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Sugg JN, Lee JW. Neurologic Dysphagia. Otolaryngol Clin North Am 2024; 57:599-608. [PMID: 38664090 DOI: 10.1016/j.otc.2024.03.005] [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] [Indexed: 07/01/2024]
Abstract
Dysphagia is commonly associated with neurologic/neuromuscular disorders including prematurity, cerebral palsy, traumatic brain injury, brain tumors, genetic disorders, and neuromuscular diseases. This article aims to review the major categories of neurologic dysphagia, to outline specific findings and special considerations for each population, and to acknowledge the importance of integrating each patient's medical prognosis, goals of care, and developmental stage into a multidisciplinary treatment plan.
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Affiliation(s)
- Jillian Nyswonger Sugg
- Department of Head and Neck Surgery & Communication Sciences, Division of Speech Pathology and Audiology, Duke University, DUMC 3887, Durham, NC 27710, USA
| | - Janet Waimin Lee
- Department of Head and Neck Surgery & Communication Sciences, Division of Pediatric Otolaryngology, Duke University, DUMC 3805, Durham, NC 27710, USA.
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Simon MV, Rutkove SB, Ngo L, Fehnel CR, Das AS, Sarge T, Bose S, Selim M, Kumar S. Understanding the variability of the electrophysiologic laryngeal adductor reflex. Clin Neurophysiol 2024; 162:141-150. [PMID: 38631074 DOI: 10.1016/j.clinph.2024.03.019] [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: 12/02/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE The laryngeal adductor reflex (LAR) is vital for airway protection and can be electrophysiologically obtained under intravenous general anesthesia (IGA). This makes the electrophysiologic LAR (eLAR) an important tool for monitoring of the vagus nerves and relevant brainstem circuitry during high-risk surgeries. We investigated the intra-class variability of normal and expected abnormal eLAR. METHODS Repeated measures of contralateral R1 (cR1) were performed under IGA in 58 patients. Data on presence/absence of cR2 and potential confounders were also collected. Review of neuroimaging, pathology and clinical exam, allowed classification into normal and expected abnormal eLAR groups. Using univariate and multivariate analysis we studied the variability of cR1 parameters and their differences between the two groups. RESULTS In both groups, cR1 latencies had coefficients of variation of <2%. In the abnormal group, cR1 had longer latencies, required higher activation currents and was more frequently desynchronized and unsustained; cR2 was more frequently absent. CONCLUSIONS cR1 latencies show high analytical precision for measurements. Delayed onset, difficult to elicit, desynchronized and unsustained cR1, and absence of cR2 signal an abnormal eLAR. SIGNIFICANCE Understanding the variability and behavior of normal and abnormal eLAR under IGA can aid in the interpretation of its changes during monitoring.
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Affiliation(s)
- Mirela V Simon
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Corey R Fehnel
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Todd Sarge
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Somnath Bose
- Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sandeep Kumar
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Wright SH, Blumenow W, Kumar R, Mallucci C, Felton A, McMahon S, Hennigan D, Avula S, Pizer B. Prevalence of dysphagia following posterior fossa tumour resection in children: the Alder Hey experience. Childs Nerv Syst 2023; 39:609-616. [PMID: 36512048 DOI: 10.1007/s00381-022-05774-3] [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: 09/06/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Surgery for posterior fossa tumours (PFTs) in children is associated with bulbar palsy and swallowing difficulties although this risk is not well defined in the literature and issues contributing to dysphagia following surgery are not fully understood. AIMS This study aims to study the eating, drinking and swallowing function of children following PFT resection in a specialist paediatric neurosurgery centre. This included the frequency and duration of dysphagia, the risk of aspiration and the link between tumour type and dysphagia. MATERIALS AND METHODS This is a retrospective review of children undergoing surgery for PFT between 2014 and 2019. Information was obtained from the patients' hospital and speech and language therapy (SLT) notes, oncology database and clinical letters. The International Dysphagia Diet Standardisation Initiative (IDDSI) Framework was used to describe food and fluid modifications. RESULTS Seventy children had surgery to resect a posterior fossa tumour at Alder Hey from 2014 to 2019. Thirty-one children were included in the study following referral to SLT. Videofluoroscopy (VF) was undertaken at our institution in 68% (21/31) of cases. Fifty-two percent (11/21) of children aspirated or were considered at risk, and 55% (6/11) of those who aspirated showed silent aspiration. After 3 months, 43% (13/30) still required modified food and/or fluid textures, with this proportion reducing as time progressed. By tumour type, VF was performed in 5/7 medulloblastoma patients with 3/5 showing aspiration and 3/3 silently aspirating; in 8/9 patients with ependymoma with 4/8 patients aspirating with 2/4 showing silent aspiration; and 6/12 glioma patients with 4/6 aspirating with 1/4 showing silent aspiration. CONCLUSION Swallowing difficulties, including silent aspiration, are an important complication of PFT resection. A proportion of children will need ongoing food and/or fluid modification. Further study into dysphagia following PFT resection is indicated.
