1016/j.jnma.2023.11.005] [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: 07/12/2023] [Revised: 10/02/2023] [Accepted: 11/20/2023] [Indexed: 01/25/2024]
Abstract
Dysphagia which is defined as disordered swallowing is well known as one of the most common and dangerous symptoms of many diseases, including neurological disorders such as Parkinson's disease, amyotrophic lateral sclerosis, myasthenia gravis, and most commonly, stroke. Strokes are a potentially devastating complication of sickle cell disease (SCD), the most common genetic hemoglobinopathy worldwide, yet little is known about dysphagia as it relates to SCD. Thus, the purposes of this article are to review briefly the primary causes and health consequences of dysphagia, to highlight the relevance of dysphagia to SCD, to review what little is known about dysphagia in SCD, to recommend, based on our consensus and the available literature, when to screen, evaluate, and monitor dysphagia in patients with SCD, and to outline unanswered questions where research on dysphagia in SCD might improve health outcomes.
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Affiliation(s)
- Candice J Adams-Mitchell
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, FL, United States.
| | - Wally R Smith
- Florence Neal Cooper Smith Professor of Sickle Cell Disease Vice-Chair for Research, Division of General Internal Medicine Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science University of Florida, Gainesville, FL, United States
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Yu C, Chunmei L, Qin L, Caiping S. Application of Intraoperative Neurophysiological Monitoring (IONM) for Preventing Dysphagia After Anterior Cervical Surgery: A Prospective Study. World Neurosurg 2024; 184:e390-e396. [PMID: 38307198 DOI: 10.1016/j.wneu.2024.01.135] [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: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To evaluate the clinical value of intraoperative nerve monitoring (IONM) for dysphagia after anterior cervical surgery with and without IONM. METHODS A prospective, randomized, controlled study was conducted on 46 patients who underwent anterior cervical spine surgery by an experienced orthopaedic surgeon. Twenty-three patients who underwent anterior cervical surgery did not undergo IONM (non-IONM group), while the other 23 patients who underwent anterior cervical surgery did ("IONM group"). The swallowing function of patients was evaluated using the EAT-10 and endoscopic evaluation of swallowing (FEES) after surgery. RESULTS There was no difference in the incidence of swallowing difficulties between the intervention group and the control group on the third day or sixth week after surgery. At the 12th week after surgery, the incidence of swallowing difficulties in the intervention group and the control group was significantly different (43.5% vs. 13.0%, P = 0.024). CONCLUSIONS IONM is a promising tool for identifying and protecting the spinal cord and nerves during anterior cervical surgery. Our research revealed that IONM significantly reduced the occurrence of swallowing disorders 12 weeks after surgery, but the effect was not significant at the third or sixth week after surgery.
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Affiliation(s)
- Chen Yu
- Department of Urology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Luo Chunmei
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Qin
- Department of Office of the Hospital, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Song Caiping
- Department of Neurology, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Briguglio M, Wainwright TW, Latella M, Ninfa A, Cordani C, Colombo C, Banfi G, Francetti L, Corbella S. A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS). Geriatrics (Basel) 2024; 9:39. [PMID: 38525756 PMCID: PMC10961760 DOI: 10.3390/geriatrics9020039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.
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Affiliation(s)
- Matteo Briguglio
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Thomas W. Wainwright
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8FT, UK
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Bournemouth BH7 7DW, UK
| | - Marialetizia Latella
- Laboratory of Nutritional Sciences, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Aurora Ninfa
- Operational Unit of Phoniatry, ASST Fatebenefratelli-Sacco, 20154 Milan, Italy
| | - Claudio Cordani
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Cecilia Colombo
- Orthopaedic Biotechnology Laboratory, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Giuseppe Banfi
- Scientific Direction, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Luca Francetti
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
- Operational Unit of Odontostomatology, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
| | - Stefano Corbella
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy
- Operational Unit of Odontostomatology, IRCCS Orthopedic Institute Galeazzi, 20161 Milan, Italy
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Yao S, Wang X, Sun J, Guo P. Efficacy of non-invasive brain stimulation for post-stroke dysphagia: a meta-analysis. Psychogeriatrics 2024; 24:433-442. [PMID: 38337190 DOI: 10.1111/psyg.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Given the potential harms of dysphagia after stroke, we noticed the possibility of non-invasive brain stimulation treatments in the management process. METHODS The meta-analysis search for articles published before May 2023 in databases. We used STATA 12.0 software to compute the standard mean difference (SMD) and 95% confidence intervals (CI). RESULTS The study showed a greater improvement in swallowing function in post-stroke dysphagia given transcranial direct current stimulation (tDCS) immediately after treatment, compared to those given sham tDCS (SMD = 2.99, 95% CI = 1.86-4.11). The study showed a greater improvement in swallowing function in post-stroke dysphagia given tDCS some days after treatment, compared to those given sham tDCS (SMD = 2.01, 95% CI = 0.87-3.16). The study showed a greater improvement in swallowing function in post-stroke dysphagia given repetitive transcranial magnetic stimulation (rTMS) immediately after treatment, compared to those given sham rTMS (SMD = 4.17, 95% CI = 3.11-5.23). The study showed a greater improvement in swallowing function in post-stroke dysphagia given rTMS some days after treatment, compared to those given sham rTMS (SMD = 1.77, 95% CI = 0.94-2.60). CONCLUSIONS In conclusion, our study showed the beneficial effects of non-invasive brain stimulation on difficulty swallowing for stroke patients and speculated about the potential application of non-invasive brain stimulation on post-stroke dysphagia improvement.
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Affiliation(s)
- Shan Yao
- Department of Rehabilitation, Xuzhou Central Hospital, Xuzhou, China
| | - Xuxia Wang
- Department of Rehabilitation, Xuzhou Central Hospital, Xuzhou, China
| | - Jie Sun
- Department of Rehabilitation, Xuzhou Central Hospital, Xuzhou, China
| | - Pengfei Guo
- Department of Rehabilitation, Xuzhou Central Hospital, Xuzhou, China
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11
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Cheng H, Song S, Tang Y, Yuan S, Huang X, Ling Y, Wang Z, Tian X, Lyu J. Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study. BMC Psychiatry 2024; 24:65. [PMID: 38263028 PMCID: PMC10804594 DOI: 10.1186/s12888-024-05520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Delirium is prevalent in ischemic stroke patients, particularly those in the intensive care unit (ICU), and it poses a significant burden on patients and caregivers, leading to increased mortality rates, prolonged hospital stays, and impaired cognitive function. Dysphagia, a common symptom in critically ill patients with ischemic stroke, further complicates their condition. However, the association between dysphagia and delirium in this context remains unclear. The objective of this study was to investigate the correlation between dysphagia and delirium in ICU patients with ischemic stroke. METHODS A retrospective analysis was conducted on adult patients diagnosed with ischemic stroke at a medical center in Boston. Ischemic stroke cases were identified using the ninth and tenth revisions of the International Classification of Diseases. Dysphagia was defined as a positive bedside swallowing screen performed by medical staff on the day of ICU admission, while delirium was assessed using the ICU Confusion Assessment Method and review of nursing notes. Logistic regression models were used to explore the association between dysphagia and delirium. Causal mediation analysis was employed to identify potential mediating variables. RESULTS The study comprised 1838 participants, with a median age of approximately 70 years, and 50.5% were female. Among the total study population, the prevalence of delirium was 43.4%, with a higher prevalence observed in the dysphagia group (60.7% vs. 40.8%, p < 0.001) compared to the non-dysphagia group. After adjusting for confounding factors including age, sex, race, dementia, depression, sedative medications, history of falls, visual or hearing deficit, sequential organ failure score, and Glasgow coma score, multifactorial logistic regression analysis demonstrated a significant association between dysphagia and an increased likelihood of delirium (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.07-2.05; p = 0.018; E-value = 1.73). Causal mediation analysis revealed that serum albumin levels partially mediated the association between dysphagia and delirium in critically ill patients with ischemic stroke (average causal mediated effect [ACME]: 0.02, 95% CI: 0.01 to 0.03; p < 0.001). CONCLUSION ICU admission dysphagia may independently contribute to the risk of delirium in patients with ischemic stroke. Early identification and intervention in ischemic stroke patients with dysphagia may help mitigate the risk of delirium and improve patient prognosis.
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Affiliation(s)
- Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Simeng Song
- School of Nursing, Jinan University, Guangzhou, China
| | - Yonglan Tang
- School of Nursing, Jinan University, Guangzhou, China
| | - Shiqi Yuan
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaxuan Huang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yitong Ling
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaoying Tian
- School of Nursing, Jinan University, Guangzhou, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
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12
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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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13
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Dyreborg L, Raunbak SM, Sørensen SS, Melgaard D, Westmark S. The Cost-Effectiveness of Chin Tuck Against Resistance Compared to Usual Care in Citizens with Oropharyngeal Dysphagia - An Economic Evaluation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:787-797. [PMID: 38143783 PMCID: PMC10749109 DOI: 10.2147/ceor.s431380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose This study aims to evaluate the cost-effectiveness of chin tuck against resistance (CTAR) for citizens suffering from dysphagia compared to the standard municipal treatment in Denmark. Patients and Methods A cost-utility analysis, employing a municipal perspective, was conducted using cost data collected alongside clinical data of a randomized controlled trial evaluating the effect of CTAR training for citizens with dysphagia. The composition of the clinical randomized controlled trial, which included citizens with different diagnoses, means that participants had different disease courses. Ninety-two citizens from seven different Danish municipalities were enrolled, of whom 43 received standard care, and 49 received CTAR in addition to standard care. The effect outcome of the economic evaluation was quality-adjusted life years (QALY), estimated using the EQ-5D-5L questionnaire. Individual resource consumption of each citizen was determined based on the use of home care, home nursing care, physio- and occupational therapy, dietitian guidance, and hospital admissions. The incremental costs and QALYs between the intervention group (CTAR in addition to standard care) and standard care group were estimated using regression analysis, and sensitivity analyses were performed to investigate the robustness of the results. Results The base case analysis showed that the intervention group was dominant compared to the standard care group, with a decrease in incremental costs of £542.38 and an increase in incremental QALYs of 0.0118. All sensitivity analyses demonstrated similar findings as the base case analysis, supporting the robustness of the results. Conclusion This study found that the intervention group was the dominant alternative, hence being more effective and cost-saving, compared to the standard care group in a Danish municipality perspective with a three-month time horizon. This study adds to the scarce evidence on the cost-effectiveness of CTAR in a Danish clinical setting, but further studies should focus on estimating long-term cost-effectiveness.