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Affiliation(s)
- Samantha H Wright
- Department of Speech and Language Therapy, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Wendy Blumenow
- Department of Speech and Language Therapy, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ram Kumar
- Department of Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Alison Felton
- Department of Speech and Language Therapy, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Siobhan McMahon
- Department of Speech and Language Therapy, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- Department of Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Knollhoff SM, Krueger BI, Imgrund CM. Speech-Language Pathology Services in Pediatric Cancer: Survey and Interview Data on Caregiver Experiences. Semin Speech Lang 2023; 44:4-14. [PMID: 36649701 DOI: 10.1055/s-0042-1756682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pediatric cancer and its treatment can cause disruption in typical child development, including the development of speech, language, and swallowing skills. Despite the potential for significant impact on communication and swallowing, speech-language pathologists are not routinely involved in the care teams of children diagnosed with cancer. The goal of this investigation was to enhance the understanding of the speech-language pathology services rendered and caregivers' perspectives on the current needs of children and adolescents who have undergone cancer treatment. Caregiver's perspectives offer unique insights and are beneficial when utilizing a person- and family-centered care framework. Eleven caregivers of children treated for cancer completed an online survey, and an additional three caregivers participated in a semistructured interview. Results provided insight into caregivers' perspectives regarding speech-language pathology-related needs and services. Survey results and thematic analysis of the semistructured interviews indicated the need for involvement of speech-language pathology services during and after cancer treatment. Cancer diagnoses and oncological treatment occur during key developmental periods, and may negatively impact children's speech, language, and swallowing abilities. Speech-language pathologists are uniquely positioned to provide support for children undergoing or following cancer treatment.
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Affiliation(s)
- Stephanie M Knollhoff
- Department of Speech, Language and Hearing Services, University of Missouri, Columbia, Missouri
| | - Breanna I Krueger
- Division of Communication Disorders, University of Wyoming, Laramie, Wyoming
| | - Caitlin M Imgrund
- Department of Communication Sciences and Disorders, Florida Atlantic University, Boca Raton, Florida
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Chami S, Hodges R, Campbell E, Knijnik SR, Docking K. Communication and swallowing management in childhood brain tumour or leukaemia: A survey of health professionals and consumers. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:395-406. [PMID: 34651529 DOI: 10.1080/17549507.2021.1987520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Brain tumour and leukaemia represent the most common childhood cancers and can result in communication and swallowing difficulties. The purpose of this study was to survey health professionals and consumers regarding the management of communication and swallowing difficulties in children with brain tumour or leukaemia (CBTL).Method: In this study participants completed a survey focussing on (1) communication and swallowing assessment and intervention, (2) multidisciplinary team (MDT) practices and (3) risk factors. Quantitative data were reported using descriptive statistics. Qualitative data were analysed using NVivo12 Qualitative Data Analysis Software.Result: Twenty-four participants were included (22 health professionals; two consumers). Most participants (≥80%) agreed that comprehensive and regular communication and swallowing assessments improved outcomes. Communication and swallowing interventions were reported to improve outcomes by 96% of participants. MDT care was considered essential in improving outcomes. Speech-language pathologists were the primary health professional identified in communication management; additional multidisciplinary health professionals were highlighted in swallowing management. Risk factors were identified across three categories: cancer-related, treatment-related and child-factors.Conclusion: This study collates the expertise and experience of multidisciplinary health professionals and consumers which can be used to guide assessment and intervention for communication and swallowing in CBTL. It also provides perspectives on MDT care and consideration of patient values and risk factors.
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Affiliation(s)
- Sara Chami
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rosemary Hodges
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Western Sydney Speech Pathology, Sydney, Australia
| | - Emma Campbell
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Integrated & Community Health, Western Sydney Local Health District Sydney, Australia
| | - Stefani R Knijnik
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kimberley Docking
- Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Runco DV, Wasilewski-Masker K, Mazewski CM, Patterson BC, Mertens AC. Features Associated With Weight Loss and Growth Stunting for Young Children During Cancer Therapy. J Pediatr Hematol Oncol 2021; 43:301-307. [PMID: 34133373 PMCID: PMC9580507 DOI: 10.1097/mph.0000000000002246] [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: 08/18/2020] [Accepted: 05/25/2021] [Indexed: 11/25/2022]
Abstract
Features associated with malnutrition are poorly elucidated in pediatric cancer care. We aimed to better understand characteristics associated with weight-for-height (WHZ) and height-for-age (HAZ) changes for infants and young children during cancer treatment. This retrospective study included 434 patients diagnosed <3 years old from 2007 to 2015 at a large pediatric cancer center. Patients starting treatment outside our center, those with relapsed or secondary malignancies, or with inaccurate information were excluded. Abstracted weights and heights for a 24-month period after treatment initiation were converted to sex-specific and age-specific z scores. Although not statistically different at baseline, patients with hematologic malignancies gained weight over time, while other tumor types did not. Higher treatment intensity and younger age at diagnosis increased odds of clinically significant weight loss. Older children had higher HAZ at diagnosis and HAZ also significantly decreased over time for all examined risk factors, which is distinctly different from patterns in WHZ over time. In conclusion, WHZ and HAZ are affected differently by cancer treatment in infants and young children. We identify key risk factors for weight loss and growth stunting which will be necessary to develop prospective trials to examine anthropometric, biochemical, and patient recorded outcomes around nutrition.
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Affiliation(s)
- Daniel V. Runco
- Department of Pediatrics, Division of Hematology/Oncology/BMT, Indiana University School of Medicine
- Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Karen Wasilewski-Masker
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
| | - Claire M. Mazewski
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
| | - Briana C. Patterson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
- Department of Pediatrics, Division of Endocrinology and Diabetes, Emory University School of Medicine, Atlanta, GA
| | - Ann C. Mertens
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Pediatrics, Division of Hematology/Oncology/BMT
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Alighieri C, De Maere K, Poncelet G, Willekens L, Linden CV, Oostra K, Van Lierde K, D'haeseleer E. Occurrence of speech-language disorders in the acute phase following pediatric acquired brain injury: results from the Ghent University Hospital. Brain Inj 2021; 35:907-921. [PMID: 34056971 DOI: 10.1080/02699052.2021.1927185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIMS This study investigated the occurrence of speech-language disorders during the acute phase of recovery in children with acquired brain injury (ABI) with an age between 0 and 16 years. METHODS A retrospective chart analysis was performed including 228 children (n = 118 boys, n = 110 girls) who consecutively presented with ABI over a 10-year period (2006-2016) at the children's rehabilitation center at Ghent University Hospital. Descriptive statistical analyses were applied. RESULTS 71.1% (162/228) of the children who were admitted to the rehabilitation center presented with a speech-language disorder. Within this sample (n = 162), results demonstrated the occurrence of acquired disorders in language (48.9%), speech (35.1%), learning (33.3%), swallowing (21.5%), and early communicative functions (17.4%). The proportion of children presenting with disturbances in early communicative functions differed by ABI cause. More than half (10/18, 58.8%) of the children who presented with ABI following inflammatory processes demonstrated disorders in early communicative functions. CONCLUSIONS Especially in young children who present with inflammatory processes as the ABI cause, speech-language pathologists (SLPs) must be aware of disorders in early speech-language development. The present findings allow the SLP to appropriately plan research, education, and clinical management.