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Affiliation(s)
- Line Dyreborg
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Sabine Michelsen Raunbak
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Sabrina Storgaard Sørensen
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Dorte Melgaard
- North Denmark Regional Hospital, Hjørring, Denmark
- Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Mech-sense, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Westmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
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14
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Starace E, De Pasquale G, Morenghi E, Crippa C, Matteucci S, Pieri G, Soekeland F, Gibbi SM, Lo Cricchio G, Reggiani F, Calatroni M, Pastore M, Mazzoleni B, Mancin S. Hospital Malnutrition in the Medicine and Neurology Departments: A Complex Challenge. Nutrients 2023; 15:5061. [PMID: 38140320 PMCID: PMC10745339 DOI: 10.3390/nu15245061] [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: 11/22/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Hospital malnutrition is especially common among elderly patients with neurological deficits or dementia. These conditions can be exacerbated by unpalatable diets and issues such as dysphagia and presbyphagia. Our study aimed to investigate the prevalence of malnutrition in patients on a homogenized diet and to identify potential correlations with specific clinical variables. We conducted a retrospective observational study in compliance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. The study encompassed 82 patients, mainly elderly and diagnosed with neurodegenerative diseases. Upon initial assessment, 46.34% of the sample displayed a risk of malnutrition based on the Malnutrition Universal Screening Tool (MUST), and 62.20% were classified as malnourished based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Only 45.12% retained autonomy in food intake. Weight loss identified prior to the study was closely tied to malnutrition and influenced BMI. Moreover, autonomy in food intake was strongly associated with a prolonged hospital stay (LOS), and a similar trend was observed for water intake. Our findings emphasize the importance of promptly recognizing patients at risk of malnutrition, especially within such a vulnerable population. Autonomy in food intake and hydration emerge as critical indicators in the clinical management of hospitalized patients.
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Affiliation(s)
- Erica Starace
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Giulia De Pasquale
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Camilla Crippa
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Sofia Matteucci
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Fanny Soekeland
- School of Health Professions, University of Applied Sciences, 3008 Bern, Switzerland;
| | - Stefano Maria Gibbi
- Department of Drug Science, School of Pharmacy, University of Pavia, 27100 Pavia, Italy;
| | - Giuliana Lo Cricchio
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Francesco Reggiani
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Marta Calatroni
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Manuela Pastore
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | - Stefano Mancin
- IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (E.S.); (G.D.P.); (E.M.); (C.C.); (S.M.); (G.P.); (G.L.C.); (F.R.); (M.C.); (M.P.)
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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15
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Li X, Lu L, Fu X, Li H, Yang W, Guo H, Guo K, Huang Z. Systematic review and meta-analysis of the efficacy and safety of electroacupuncture for poststroke dysphagia. Front Neurol 2023; 14:1270624. [PMID: 38125830 PMCID: PMC10731355 DOI: 10.3389/fneur.2023.1270624] [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: 08/02/2023] [Accepted: 11/16/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction Optimal treatment strategies for post-stroke dysphagia (PSD) remain to be explored. Electroacupuncture (EA) has attracted widespread attention due to its simplicity, cheapness, and safety. However, the efficacy of EA in the treatment of PSD lacks high-level evidence-based medical support. This study aimed to systematically evaluate the clinical value of EA in the treatment of PSD. Methods A total of seven databases were searched for relevant literature. All randomized controlled trials (RCTs) on EA alone or EA combined with other interventions for the treatment of PSD were assessed using the modified Jadad scale. The studies with a score of ≥4 were included. The quality of the included studies was then assessed using the Cochrane Collaboration's tool. The meta-analysis was performed using Rev. Man 5.3 software. Results Twelve studies involving 1,358 patients were included in the meta-analysis. Meta-analysis results showed that the EA group was superior to the control group in terms of clinical response rate (OR = 2.63, 95% CI = 1.97 to 3.53) and videofluoroscopic swallowing study (VFSS) score (MD = 0.73, 95% CI = 0.29 to 1.16). There was no significant difference between the two groups in the standardized swallowing assessment (SSA) score (MD = -3.11, 95% CI = -6.45 to 0.23), Rosenbek penetration-aspiration scale (PAS) score (MD = -0.68, 95% CI = -2.78 to 1.41), Swallowing Quality of Life (SWAL-QOL) score (MD = 13.24, 95% CI = -7.74 to 34.21), or incidence of adverse events (OR = 1.58, 95% CI = 0.73 to 3.38). Conclusion This study shows that EA combined with conventional treatment or other interventions can significantly improve the clinical response rate and VFSS score in patients with PSD without increasing adverse reactions.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=396840.
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Affiliation(s)
- Xuezheng Li
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Lijun Lu
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Xuefeng Fu
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Hao Li
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Wen Yang
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Hua Guo
- Postgraduate Cultivation Base of Guangzhou University of Chinese Medicine, Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Kaifeng Guo
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou Guangdong, China
| | - Zhen Huang
- Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, Guangzhou Guangdong, China
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16
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Antunes C, Sloan JA. Esophageal Radiography Interpretation: a Primer for the Gastroenterologist. Curr Gastroenterol Rep 2023; 25:363-373. [PMID: 37938496 DOI: 10.1007/s11894-023-00903-7] [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] [Accepted: 10/20/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW Radiological studies can be helpful when evaluating patients with suspect esophageal disorders. From benign strictures to malignancy and motility disorders such as achalasia, imaging modalities play a significant role in diagnosis. This review explores the role of different imaging modalities in the most frequently encountered esophageal pathologies. RECENT FINDINGS Conventional barium esophagram has long been considered the primary imaging modality of the esophagus. In the same fashion, a timed barium esophagram is a valuable tool in the evaluation of achalasia and esophagogastric junction outlet obstruction. Over the last few decades there has been an increase in CT and MRI studies, which also play a role in the evaluation of esophageal pathologies. However, not infrequently, these newer imaging techniques can result in incidental esophageal findings. It is important that gastroenterologists appreciate the value of different modalities and recognize key imaging features. The diagnosis and management of esophageal disorders is evolving. A basic understanding of esophageal radiology is essential to any gastroenterologist caring for patients with esophageal complaints.
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Affiliation(s)
- Catiele Antunes
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Joshua A Sloan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota Medical School, 420 Delaware Street SE, MMC 36, 1-203, Minneapolis, MN, 55455, USA.
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17
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Rodrigues CDS, Souza RKS, Rocha Neto CV, Otani RH, Batista DDM, Maia AKNDO, Filho KPDO, de Andrade TD, de Andrade Almeida E, Maciel LHG, Castro LDFAAP, Abtibol-Bernardino MR, Baia-da-Silva DC, Benzecry SG, Castilho MDC, Martínez-Espinosa FE, Alecrim MDGC, Santos RS, Botto-Menezes C. Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study. Viruses 2023; 15:2363. [PMID: 38140604 PMCID: PMC10747239 DOI: 10.3390/v15122363] [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: 09/15/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.
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Affiliation(s)
- Cristina de Souza Rodrigues
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Cosmo Vieira Rocha Neto
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Rodrigo Haruo Otani
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Daniel de Medeiros Batista
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | - Ana Karla Nelson de Oliveira Maia
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | | | | | - Luiz Henrique Gonçalves Maciel
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
| | | | - Marília Rosa Abtibol-Bernardino
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Department of Maternal and Child Health, Medical School, Federal University of Amazonas, Manaus 69020-160, Brazil
| | - Djane Clarys Baia-da-Silva
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Faculty of Pharmacy, University Nilton Lins, Manaus 69058-030, Brazil; (K.P.d.O.F.); (T.D.d.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
| | - Silvana Gomes Benzecry
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
| | | | - Flor Ernestina Martínez-Espinosa
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Leônidas & Maria Deane Institute, Fiocruz Amazonia, Manaus 69057-070, Brazil
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
| | - Maria das Graças Costa Alecrim
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- Medical Course Coordination at Manaus Metropolitan College/FAMETRO, Manaus 69050-000, Brazil
| | - Rosane Sampaio Santos
- Postgraduate Program in Communication Disorders (PPGDIC), University of Tuiuti do Paraná (UTP), Paraná 82010-210, Brazil;
| | - Camila Botto-Menezes
- Postgraduate Program in Tropical Medicine (PPGMT), University of Amazonas State (UEA), Manaus 69040-000, Brazil; (C.d.S.R.); (L.H.G.M.); (L.d.F.A.A.P.C.); (M.R.A.-B.); (F.E.M.-E.); (M.d.G.C.A.)
- School of Health Sciences, University of Amazonas State, Manaus 69065-001, Brazil; (C.V.-R.N.); (R.H.O.); (D.d.M.B.); (A.K.N.d.O.M.); (S.G.B.)