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Affiliation(s)
| | - Katrien De Maere
- Children's Rehabilitation Center, Ghent University Hospital, Gent, Belgium
| | - Gaby Poncelet
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Lore Willekens
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | | | - Kristine Oostra
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
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Hodges R, Campbell L, Chami S, Knijnik SR, Docking K. Communication and swallowing outcomes of children diagnosed with childhood brain tumor or leukemia: A systematic review. Pediatr Blood Cancer 2021; 68:e28809. [PMID: 33219751 DOI: 10.1002/pbc.28809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 11/11/2022]
Abstract
The purpose of this systematic review was to appraise and synthesize evidence on communication and swallowing outcomes associated with childhood brain tumor or leukemia (CBTL). A comprehensive database and grey literature search was conducted. Studies included: (a) peer-reviewed research published between 1998 and 2019, (b) English language, (c) children aged 0-16 years diagnosed with CBTL, and (d) used outcome measures focused on communication and/or swallowing. Quality assessment was completed and certainty of evidence rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Fifty-seven studies met inclusion criteria: 46 examined communication, seven examined swallowing, and four considered both. Most studies were descriptive and prospective. Communication difficulties were frequently reported and apparent at one or more points from diagnosis to survivorship. Swallowing difficulties were frequently reported during oncology treatment. Despite quality assessment revealing methodological shortcomings, results have implications for clinical services and future research.
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Affiliation(s)
- Rosemary Hodges
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lani Campbell
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sara Chami
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Stefani Ribeiro Knijnik
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kimberley Docking
- Discipline of Speech Pathology, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Goethe EA, LoPresti MA, Gadgil N, Lam S. Predicting postoperative tracheostomy requirement in children undergoing surgery for posterior fossa tumors. Childs Nerv Syst 2020; 36:3013-3019. [PMID: 32270273 DOI: 10.1007/s00381-020-04605-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE Posterior fossa tumor (PFT) resection can be associated with postoperative respiratory failure. We aimed to identify risk factors predicting tracheostomy dependence in children after PFT resection. METHODS Retrospective chart review of all children undergoing PFT resection from April 2007 to May 2017 at our institution was performed. RESULTS A total of 197 patients were included; 12 (6.1%) required tracheostomy placement at a mean 69.1 days postoperatively (SD 112.7, range 7-388). Patients requiring tracheostomy were younger (3.4 vs. 6.8 years, p < 0.01), more likely to have postoperative dysphagia (91.7% vs. 17.3%, p < 0.01), and more likely to have an ependymoma (41.7% vs. 15.1%, p < 0.01) or astrocytoma (25.0% vs. 8.1%, p < 0.01). Patients with eventual tracheostomy were less likely extubated immediately postoperatively (45.5% vs. 79.6%, p < 0.01), had longer intubation duration postoperatively (5.7 vs. 0.5 days, p < 0.01), and had higher rates of reintubation within 48 h (63.6% vs. 1.3%, p < 0.01). Patients requiring tracheostomy had longer hospital length of stay (45.8 vs. 15.3 days, p < 0.01) and ICU stay postoperatively (13.5 vs. 2.1 days, p < 0.01). Of those requiring tracheostomy, three (25.0%) were decannulated by 1 year postoperatively. Decannulation rates did not vary by age (p < 0.47), extubation failure (p < 0.24), duration of intubation (p < 0.10), tumor histology (p < 0.23), or tumor grade (p < 0.13). CONCLUSION Lower cranial neuropathy following PFT resection is common. Identifying risk factors correlated with need for tracheostomy can help identify patients who may benefit from early tracheostomy, reducing prolonged intubation trauma, time on mechanical ventilation, and length of stay.
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Affiliation(s)
- Eric A Goethe
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX, 77030, USA
| | - Melissa A LoPresti
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX, 77030, USA
| | - Nisha Gadgil
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX, 77030, USA
| | - Sandi Lam
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin St, Houston, TX, 77030, USA.
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Northwestern University Feinberg School of Medicine, Lurie Children's Hospital, 225 E Chicago Ave, Chicago, IL, 60611, USA.