- Tropical Medicine Foundation Doutor Heitor Vieira Dourado (FMT-HVD), Manaus 69040-000, Brazil;
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18
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Ambrus A, Rovó L, Sztanó B, Burián A, Molnár-Tóth A, Bach Á. [Introduction of fiberoptic endoscopic evaluation of swallowing and increase of the range of indications in our department]. Orv Hetil 2023; 164:1817-1823. [PMID: 37980634 DOI: 10.1556/650.2023.32912] [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: 08/14/2023] [Accepted: 09/16/2023] [Indexed: 11/21/2023]
Abstract
Dysphagia is a disease resulting from preparatory or transport disorder of the swallowing process and it is divided into oropharyngeal and esophageal phases according to the site of the lesion. The ear, nose and throat assessment focuses on the oropharyngeal phase, but differential diagnosis, investigation, and treatment of the cause of dysphagia is often a complex task requiring multidisciplinary approach and collaboration. The method of fiberoptic endoscopic evaluation of swallowing (FEES) has been introduced at the Department of Ear, Nose and Throat and Head-Neck Surgery, University of Szeged, enabling the examination of otorhinolaryngological and neurological disorders of swallowing as well as objective analysis of patients' swallowing quality. The fiberoptic endoscopic evaluation of swallowing is a minimally invasive procedure that allows visualization of the oropharyngeal phase of swallowing. It can identify anatomical abnormalities or neurological disorders causing dysphagia, thus playing a significant role in later patient rehabilitation. We hereby present our experiences in examinations of patients who underwent partial laryngectomy and/or pharyngectomy due to head and neck tumors as well as of those who underwent airway surgery duo to upper airway stenosis. Thanks to our collaboration with the Neurology Department, we also share our experiences gained during the examinations of patients struggling with oropharyngeal swallowing problems of various neurological origins. Orv Hetil. 2023; 164(46): 1817-1823.
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Affiliation(s)
- Andrea Ambrus
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - László Rovó
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - Balázs Sztanó
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
| | - András Burián
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Pécs Magyarország
| | - Alinka Molnár-Tóth
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Neurológiai Klinika Szeged Magyarország
| | - Ádám Bach
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinika Szeged, Tisza Lajos krt. 111., 6725 Magyarország
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Wong MC, Chan KMK, Wong TT, Tang HW, Chung HY, Kwan HS. Quantitative Textural and Rheological Data on Different Levels of Texture-Modified Food and Thickened Liquids Classified Using the International Dysphagia Diet Standardisation Initiative (IDDSI) Guideline. Foods 2023; 12:3765. [PMID: 37893658 PMCID: PMC10606379 DOI: 10.3390/foods12203765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Diet modification is a common compensation strategy to promote swallowing safety in patients with swallowing difficulties. The International Dysphagia Diet Standardisation Initiative (IDDSI) guideline provides qualitative descriptions on texture-modified food and thickened liquid. This study aimed to establish quantitative textural and rheological data on different IDDSI levels based on common Chinese ingredients and dishes. Textural and rheological properties of 226 samples of various food textures and 93 samples of various liquid consistencies were obtained using a texture profile analysis (TPA) and viscometer, respectively. The establishment of such quantitative data can be used for future texture-modified food product development and research purposes.
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Affiliation(s)
- Man Chun Wong
- Food Research Centre, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China (H.Y.C.)
| | - Karen M. K. Chan
- Swallowing Research Laboratory, The University of Hong Kong, Hong Kong, China;
| | - Tsz Ting Wong
- Food Research Centre, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China (H.Y.C.)
| | - Ho Wah Tang
- Swallowing Research Laboratory, The University of Hong Kong, Hong Kong, China;
| | - Hau Yin Chung
- Food Research Centre, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China (H.Y.C.)
| | - Hoi Shan Kwan
- Food Research Centre, School of Life Sciences, The Chinese University of Hong Kong, Hong Kong, China (H.Y.C.)
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20
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Ornelas G, Bueno Garcia H, Bracken DJ, Linnemeyer-Risser K, Coleman TP, Weissbrod PA. Differentiation of Bolus Texture During Deglutition via High-Density Surface Electromyography: A Pilot Study. Laryngoscope 2023; 133:2695-2703. [PMID: 36734335 DOI: 10.1002/lary.30589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 10/26/2022] [Accepted: 12/03/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Swallowing is a complex neuromuscular task. There is limited spatiotemporal data on normative surface electromyographic signal during swallow, particularly across standard textures. We hypothesize the pattern of electromyographic signal of the anterior neck varies cranio-caudally, that laterality can be evaluated, and categorization of bolus texture can be differentiated by high-density surface electromyography (HDsEMG) through signal analysis. METHODS An HDsEMG grid of 20 electrodes captured electromyographic activity in eight healthy adult subjects across 240 total swallows. Participants swallowed five standard textures: saliva, thin liquid, puree, mixed consistency, and dry solid. Data were bandpass filtered, underwent functional alignment of signal, and then placed into binary classifier receiver operating characteristic (ROC) curves. Muscular activity was visualized by creating two-dimensional EMG heat maps. RESULTS Signal analysis results demonstrated a positive correlation between signal amplitude and bolus texture. Greater differences of amplitude in the cranial most region of the array when compared to the caudal most region were noted in all subjects. Lateral comparison of the array revealed symmetric power levels across all subjects and textures. ROC curves demonstrated the ability to correctly classify textures within subjects in 6 of 10 texture comparisons. CONCLUSION This pilot study suggests that utilizing HDsEMG during deglutition can noninvasively differentiate swallows of varying texture noninvasively. This may prove useful in future diagnostic and behavioral swallow applications. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2695-2703, 2023.
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Affiliation(s)
- Gladys Ornelas
- Department of Bioengineering, University of California San Diego, La Jolla, California, U.S.A
| | - Hassler Bueno Garcia
- Department of Bioengineering, University of California San Diego, La Jolla, California, U.S.A
| | - David J Bracken
- Department of Otolaryngology, University of California San Francisco, San Francisco, California, U.S.A
| | | | - Todd P Coleman
- Department of Bioengineering, University of California San Diego, La Jolla, California, U.S.A
| | - Philip A Weissbrod
- Department of Otolaryngology, University of California San Diego, La Jolla, California, U.S.A
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21
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Hagiwara A, Komiya K, Yoshimatsu Y, Kudoh R, Hiramatsu K, Kadota JI. Factors Associated With Swallowing Function Among Physicians in Their 50s and 60s: A Cross-Sectional Study. Cureus 2023; 15:e47921. [PMID: 37905163 PMCID: PMC10613514 DOI: 10.7759/cureus.47921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Individuals with swallowing dysfunction in their 50s and 60s may be at risk for aspiration pneumonia as they age. The association of background and lifestyle with swallowing dysfunction for those in their 50s and 60s has not been fully studied. This study aimed to clarify the relationship between lifestyle and swallowing function in this group. PATIENTS AND METHODS We targeted physicians in their 50s and 60s as participants. The repetitive saliva swallowing test (RSST) was used to evaluate swallowing function, and self-reported questionnaires about their lifestyle were administered. The associations between RSST scores and participants' backgrounds and lifestyles were analyzed. RESULTS This study included 310 participants, who were divided into two groups: 162 in the low RSST group and 148 in the high RSST group. The low RSST group had significantly shorter daily conversation times and a lower incidence of hyperlipidemia than the high RSST group. On multivariate analysis, less than three hours of daily conversation time was independently related to lower RSST scores (adjusted odds ratio: 1.863; 95% confidence interval: 1.167-2.974). CONCLUSIONS Shorter conversation time may serve as a predictor of impaired swallowing function, potentially increasing the risk of aspiration pneumonia in the future.
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Affiliation(s)
- Akihiko Hagiwara
- Department of Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Kosaku Komiya
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, JPN
| | - Yuki Yoshimatsu
- Department of Internal Medicine, University of Greenwich, London, GBR
| | - Ryohei Kudoh
- Department of Respiratory Medicine and Infectious Diseases, Oita University, Oita, JPN
| | - Kazufumi Hiramatsu
- Department of Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Yufu, JPN
| | - Jun-Ichi Kadota
- Department of Respiratory Medicine and Infectious Diseases, Oita University, Yufu, JPN
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22
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Zugasti Murillo A, Gonzalo Montesinos I, Cancer Minchot E, Botella Romero F. Hospital management of the patient with dysphagia. Survey and recommendations of SEEN nutrition area. ENDOCRINOL DIAB NUTR 2023; 70 Suppl 3:1-9. [PMID: 37468415 DOI: 10.1016/j.endien.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/03/2022] [Indexed: 07/21/2023]
Abstract
INTRODUCTION The prevalence of dysphagia in hospitalized patients is extraordinarily high and little known. The goal of care should be to assess the efficacy and safety of swallowing, to indicate personalized nutritional therapy. The development of Dysphagia Units, as a multidisciplinary team, facilitates comprehensive care for this type of patient. MATERIAL AND METHODS A observational, cross-sectional, web-based survey-type study, focused on Spanish Society of Endocrinology and Nutrition department heads, was conducted in September-October 2021. The following data were analyzed: size and type of center, existence of a dysphagia unit, dysphagia screening, dietary and nutritional therapy, education and training of professionals and patients, codification, and quality of life evaluation. RESULTS 65 responses (39% of the total Endocrinology and Nutrition departments). 37% of hospitals have a Dysphagia Unit and 25% are developing it. 75.4% perform screening, with MECV-V in 80.6%, and VED (61.4%) and VFS (54.4%) are performed as main complementary tests. The centers have different models of oral diet, thickeners and nutritional oral supplements adapted to dysphagia. In 40% of the centers, no information is offered on dysphagia, nor on the use of thickeners, dysphagia is coded in 81%, 52.3% have specific nursing protocols and only 8% have scales for quality-of-life evaluation. CONCLUSIONS The high prevalence and the risk of serious complications require early and multidisciplinary management at the hospital level. The information received by the patient and caregiver about the dietary adaptations they need, is essential to minimize risks and improve quality of life.