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Lapa S, Quick-Weller J, Nasari C, Dziewas R, Gessler F, Wagner M, Warnecke T, Hattingen E, Seifert V, Konczalla J. Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study. Cancers (Basel) 2020; 12:E2561. [PMID: 32916787 PMCID: PMC7564918 DOI: 10.3390/cancers12092561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/05/2020] [Accepted: 09/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND While swallowing disorders are frequent sequela following posterior fossa tumor (PFT) surgery in children, data on dysphagia frequency, severity, and outcome in adults are lacking. The aim of this study was to investigate dysphagia before and after surgical removal of PFT. Additionally, we tried to identify clinical predictors for postsurgical swallowing disorders. Furthermore, this study explored the three-month outcome of dysphagic patients. METHODS In a cohort of patients undergoing PFT surgery, dysphagia was prospectively assessed pre- and postoperatively using fiberoptic endoscopic evaluation of swallowing. Patients with severe dysphagia at discharge were re-evaluated after three months. Additionally, clinical and imaging data were collected to identify predictors for post-surgical dysphagia. RESULTS We included 26 patients of whom 15 had pre-operative swallowing disorders. After surgery, worsening of pre-existing dysphagia could be noticed in 7 patients whereas improvement was observed in 2 and full recovery in 3 subjects. New-onset dysphagia after surgery occurred in a minority of 3 cases. Postoperatively, 47% of dysphagic patients required nasogastric tube feeding. Re-evaluation after three months of follow-up revealed that all dysphagic patients had returned to full oral intake. CONCLUSION Dysphagia is a frequent finding in patients with PFT already before surgery. Surgical intervention can infer a deterioration of impaired swallowing function placing affected patients at temporary risk for aspiration. In contrast, surgery can also accomplish beneficial results resulting in both improvement and full recovery. Overall, our findings show the need of early dysphagia assessment to define the safest feeding route for the patient.
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Affiliation(s)
- Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, 60528 Frankfurt, Germany;
- Department of Neurosurgery, University Hospital Frankfurt, 60528 Frankfurt, Germany; (J.Q.-W.); (F.G.); (V.S.); (J.K.)
| | - Johanna Quick-Weller
- Department of Neurosurgery, University Hospital Frankfurt, 60528 Frankfurt, Germany; (J.Q.-W.); (F.G.); (V.S.); (J.K.)
| | - Christiane Nasari
- Department of Neurology, University Hospital Frankfurt, 60528 Frankfurt, Germany;
- Department of Neurosurgery, University Hospital Frankfurt, 60528 Frankfurt, Germany; (J.Q.-W.); (F.G.); (V.S.); (J.K.)
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany; (R.D.); (T.W.)
| | - Florian Gessler
- Department of Neurosurgery, University Hospital Frankfurt, 60528 Frankfurt, Germany; (J.Q.-W.); (F.G.); (V.S.); (J.K.)
| | - Marlies Wagner
- Department of Neuroradiology, University Hospital Frankfurt, 60528 Frankfurt, Germany; (M.W.); (E.H.)
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, 48149 Münster, Germany; (R.D.); (T.W.)
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, 60528 Frankfurt, Germany; (M.W.); (E.H.)
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, 60528 Frankfurt, Germany; (J.Q.-W.); (F.G.); (V.S.); (J.K.)
| | - Jürgen Konczalla
- Department of Neurosurgery, University Hospital Frankfurt, 60528 Frankfurt, Germany; (J.Q.-W.); (F.G.); (V.S.); (J.K.)