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Affiliation(s)
- Ana Zugasti Murillo
- Sección de Nutrición Clínica, Servicio Endocrinología y Nutrición, Hospital Universitario de Navarra, Pamplona, Navarra, Spain.
| | | | - Emilia Cancer Minchot
- Sección de Endocrinología y Nutrición, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Francisco Botella Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete Área de Nutrición de la SEEN, Albacete, Spain
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23
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Liu C, Li Y, Tan Z, Liu H, Zhou M, Li J, Liang J, Xiao L. Endoscopic botulinum toxin injection combined with balloon dilatation for treatment of cricopharyngeal achalasia in patient with brainstem stroke. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1203-1209. [PMID: 37875360 PMCID: PMC10930855 DOI: 10.11817/j.issn.1672-7347.2023.230254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVES At present, there are many reports about the treatment of cricopharyngeal achalasia by injecting botulinum toxin type A (BTX-A) into cricopharyngeal muscle guided by ultrasound, electromyography or CT in China, but there is no report about injecting BTX-A into cricopharyngeal muscle guided by endoscope. This study aims to evaluate the efficacy of endoscopic BTX-A injection combined with balloon dilatation in the treatment of cricopharyngeal achalasia after brainstem stroke, and to provide a better method for the treatment of dysphagia after brainstem stroke. METHODS From June to December 2022, 30 patients with cricopharyngeal achalasia due to brainstem stroke were selected from the Department of Rehabilitation Medicine, the First Hospital of Changsha. They were randomly assigned into a control group and a combined group, 15 patients in each group. Patients in both groups were treated with routine rehabilitation therapy, while patients in the control group were treated with balloon dilatation, and patients in the combined group were treated with balloon dilatation and BTX-A injection. Before treatment and after 2 weeks of treatment, the patients were examined by video fluoroscopic swallowing study, Penetration-aspiration Scale (PAS), Dysphagia Outcome Severity Scale (DOSS), and Functional Oral Intake Scale (FOIS) were used to assess the swallowing function. RESULTS In the combined group, 1 patient withdrew from the treatment because of personal reasons. Two weeks after treatment, the scores of DOSS, PAS, and FOIS in both groups were better than those before treatment (all P<0.01), and the combined group was better than the control group (all P<0.001). The effective rate was 85.7% in the combined group and 66.7% in the control group, with no significant difference between the 2 groups (P>0.05). CONCLUSIONS BTX-A injection combined with balloon dilatation is more effective than balloon dilatation alone in improving swallowing function and is worthy of clinical application.
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Affiliation(s)
- Chao Liu
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005.
| | - Yuan Li
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Zhi Tan
- Department of Gastroenterology, First Hospital of Changsha, Changsha 410005, China
| | - Hua Liu
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Meiyun Zhou
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Jie Li
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Junjun Liang
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005
| | - Le Xiao
- Department of Rehabilitation Medicine, First Hospital of Changsha, Changsha 410005.
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24
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Ito H, Nagao A, Maeda S, Nakahira M, Hyodo M. Clinical Significance of Surgical Intervention to Restore Swallowing Function for Sustained Severe Dysphagia. J Clin Med 2023; 12:5555. [PMID: 37685624 PMCID: PMC10488804 DOI: 10.3390/jcm12175555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
Owing to rapid population aging, patients with dysphagia are significantly increasing in society. Dysphagia treatment is aimed at the restoration of the swallowing function and the prevention of recurrent aspiration-induced pulmonary infection. However, despite intensive rehabilitation, oral food intake remains inadequate in many patients with severe dysphagia, which results in the deterioration of patients' quality of life and joy of living. Surgical intervention may serve as a useful therapeutic strategy to restore swallowing function in these patients. The study included 25 patients (mean, 70.4 years; male/female ratio, 20:5) with chronic dysphagia. Dysphagia was associated with cerebrovascular diseases in sixteen patients; with age-induced physiological deterioration in five patients; and with miscellaneous etiologies in four cases. Cricopharyngeal and infrahyoid myotomies were performed in all patients. Laryngeal elevation and the medialization of the paralyzed vocal fold were performed in 15 and 3 patients, respectively. The Food Intake Level Scale (FILS) and videoendoscopic examination score (VEES) were used to evaluate swallowing function. The FILS showed a restoration of oral food intake alone in 72% of patients, and 64% of patients maintained this improvement at their last follow-up visit. We observed significantly improved VEES scores postoperatively. However, patients with cognitive impairment or advanced age showed poor outcomes. In conclusion, surgical intervention may be an effective therapeutic option to restore swallowing function in cases of sustained severe dysphagia; however, surgical indications require careful consideration.
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Affiliation(s)
- Hiroaki Ito
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
| | - Asuka Nagao
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
| | - Suguru Maeda
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
| | - Maya Nakahira
- Department of Rehabilitation, Kochi Medical School Hospital, Kohasu, Okou-cho, Nankoku 783-8505, Japan;
| | - Masamitsu Hyodo
- Department of Otolaryngology, Kochi Medical School, Kohasu, Okou-cho, Nankoku 783-8505, Japan; (H.I.); (A.N.); (S.M.)
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25
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Chaudhry TS, Senapati SG, Gadam S, Mannam HPSS, Voruganti HV, Abbasi Z, Abhinav T, Challa AB, Pallipamu N, Bheemisetty N, Arunachalam SP. The Impact of Microbiota on the Gut-Brain Axis: Examining the Complex Interplay and Implications. J Clin Med 2023; 12:5231. [PMID: 37629273 PMCID: PMC10455396 DOI: 10.3390/jcm12165231] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/30/2023] [Accepted: 08/02/2023] [Indexed: 08/27/2023] Open
Abstract
The association and interaction between the central nervous system (CNS) and enteric nervous system (ENS) is well established. Essentially ENS is the second brain, as we call it. We tried to understand the structure and function, to throw light on the functional aspect of neurons, and address various disease manifestations. We summarized how various neurological disorders influence the gut via the enteric nervous system and/or bring anatomical or physiological changes in the enteric nervous system or the gut and vice versa. It is known that stress has an effect on Gastrointestinal (GI) motility and causes mucosal erosions. In our literature review, we found that stress can also affect sensory perception in the central nervous system. Interestingly, we found that mutations in the neurohormone, serotonin (5-HT), would result in dysfunctional organ development and further affect mood and behavior. We focused on the developmental aspects of neurons and cognition and their relation to nutritional absorption via the gastrointestinal tract, the development of neurodegenerative disorders in relation to the alteration in gut microbiota, and contrariwise associations between CNS disorders and ENS. This paper further summarizes the synergetic relation between gastrointestinal and neuropsychological manifestations and emphasizes the need to include behavioral therapies in management plans.
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Affiliation(s)
| | | | - Srikanth Gadam
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (S.G.); (N.P.)
| | - Hari Priya Sri Sai Mannam
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (H.P.S.S.M.); (H.V.V.); (Z.A.); (T.A.); (N.B.)
| | - Hima Varsha Voruganti
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (H.P.S.S.M.); (H.V.V.); (Z.A.); (T.A.); (N.B.)
| | - Zainab Abbasi
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (H.P.S.S.M.); (H.V.V.); (Z.A.); (T.A.); (N.B.)
| | - Tushar Abhinav
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (H.P.S.S.M.); (H.V.V.); (Z.A.); (T.A.); (N.B.)
| | | | - Namratha Pallipamu
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (S.G.); (N.P.)
| | - Niharika Bheemisetty
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (H.P.S.S.M.); (H.V.V.); (Z.A.); (T.A.); (N.B.)
| | - Shivaram P. Arunachalam
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA; (S.G.); (N.P.)
- GIH Artificial Intelligence Laboratory (GAIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (H.P.S.S.M.); (H.V.V.); (Z.A.); (T.A.); (N.B.)
- Microwave Engineering and Imaging Laboratory (MEIL), Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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26
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Cui Q, Wei B, He Y, Zhang Q, Jia W, Wang H, Xi J, Dai X. Findings of a videofluoroscopic swallowing study in patients with dysphagia. Front Neurol 2023; 14:1213491. [PMID: 37609654 PMCID: PMC10441781 DOI: 10.3389/fneur.2023.1213491] [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: 04/28/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Objective Swallowing examination is crucial in patients with dysphagia. We aimed to compare qualitative and quantitative videofluoroscopic swallowing study (VFSS) results to provide reference for standardizing quantitative parameters. Materials and methods In total, 117 patients with dysphagia were included, 38 with Parkinson's disease and 39 and 40 in convalescence following cerebral hemorrhage and infarction. VFSS was both qualitatively and quantitatively analyzed. Results A significant difference of Oral transit time was found between the oral motor function grades (p < 0.001), also was swallowing reaction times found between swallowing reaction duration grades (p < 0.001), and soft palate lift duration between the soft palate lift grades (p < 0.001). Superior hyoid bone movement (p < 0.001), anterior hyoid bone movement (p < 0.001), hyoid pause time (p < 0.001), and hyoid movement duration (p = 0.032) had significant differences between the hyoid laryngeal complex movement grades, as did the pharyngeal cavity transit time among the cricopharyngeal muscle opening duration grades (p < 0.001). The laryngeal vestibule closure duration differed among the glottic closure grades (p < 0.001). No statistically significant difference in upper esophageal sphincter opening diameter (p = 0.682) or duration (p = 0.682) among the cyclopharyngeal muscle opening duration grades. The pharyngeal area at rest did not significantly differ among the different vallecular residue (p = 0.202) and pyriform sinus residue (p = 0.116) grades. Conclusion Several quantitative parameters can reflect the swallowing assessment process well. Further optimization of quantitative parameters is recommended.
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Affiliation(s)
- Qingjia Cui
- Rehabilitation Centre of Otolaryngology-Head and Neck, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Bing Wei
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan He
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Weiwei Jia
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Haiying Wang
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xin Dai
- Speech Rehabilitation Department of Neurorehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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27
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El Halabi M, Arwani R, Parkman HP. Dysphagia in Neurological Disorders. Semin Neurol 2023; 43:530-539. [PMID: 37579785 DOI: 10.1055/s-0043-1771458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Dysphagia is a common symptom in many neurologic disorders. Patients with oropharyngeal dysphagia present with difficulties when they start to swallow, often with coughing and choking; whereas patients with esophageal dysphagia describe the feeling that swallowed food stops in the chest. Chronic neurologic diseases such stroke, Parkinson's disease, or dementia often have dysphagia as a symptom, particularly oropharyngeal dysphagia, and the term "neurogenic dysphagia" is often used. A disruption of the sophisticated, integrated sensorimotor swallowing system is usually the main reason behind dysphagia. Dysphagia can be associated with aspiration leading to aspiration pneumonia, and chronic dysphagia can lead to weight loss and malnutrition. Patients with dysphagia, when accurately and promptly diagnosed through medical history, physical examination, and diagnostic tests, often can be treated and experience improved quality of life. The pathophysiological mechanisms behind dysphagia, its diagnosis, and potential treatments are discussed in this manuscript.
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Affiliation(s)
- Maan El Halabi
- Section of Gastroenterology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Remy Arwani
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Henry P Parkman
- GI Motility Laboratory, Section of Gastroenterology, Department of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
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28
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Shaik MR, Shaik NA, Mikdashi J. Autoimmune Dysphagia Related to Rheumatologic Disorders: A Focused Review on Diagnosis and Treatment. Cureus 2023; 15:e41883. [PMID: 37581141 PMCID: PMC10423619 DOI: 10.7759/cureus.41883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
Autoimmune dysphagia is defined as dysphagia caused by autoimmune processes affecting various components of the swallowing process such as muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. These autoimmune causes can be classified into gastroenterological, dermatological, rheumatologic, and neurologic. Rheumatological disorders, such as scleroderma, Sjogren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, sarcoidosis, Behcet's disease, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, or granulomatosis with polyangiitis, have been associated with dysphagia. Autoimmune dysphagia in the context of rheumatological disorders is particularly significant because it can occur as a sole manifestation or as part of a symptom complex associated with the underlying disorder and often responds to immunosuppressive therapies. However, diagnosing autoimmune dysphagia can be challenging as it requires the exclusion of structural and primary motility disorders through procedures such as endoscopy and manometry. Early diagnosis is important to improve the quality of life and prevent significant mortality and morbidity. Management focuses on treating the underlying disease activity, and a multidisciplinary approach involving various medical specialties may be necessary to achieve success. This article aims to review the autoimmune rheumatological conditions that can lead to dysphagia and discuss the associated pathophysiological mechanisms. We also outline the clinical clues and laboratory testing methods that facilitate early diagnosis, with the goal of improving patient outcomes through timely intervention and appropriate management.
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Affiliation(s)
- Mohammed Rifat Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Nishat Anjum Shaik
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Jamal Mikdashi
- Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, USA
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29
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Jiang W, Zou Y, Huang L, Zeng Y, Xiao LD, Chen Q, Zhang F. Gustatory stimulus interventions for older adults with dysphagia: a scoping review. Aging Clin Exp Res 2023:10.1007/s40520-023-02437-4. [PMID: 37209267 DOI: 10.1007/s40520-023-02437-4] [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: 12/07/2022] [Accepted: 05/07/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Gustatory stimulus interventions have been shown to improve swallowing function in older adults with dysphagia. However, the optimal intervention strategies as well as their effects and safety remain unclear. AIMS To explore current evidence regarding gustatory stimulus interventions for dysphagia in older adults. METHODS Nine electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Sinomed) were searched from their inception to August 2022. RESULTS This review identified 263 articles, and 15 met the inclusion criteria. The types of gustatory stimulus interventions included spicy (n = 10), sour (n = 3), and mixed (sour-sweet) stimuli (n = 2), with most studies focusing on spicy stimuli. The most frequently reported spicy stimulus was capsaicin. Further, the most commonly reported intervention frequency was thrice a day before meals for 1-4 weeks. The stimuli concentrations and dosages could not be standardized due to the among-study heterogeneity. These studies reported 16 assessment tools and 42 outcomes, which mainly included videofluoroscopy and swallowing response time respectively. More than half of the included studies reported no adverse effects of gustatory stimulus interventions. CONCLUSION AND DISCUSSIONS Gustatory stimulus interventions improved swallowing function in older adults with dysphagia. However, assessment tools and outcomes for dysphagia should be standardized in the future, and explore personalized interventions based on different diseases and their stages, to determine the most cost-effective interventions, and to prevent its complications.
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Affiliation(s)
- Wenyi Jiang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Ying Zou
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Lei Huang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China
- West China Hospital, Sichuan University, Chengdu, China
| | - Yanli Zeng
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lily Dongxia Xiao
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Qian Chen
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Fengying Zhang
- West China School of Nursing, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
- Nursing Key Laboratory of Sichuan Province, Chengdu, China.
- Innovation Center of Nursing Research, Sichuan University, Chengdu, China.
- West China Hospital, Sichuan University, Chengdu, China.
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Chu ECP. Remission of cervicogenic dysphagia associated with biomechanical dysfunction following chiropractic therapy. J Med Life 2023; 16:794-798. [PMID: 37520480 PMCID: PMC10375352 DOI: 10.25122/jml-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/09/2023] [Indexed: 08/01/2023] Open
Abstract
Cervicogenic dysphagia is a complex condition that can arise from biomechanical dysfunction in the cervical spine. Conventional treatment outcomes are not always guaranteed. Chiropractic treatment is considered an alternative treatment for dysphagia, yet there is a lack of evidence supporting its effectiveness. We present the case of a 48-year-old male who had difficulty swallowing for eight months. He had a feeling of food stuck in his throat when eating hard food but without any pain when swallowing, and eventually, he could not swallow any dry food. He was diagnosed with dysphagia associated with an anxiety disorder and was treated with medication, but there was no improvement in his condition. A full-spine radiograph revealed biomechanical dysfunction, including reduced cervical lordosis and levoscoliosis of the upper thoracic spine. After nine months of conventional physiotherapy, the patient completely recovered from his symptoms, with significantly improved biomechanical parameters. This study highlights the potential mechanism of cervicogenic dysphagia and the effect of chiropractic treatment in managing it. Applying chiropractic treatment, including spinal manipulative therapy, instrument-assisted soft tissue manipulation, and mechanical traction, might bring a positive outcome for dysphagia patients with careful consideration.
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Affiliation(s)
- Eric Chun-Pu Chu
- New York Chiropractic and Physiotherapy Centre, Hong Kong, China
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Helliwell K, Hughes VJ, Bennion CM, Manning-Stanley A. The use of videofluoroscopy (VFS) and fibreoptic endoscopic evaluation of swallowing (FEES) in the investigation of oropharyngeal dysphagia in stroke patients: A narrative review. Radiography (Lond) 2023; 29:284-290. [PMID: 36640583 DOI: 10.1016/j.radi.2022.12.007] [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: 10/19/2022] [Revised: 12/18/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Patients with suspected acute stroke require rapid assessment of swallowing on admission. If aspiration is suspected, this takes the form of specialist assessment, using either videofluoroscopy (VFS) or fibreoptic endoscopic evaluation of swallowing (FEES). The review aim was to evaluate and compare the effectiveness of each method in stroke patients. Literature was collected from the databases Scopus, Web of Science and Medline, and articles included in the review were published within the last 10 years, in the English language. KEY FINDINGS Sensitivity and specificity ranged from 0.29-0.33 and 0.96-1.0 for VFS, respectively, and 0.37-1.0 and 0.65-0.87 for FEES, respectively, depending on the type of bolus utilised. VFS is the current gold-standard for the investigation of oropharyngeal dysphagia (OD), however, radiation dose and patient transport implications mean FEES may be preferred. FEES has limitations including 'whiteout' and the invasive nature of the endoscope. The NICE guidelines do not recommend a definitive protocol specifically in stroke patients. This suggests further research may be required to determine the most effective method. CONCLUSION FEES is a beneficial first line examination, providing limited invasiveness, and administering a high level of patient suitability, without using ionising radiation. VFS could potentially be useful following FEES to secure full visualisation, ensuring an aspiration event is not missed during FEES. IMPLICATIONS FOR PRACTICE Use of FEES as the first line test rather than VFS, ensures radiation dose is as low as reasonably practicable (ALARP). Ongoing research to ensure protocols follow current best practice can help ensure accurate management of oropharyngeal dysphagia in stroke patients.
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Affiliation(s)
- K Helliwell
- Calderdale and Huddersfield NHS Foundation Trust, Calderdale Royal Hospital, Salterhebble, Halifax, HX3 0PW, UK.
| | - V J Hughes
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
| | - C M Bennion
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
| | - A Manning-Stanley
- Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
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Implementation of a free water protocol at a long term acute care hospital. Sci Rep 2023; 13:2626. [PMID: 36823156 PMCID: PMC9950376 DOI: 10.1038/s41598-023-29448-5] [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: 02/23/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
This feasibility study aimed to trial a Free Water Protocol (FWP) for patients with thin liquid dysphagia in the Long-Term Acute Care Hospital (LTACH) setting. Patients with dysphagia are often prescribed thickened liquids to avoid or mitigate aspiration. While this clinical intervention can minimize the risk of aspiration pneumonia (PNA), it is generally not well received by patients. As such, the goal of this study was to determine if patients who knowingly aspirate thin liquids can safely tolerate thin liquid water, and if so, to what degree of benefit. The study assessed for adverse events, fluid intake, hydration status, quality of life, and overall swallow function outcomes. These measurements were taken over a 7 day trial period using inventories, lab work, clinical judgment, and observation. Ten participants were enrolled in this study with 9 having sufficient data for analysis (n = 9). No adverse events related to the FWP were observed, and patients saw improved total fluid intake (P = 0.0074), swallow-related quality of life (P = 0.0273), and overall swallow function (P = 0.0002). The results in this feasibility study allowed for the hospital wide implementation of the FWP and laid out the groundwork for future studies looking at longitudinal effects of a FWP.
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Potente P, Buoite Stella A, Vidotto M, Passerini M, Furlanis G, Naccarato M, Manganotti P. Application of Ultrasonography in Neurogenic Dysphagia: A Systematic Review. Dysphagia 2023; 38:65-75. [PMID: 35556172 PMCID: PMC9873712 DOI: 10.1007/s00455-022-10459-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 04/22/2022] [Indexed: 01/28/2023]
Abstract
Swallowing disorders are common in neurological diseases, with dysphagia representing one of the most prevalent complications that may cause poor quality of life, reduce independence, and increase mortality. Rapid identification of dysphagia is necessary to reduce the risk of penetration and aspiration, and to early start rehabilitation protocols. Among the methods that can be used to evaluate dysphagia and its components, ultrasound imaging has been suggested to support the evaluation of dysphagia by providing measures of both static and dynamic anatomical components. The aim of this systematic review is to evaluate the usefulness of ultrasonography in neurogenic dysphagia according to current literature. From 2000 to 2020, 633 studies with the appropriate search terms for ultrasound and dysphagia were identified. After screening them, 10 studies were included in the qualitative analysis. Patients with the following neurologic conditions were studied with ultrasonography for dysphagia: Parkinson's disease, muscle dystrophy, amyotrophic lateral sclerosis, and stroke. The main outcomes of ultrasonography were swallowing muscles thickness (e.g., tongue), and dynamic measures such as hyoid displacement. The different protocols used in the studies, as well as their outcomes, did not allow to provide standard procedures and normative or cut-off values in the presented diseases. Because there are a variety of tools, methods, and techniques that have been used in the studies that were reviewed, it is difficult to evaluate them using established standards. However, ultrasonography correlates well with clinical evaluation of dysphagia and therefore has prognostic and rehabilitation potential. Future studies should aim to develop and utilize a common interdisciplinary protocol that includes standard procedures and outcomes to define normative values applicable in the different conditions.
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Affiliation(s)
- Paola Potente
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Monica Vidotto
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Michelle Passerini
- School of Speech and Language Therapy, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital of Trieste ASUGI, University of Trieste, Strada di Fiume 447, 34100, Trieste, Italy.
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Neuroplasticity Elicited by Modified Pharyngeal Electrical Stimulation: A Pilot Study. Brain Sci 2023; 13:brainsci13010119. [PMID: 36672100 PMCID: PMC9856550 DOI: 10.3390/brainsci13010119] [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: 11/13/2022] [Revised: 12/26/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023] Open
Abstract
Modified pharyngeal electrical stimulation (mPES) is a novel therapeutic method for patients with neurogenic dysphagia and tracheostomy. However, the underlying neural mechanisms are still unclear. This study aims to investigate the impact of mPES on swallowing-related neural networks and involuntary swallowing frequency using functional near-infrared spectroscopy (fNIRS). 20 healthy volunteers participated in this study, including two separate experimental paradigms. Experiment 1: Immediate effect observation, 20 participants (10 female; mean age 47.65 ± 10.48) were delivered with real and sham mPES in random order for 8 repetitions. fNIRS signals were collected during the whole period of Experiments 1. Swallowing frequency was assessed during sham/real mPES. Experiment 2: Prolonged effect observation, 7 out of the 20 participants (4 female; mean age 49.71 ± 6.26) completed real mPES for 5 sessions (1 session/day). 13 of the 20 participants withdrew for personal reasons. Hemodynamic changes were recorded by fNIRS on day 1 and 5. Results show that mPES evoked cortical activation over a distributed network in bilateral primary somatosensory, primary motor, somatosensory association cortex, pre-motor and supplementary motor area, dorsolateral prefrontal cortex, Broca's area, and supramarginal gyrus part of Wernicke's area. Meanwhile, the increased frequency of involuntary swallowing was associated with decreased frontopolar activation (frontopolar cortex: Channel 6, p = 0.024, r = -0.529; Channel 23, p = 0.019, r = -0.545). Furthermore, after five days of mPES, decreased cortical activations were observed in the right dorsolateral prefrontal and supramarginal gyrus part of Wernicke's area, and left frontopolar and M1 areas. Overall, these results might suggest that mPES could elicit changes in neuroplasticity that could reorganize the swallowing-related neural network and increase involuntary swallow frequency.
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Caruso AM, Bommarito D, Girgenti V, Amato G, Figuccia A, Casuccio A, Ferlisi A, Genuardi R, La Fata S, Mattei R, Milazzo MPM, Di Pace MR. Evaluation of Dysphagia and Inhalation Risk in Neurologically Impaired Children Using Esophageal High-Resolution Manometry with Swallowing Analysis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121987. [PMID: 36553430 PMCID: PMC9777053 DOI: 10.3390/children9121987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Dysphagia in neurologically impaired children is associated with feeding difficulties, malnutrition and aspiration pneumonia. Esophageal high-resolution manometry (HRM) has been used in the diagnosis of motility disorders affecting the swallowing process. The aim of this study was to analyze swallowing functions in NI children by using HRM in order to establish swallow parameters identifying inhalation risk. METHODS Twenty-five NI children with cerebral palsy were submitted to esophageal HRM with UES analysis, comparing the results with non-NI children. The following parameters were evaluated: maximum pressure and duration of contraction of the velopharynx (VP) and tongue base (TB), and maximal, minimal, resting pressure and relaxation duration of the upper esophageal sphincter (UES). RESULTS pVP max, pTB max, pUES max and resting pressure were lower, while p UES minimal was higher and relaxation duration was shorter in NI children vs. the control group. Predictive values of inhalation risk were evaluated. CONCLUSIONS This study evaluates inhalation risk in NI children using HRM to study UES function. Our results confirm the alterations described in NI children: insufficient contraction and clearing force for bolus transmission through the pharynx and incomplete UES relaxation can predispose to pharyngeal residues and inhalation independently of swallowing because of lower values of UES resting.
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Affiliation(s)
- Anna Maria Caruso
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-091-6666-009; Fax: +39-091-6666-006
| | - Denisia Bommarito
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Vincenza Girgenti
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Glenda Amato
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Adele Figuccia
- Pediatric Surgical Unit, Department Health Promotion, of Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 61, 90133 Palermo, Italy
| | - Alessandra Casuccio
- Pediatric Surgical Unit, Department Health Promotion, of Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 61, 90133 Palermo, Italy
| | - Annalisa Ferlisi
- Cystic Fibrosis and Respiratory Pediatric Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Rosaria Genuardi
- Pediatric Anestesiologit Intensive Unit Care Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Sabrina La Fata
- Medical Direction, Pediatric Nutritional Service, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | - Rosalia Mattei
- Pediatric Surgical Unit, Children’s Hospital ‘G. di Cristina’, ARNAS Civico, 4, 90127 Palermo, Italy
| | | | - Maria Rita Di Pace
- Pediatric Surgical Unit, Department Health Promotion, of Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 61, 90133 Palermo, Italy
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Shao X, Chen B, Zhu L, Zhu L, Zheng J, Pu X, Chen J, Xia J, Wu X, Zhang J, Wu D. The Effects of Adding Di-Tan Decoction (DTD) and/or Electroacupuncture (EA) to Standard Swallowing Rehabilitation Training (SRT) for Improving Poststroke Dysphagia (PSD): A Pilot, Single-Centred, Randomized Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2011597. [PMID: 36532853 PMCID: PMC9754838 DOI: 10.1155/2022/2011597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 01/06/2024]
Abstract
OBJECTIVES To evaluate the effect of adding Di-tan decoction (DTD) and/or electroacupuncture (EA) to standard swallowing rehabilitation training (SRT) on improving PSD. METHODS In total, 80 PSD patients were enrolled and randomly assigned to the DTD, EA, DTD + EA or control group at a 1 : 1 : 1 : 1 ratio. All patients received basic treatment and standard SRT. The DTD group received DTD orally, the EA group received EA, the DTD + EA group received both DTD and EA simultaneously, and the control group received only basic treatment and standard SRT. The interventions lasted for 4 weeks. The outcome measurements included the Standardized Swallowing Assessment (SSA) and Swallowing-Quality of Life (SWAL-QOL), performed and scored from baseline to 2, 4, and 6 weeks after intervention, and the Videofluoroscopic Dysphagia Scale (VDS), scored at baseline and 4 weeks after intervention. Scores were compared over time by repeated-measures analysis of variance (ANOVA) among all groups. Interactions between interventions were explored using factorial design analysis. RESULTS (1) The effective rates (ERs) for PSD treatment were higher in the DTD, EA and DTD + EA groups than in the control group (all P < 0.05). The ER was higher in the DTD + EA group than in the DTD or EA group (both P < 0.05). (2) There were significant group effects, time effects and interactions for the SSA and SWAL-QOL scores (all P < 0.05). All groups showed decreasing trends in SSA scores and increasing trends in SWAL-QOL scores over time from baseline to 6 weeks after intervention (all P < 0.01). (3) Factorial design analysis for ΔVDS showed that there was a significant main effect for DTD intervention (F = 11.877, P < 0.01) and for EA intervention (F = 29.357, P < 0.01). However, there was no significant interaction effect between DTD and EA (F = 0.133, P = 0.717). Multiple comparisons showed that the DTD, EA and DTD + EA groups all had higher ΔVDS values than the control group (P < 0.05). The DTD + EA group had a higher ΔVDS than the DTD or EA group (both P < 0.05). (4) Most adverse reactions were mild and transient. CONCLUSIONS Adding DTD or EA to SRT can better improve PSD than applying SRT alone. Adding DTD and EA simultaneously can accelerate and amplify the recovery of swallowing function versus DTD or EA alone, and both are effective and safe treatments, alone or jointly, for PSD and are a powerful supplement to routine treatments.
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Affiliation(s)
- Xiangzhi Shao
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Bing Chen
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Lielie Zhu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Lili Zhu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jinyihui Zheng
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Xinyu Pu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jiajun Chen
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jianning Xia
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Xinming Wu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Jiacheng Zhang
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
| | - Dengchong Wu
- Department of Rehabilitation, Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou 325000, China
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Zhang J, Li Q, Wu HY, Yang Y. A Systematic Review of Swallowing Training Measures for Postoperative Oral Cancer Patients. Dysphagia 2022; 37:1839-1850. [PMID: 35435477 DOI: 10.1007/s00455-022-10445-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/28/2022] [Indexed: 12/24/2022]
Abstract
Swallowing disorder is one of the most common postoperative complications for oral cancer patients and seriously influences quality of life. Limited attention has been paid to evaluating swallowing training measures in postoperative oral cancer patients. This study systematically reviewed swallowing training measures for these patients. A comprehensive search strategy was undertaken across various databases for studies published between database inception and 15 June 2021. Raters independently judged titles, abstracts and full articles for selection according to inclusion and exclusion criteria. The included literature was evaluated for quality and data were extracted. Meta-analyses were conducted using RevMan 5.3. Ten intervention studies (four randomized controlled trials and six quasi-experimental studies) involving 588 patients were identified. Across the studies, most started in the early postoperative stage; however, there were differences in starting time, training time and duration, and type of training. We summarized four training methods: oral exercise, oral sensory stimulation, compensatory strategies and protective airway manoeuvres. The meta-analysis indicated that swallowing training could improve patients' swallowing function and quality of life in the short term, but the long-term effects were not obvious. Swallowing training mostly occurred in the early postoperative period and training measures were often used in combination. The timing, frequency and content of interventions varied between studies, and the effectiveness of any single measure was unclear. High-quality randomized controlled trials are necessary to study the efficacy and clinical applicability of various training measures, to provide a theoretical basis for their optimal selection and to develop a standardized training programme for postoperative oral cancer patients.
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Affiliation(s)
- Jing Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, 100081, China
| | - Quan Li
- Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Hong-Yun Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, 100081, China
| | - Yue Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology, Beijing, 100081, China.
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Zhang X, Liang Y, Wang X, Shan Y, Xie M, Li C, Hong J, Chen J, Wan G, Zhang Y, Lin Y, Zhao F, He Z, Dou Z, Wen H. Effect of Modified Pharyngeal Electrical Stimulation on Patients with Severe Chronic Neurogenic Dysphagia: A Single-Arm Prospective Study. Dysphagia 2022:10.1007/s00455-022-10536-z. [DOI: 10.1007/s00455-022-10536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022]
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Oral Rehabilitation from Oral and Dental Diseases. Healthcare (Basel) 2022; 10:healthcare10102065. [DOI: 10.3390/healthcare10102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/16/2022] Open
Abstract
Oral conditions, such as the number of teeth and oral hygiene, are related to oral functions and oral health-related quality of life (QoL) [...]
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Mariani L, Cilfone A, Nicastri M, Pipitone LL, Stella F, de Vincentiis M, Greco A, Mancini P, Longo L, Ruoppolo G. Accuracy of Dysphagia Standard Assessment (DSA®) bedside screening test: a flowchart for patient eligibility. Neurol Sci 2022; 43:5411-5419. [PMID: 35660987 PMCID: PMC9385749 DOI: 10.1007/s10072-022-06175-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022]
Abstract
Background Oropharyngeal dysphagia (OD) screening tests have improved patient management; however, the complex applicability and high percentage of false negatives do not allow these tests to be considered completely reliable if not supported by an instrumental investigation. The aim of the present study is to evaluate an OD screening test, the Dysphagia Standard Assessment (DSA®) with different volumes and viscosities. Materials and methods Prospective study of 72 patients evaluated for suspected OD through a double-blind methodology conducted by two operators. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) as a reference test and a separate DSA® test. DSA® was performed by administering boluses with different viscosities, with the signal of interruption of the test being: onset of the cough reflex, wet voice after swallowing, and/or desaturation of O2 ≥ 5%. The Penetration-Aspiration Scale (PAS) was evaluated by FEES. The cut-off identified to diagnose OD was PAS ≥ 3. Results The test showed an accuracy of 82%, a sensitivity of 0.93 (95% C.I. 0.84–0.97), and a specificity of 0.78 (95% C.I. 0.67–0.87); positive predictive value 0.55 (95% C.I. 0.43–0.67); negative predictive value 0.97 (95% C.I. 0.90–0.99), positive likelihood ratio 4.37 (95% C.I. 3.6–5.2); likelihood negative ratio 0.08 (95% C.I. 0.06–0.09). Conclusions According to the preliminary results, the test showed good outcomes in determining the presence or absence of OD with a wide spectrum of applicability with some limitations that could be overcome by the selection of a target population. For this reason, a flowchart to address patient eligibility was developed.
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Affiliation(s)
- Laura Mariani
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy.
| | - Armando Cilfone
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Maria Nicastri
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Lucia Libera Pipitone
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Federica Stella
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Marco de Vincentiis
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Patrizia Mancini
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
| | - Lucia Longo
- Department of Sense Organs, Otorhinolaryngology Section, Sapienza University of Rome, Policlinico Umberto I, Viale dell'Università, 33, 00161, Rome, Italy
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Manejo hospitalario del paciente con disfagia. Encuesta y recomendaciones del área de nutrición de la SEEN. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zhu L, Chen J, Shao X, Pu X, Zheng J, Zhang J, Wu X, Wu D. Botulinum toxin A injection using ultrasound combined with balloon guidance for the treatment of cricopharyngeal dysphagia: analysis of 21 cases. Scand J Gastroenterol 2022; 57:884-890. [PMID: 35213271 DOI: 10.1080/00365521.2022.2041716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND As an upper oesophageal sphincter (UES) dysfunction disorder, cricopharyngeal achalasia (CPA) is a common cause of dysphagia and is associated with an increased risk of pulmonary complications. The aim of this study was to investigate the effectiveness and safety of BTX-A injection using ultrasound combined with balloon guidance for the treatment of CPA caused by stroke. METHODS A total of 21 patients diagnosed with CPA were treated with BTX-A injection into the cricopharyngeal muscle using ultrasound combined with balloon guidance. Primary outcome measures, including the functional oral intake scale (FOIS), videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS), which are quantitative measures for a video fluoroscopic swallowing study (VFSS), and scores of the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were assessed from baseline to 12 weeks after treatment. Repeated measures analysis of variance was used to compare the scores between time points. RESULTS BTX-A injection led to improved dysphagia symptoms and scores in 19 patients (90.48%). Among them, 5 cases were cured (23.81%), 11 cases showed significant improvement (52.38%), and 3 cases showed improvement (14.29%). Two cases were absolutely ineffective (9.52%). Compared with the scores prior to treatment, the scores on the FOIS, VDS, PAS, SAS and SDS significantly improved beginning at 3 days (p < .05) and lasting for at least 12 weeks after injection. CONCLUSIONS Ultrasound with balloon-guided BTX-A injection is probably a relatively safe, easy, and effective technique for the treatment of CPA caused by stroke, with better visualization of the injection procedure. A well-designed controlled trial with a larger sample size is needed for more convincing conclusions.
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Affiliation(s)
- Lielie Zhu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Jiajun Chen
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Xiangzhi Shao
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Xinyu Pu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Jinyihui Zheng
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Jiacheng Zhang
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Xinming Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
| | - Dengchong Wu
- Department of Rehabilitation, Zhejiang Chinese Medical University Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang, China
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Reverberi C, Gottardo G, Battel I, Castagnetti E. The neurogenic dysphagia management via telemedicine: a systematic review. Eur J Phys Rehabil Med 2022; 58:179-189. [PMID: 34605620 PMCID: PMC9980496 DOI: 10.23736/s1973-9087.21.06921-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Telerehabilitation is the provision of rehabilitation remotely through Information and Communication Technologies (ICT). Recently, there has been an increase of interest in its application thanks to increasing a new technology. The aim of this systematic review was to examine the evidence of the literature regarding the management of neurogenic dysphagia via telerehabilitation, compared to face-to-face rehabilitation treatment. The secondary aim was to create recommendations on telerehabilitation sessions for patients diagnosed with neurogenic dysphagia. EVIDENCE ACQUISITION The databases were: Medline, Embase, CINAHL, Scopus. A total of 235 records emerged from bibliographic research, manual search of full text and from gray literature, published until January 2021. Two blinded authors carried out titles and abstract screening and followed by full-text analysis. Sixteen articles were included in the systematic review and assessed through critical appraisal tools. EVIDENCE SYNTHESIS The research shows that the majority of the studies on neurogenic dysphagia involved the Clinical Swallow Examination via telerehabilitation, compared with the in-person modality. Significant levels of agreement and high satisfaction from clinicians and patients are reported to support the use of telerehabilitation. Based on the results of this systematic review and qualitative analysis, the authors developed practical recommendations for the management of telerehabilitation sessions for patients with neurogenic dysphagia. CONCLUSIONS Despite the presence of barriers, telerehabilitation allowed healthcare provision and increasing access to care and services with specialized professionals, remote rehabilitation can be a valid resource during the health emergency due to COVID-19.
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Affiliation(s)
- Cristina Reverberi
- Department of Health Professions, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Irene Battel
- Department of Physical and Medical Rehabilitation, San Giovanni e Paolo Civil Hospital, Azienda ULSS3 Serenissima, Venice, Italy -
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Chang MC, Choo YJ, Seo KC, Yang S. The Relationship Between Dysphagia and Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:834240. [PMID: 35370927 PMCID: PMC8970315 DOI: 10.3389/fneur.2022.834240] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/21/2022] [Indexed: 12/12/2022] Open
Abstract
BackgroundDysphagia is a common complication after stroke and is associated with the development of pneumonia. This study aimed to summarize the relationship between dysphagia and pneumonia in post-stroke patients.Materials and MethodsArticles published up to November 2021 were searched in the PubMed, Embase, Cochrane library, and Scopus databases. Studies that investigated the development of pneumonia in acute stroke patients with and without dysphagia were included. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies-of Interventions tool, and publication bias was evaluated using a funnel plot and Egger's test.ResultsOf 5,314 studies, five studies were included in the meta-analysis. The results revealed that the incidence of pneumonia was significantly higher in the dysphagia group than in the non-dysphagia group (OR 9.60; 95% CI 5.75–16.04; p < 0.0001; I2 = 78%). There was no significant difference in the mortality rate between the two groups (OR 5.64; 95% CI 0.83–38.18; p = 0.08; I2 = 99%).ConclusionDysphagia is a significant risk factor for pneumonia after stroke. The early diagnosis and treatment of dysphagia in stroke patients are important to prevent stroke-associated pneumonia.
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Affiliation(s)
- Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Kyung Cheon Seo
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Womans University Seoul Hospital, School of Medicine, Ewha Womans University, Seoul, South Korea
- *Correspondence: Seoyon Yang
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Lim W, Jeong Y, Yoo B. Rheological Information of Pudding-Thick Liquids Prepared Using Commercial Food Thickeners Marketed in Korea for Dysphagic Patients According to the Manufacturers’ Guidelines. Clin Nutr Res 2022; 11:1-8. [PMID: 35223676 PMCID: PMC8844529 DOI: 10.7762/cnr.2022.11.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/08/2022] [Accepted: 01/09/2022] [Indexed: 12/04/2022] Open
Abstract
Food thickeners are commonly used to prepare thickened liquids for the management of dysphagia. The National Dysphagia Diet (NDD) thickness levels of thickened liquids prepared with commercial food thickeners are known to vary depending on the thickener type, recommended amount of thickener, thickener brand, and preparation instructions. Particularly, detailed preparation instructions must be provided by the manufacturers to achieve the correct thickness levels. However, the rheological information on product labels provided by manufacturers is typically not accurate. Here, various pudding-thick liquids were prepared by mixing commercial xanthan gum (XG)-based thickeners based on the manufacturers’ guidelines, and their rheological properties were characterized. Several thickened liquids prepared with four different XG-based thickeners (A-D) marketed in Korea did not meet the pudding-like criterion (> 1,750 mPa·s) based on the NDD guidelines. Significant differences in rheological parameter values (ηa,50, n, and G′) were also identified among the various thickened liquids. Only one thickener (thickener A) manufactured in Korea showed optimal results, which satisfied the pudding-thick viscosity range for various food liquids and also showed lower stickiness and enhanced bolus formation ability for easy and safe swallowing when compared to other thickeners (B, C, and D).
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Affiliation(s)
- Woobin Lim
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang 10326, Korea
| | - Yulim Jeong
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang 10326, Korea
| | - Byoungseung Yoo
- Department of Food Science and Biotechnology, Dongguk University-Seoul, Goyang 10326, Korea
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Nabatame S. The anatomical and functional rationale for conducting dysphagia rehabilitation. Pediatr Int 2022; 64:e15091. [PMID: 35313058 DOI: 10.1111/ped.15091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shin Nabatame
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan
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Jung S, Kim JS, Jang I, Kim H. Factors related to dysphagia-specific quality of life in aged patients with neurologic disorders: A cross-sectional study. Geriatr Nurs 2021; 43:159-166. [PMID: 34902750 DOI: 10.1016/j.gerinurse.2021.11.016] [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: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/25/2022]
Abstract
This cross-sectional study aimed to analyze dysphagia-specific quality of life and its influencing factors in aged patients with neurologic disorders, and is reported according to the STROBE checklist for observational research. The study included 120 outpatients, aged ≥65 years, diagnosed with neurologic diseases at a general hospital Neurology Department in Seoul, Korea. Data collected during a one-month (March and April 2021) questionnaire survey were statistically analyzed using SPSS. Factors related to dysphagia-specific quality of life were gender, education level, neurological diagnosis, type of diet, subjective swallowing disturbance, and affectionate support-a subscale of social support. The combined explanatory power of these factors was 42.1%. It is essential to note that the factors related to the emotional, functional, and physical domains-the subscales of dysphagia-specific quality of life-are different. Therefore, each factor should be considered when planning nursing interventions to improve dysphagia-specific quality of life.
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Affiliation(s)
- Sujin Jung
- Department of Nursing, Seoul National University BORAMAE Medical Center, Seoul, Republic of Korea
| | - Ji-Su Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul 06974, Republic of Korea.
| | - Insil Jang
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul 06974, Republic of Korea
| | - Hyejin Kim
- Department of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-Gu, Seoul 06974, Republic of Korea
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Luan S, Wu SL, Xiao LJ, Yang HY, Liao MX, Wang SL, Fan SN, Ma C. Comparison studies of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in the treatment of neurogenic cricopharyngeal muscle dysfunction. NeuroRehabilitation 2021; 49:629-639. [PMID: 34806624 DOI: 10.3233/nre-210113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cricopharyngeal muscle dysfunction (CPD) management has been challenging in clinical practice. OBJECTIVE To compare the efficacy and safety of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in treating CPD. METHODS Forty patients with CPD were randomly divided into two groups, namely the botulinum toxin injection group (BTX group) and balloon dilatation group (BD group). Patients in the BTX group received a single ultrasound-guided injection of 50 units of botulinum toxin type A, while the BD group received dilatation therapy five times per week, consecutively for two weeks. Relative opening percentage of the upper esophageal sphincter (UES), the penetration-aspiration scale (PAS), and the Dysphagia Outcome Severity Scale (DOSS) were evaluated by a videofluoroscopic swallowing study (VFSS) at baseline, 1-month, and 3-months posttreatment. The Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA) were also used to evaluate participants' swallowing function at baseline and the 1-week, 2-week, 1-month, and 3-month follow-ups. RESULTS A generalized estimating equation (GEE) model revealed the significant main effect for time in UES, PAS, DOSS, FOIS, and SSA compared to baseline (P <0.05), while no group-by-time interactions (except for the PAS assessment) or main effect for treatment was detected among the above multiple variances. No systematic complications or severe adverse effects were noted. CONCLUSION Both ultrasound-guided botulinum toxin type A injections and balloon dilatation therapy have been proven as safe and effective treatments for CPD patients. Future clinical trials with longer follow-up periods and more participants are warranted.
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Affiliation(s)
- Shuo Luan
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Shao-Ling Wu
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Ling-Jun Xiao
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Hai-Yun Yang
- Department of Ultrasonic, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Mei-Xin Liao
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Shao-Ling Wang
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Sheng-Nuo Fan
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
| | - Chao Ma
- Department of Rehabilitation, Sun Yat-sen Memorial Hospital, Guangzhou, People's Republic of China
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Oral Motor Treatment Efficacy: Feeding and Swallowing Skills in Children with Cerebral Palsy. Behav Neurol 2021; 2021:6299462. [PMID: 34733374 PMCID: PMC8560295 DOI: 10.1155/2021/6299462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
This study is aimed at identifying the relationship between oral motor treatment and the improvement of abilities for feeding and swallowing in boys and girls with CP residing in the state of Yucatán. The sample consisted of 30 patients with a diagnosis of CP and the presence of ADT, with gross motor function levels from II to V, between 3 and 14 years old, of which 50% received oral motor treatment. The predominant diagnosis was spastic CP and tetraplegia. An interview was carried out with the tutor, the application of the gross motor skills scale, and an assessment of feeding skills. The feeding and swallowing skills that improved significantly with the oral motor treatment were mandibular mobility, tongue activity, abnormal reflexes, control of breathing, and general oral motor skills (p ≤ 0.05). Within the sample that did not receive oral motor treatment, 46% presented low or very low weight and 40% referred recurrent respiratory diseases. In the end, it was concluded that feeding skills improve significantly with oral motor treatment, regardless of the severity of gross motor involvement. Likewise, oral motor treatment was associated with a lower presence of respiratory diseases and nutritional compromise.
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Solid Oral Dosage Forms Use in Adults with Neurological Disorders and Swallowing Difficulties: A Scoping Review. Dysphagia 2021; 37:909-922. [PMID: 34652512 DOI: 10.1007/s00455-021-10352-x] [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: 06/29/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Swallowing difficulties affects the deglutition of solid oral dosage forms (SODFs) and it is a common problem among neurological disorders. Interventions may improve the use of SODFs in healthcare settings. The aim of this study was to map the available research about the interventions aiming the effective and safe use of SODFs in adults with neurological disorders and swallowing difficulties and to identify potential literature gaps in this scientific field. A scoping review was carried out based on Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews, in PubMed, Scopus, and SciELO databases (March 2021). Peer-reviewed observational studies assessed the effectiveness and safety of SODFs in adults with neurological disorders and swallowing difficulties in the healthcare organizations setting were included. 11 studies were included (three case reports, two mixed-methods intervention studies, and six analytic studies). The frequency of women ranged from 49 to 67%, and the age from 57 to 91 years. Most studies (n = 7) included elderly patients, Parkinson (n = 6) and dementia (n = 3). Medication review was the most frequently reported intervention, 35% (9/26). In most studies, interventions were targeted to patients during hospitalization (n = 7) and performed by physicians (n = 8). At least 20 different outcomes were evaluated in the studies. Implementing specific protocols for using SODFs aimed at the swallowing difficulties of this population is not a common practice. Additional studies on interventions aimed at optimizing SODFs are needed to support the safety and efficacy of oral therapy in this patient group.
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