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Goethe EA, Gadgil N, Stormes K, Wassef A, LoPresti M, Lam S. Predicting dysphagia in children undergoing surgery for posterior fossa tumors. Childs Nerv Syst 2020; 36:925-931. [PMID: 31897637 DOI: 10.1007/s00381-019-04468-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Posterior fossa tumors (PFTs) are the most common type of brain tumor in children. Dysphagia is a known complication of PFT resection in children, but data regarding risk factors and clinical course are sparse. METHODS The records of all children who underwent resection of posterior fossa tumor between April 2007 and May 2017 at our institution were analyzed. Clinical, radiographic, histologic data were gathered. Swallowing function was assessed immediately postoperatively and at 1-year follow-up. RESULTS A total of 197 patients were included. Forty-three (21.8%) patients developed dysphagia after surgery. Patients who developed dysphagia were younger (4.5 vs. 7.2 years, p < 0.01), were more likely to have brainstem compression (74.4% vs. 57.8%, p < 0.03) or invasion (14.0 vs. 9.7%, p < 0.03), and were more likely to have ependymoma (27.9% vs. 13.6%, p < 0.01) or ATRT (atypical teratoid/rhabdoid tumor) (9.3% vs. 3.9%, p < 0.01). Patients with postoperative dysphagia also had a longer length of stay (33.7 vs. 12.7 days, p < 0.01) and were more likely to be discharged to inpatient rehabilitation (25.6% vs. 9.1%, p < 0.01). Ten patients (5.1%) were PEG-dependent by 1-year follow-up. These patients were younger (2.7 vs. 5.6 years, p < 0.01), had a longer length of stay (55.5 vs. 27.4 days, p < 0.01), and were more likely to have ATRT (30.0% vs. 0.0%, p < 0.01). Recovery was not associated with tumor grade or extent of resection. CONCLUSIONS Dysphagia after PFT resection is associated with younger age, aggressive tumor histology, and increased healthcare utilization. While most patients recover, a small percentage are still dependent on enteral feeding at 1-year follow-up. Further research is needed to identify factors associated with persistent deficits.
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Affiliation(s)
- Eric A Goethe
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Nisha Gadgil
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Katie Stormes
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Audrey Wassef
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Melissa LoPresti
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, IL, 60611, USA.
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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12
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Coça KL, Bergmann A, de Angelis EC, Ferman S, Ribeiro MG. Incidence and risk factors of communication, swallowing, and orofacial myofunctional disorders in children and adolescents with cancer and benign neoplasms. J Pediatr Rehabil Med 2020; 13:25-35. [PMID: 32176665 DOI: 10.3233/prm-180576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe the incidence and risk factors of communication, swallowing, and orofacial myofunctional disorders in a cohort of children and adolescents with cancer and benign neoplasms. METHODS A prospective cohort study conducted with children aged ⩾ 2 years and adolescents of both genders admitted at the Pediatric Oncology Department of the Instituto Nacional de Câncer (INCA) between March 2014 and April 2015. Study participants were submitted to a Speech-Language Pathology (SLP) assessment at three different times: (T1) at hospital admission; (T2) six months after admission; (T3) one year after admission. RESULTS One hundred and sixty individuals were evaluated. At the time of hospital admission, 68 individuals (42.5%) presented with some type of SLP disorder. After one year of follow-up, 22.8% of the patients had developed new impairments. The occurrence of new speech-language disorders had a statistically significant association with the tumor site. In the risk analysis for the development of speech-language disorders with respect to the primary tumor site, compared to other sites, the central nervous system (CNS) tumor group was 8.29 times more likely to present some new alterations, while the head and neck (HN) tumor group had a 10.36-fold higher risk. CONCLUSION An incidence of 22.8% for communication, swallowing, and orofacial myofunctional disorders was observed. The development of these disorders was greater in individuals with tumors in the CNS and in the HN region.
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Affiliation(s)
- Kaliani Lima Coça
- Section of Speech-Language Pathology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil
| | - Anke Bergmann
- Molecular Carcinogenesis Program, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | | | - Sima Ferman
- Pediatric Oncology Service, Instituto Nacional do Câncer, Rio de Janeiro, Brazil
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13
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Rajendran S, Antonios J, Solomon B, Kim HJ, Wu T, Smirniotopoulos J, Scott G, Benzo S, Hayes C, Heiss JD, Chittiboina P. A Prospective Evaluation of Swallowing and Speech in Patients with Neurofibromatosis Type 2. J Neurol Surg B Skull Base 2019; 82:244-250. [PMID: 33777639 DOI: 10.1055/s-0039-1694054] [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: 01/17/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
Objective Neurofibromatosis type 2 (NF2) patients report that swallowing and speech problems significantly affect their quality of life, but the etiology of these phenomena is poorly understood. Swallowing and speech deficits may arise due to the neuropathy of involved nerves, due to posterior fossa tumor growth, or as iatrogenic effects from neurosurgical procedures to remove these tumors. This study aims to identify the natural history of swallowing and speech deficits in an NF2 cohort and to characterize the factors that may lead to those deficits. Methods Subjects ( n = 168) were enrolled in a prospective, longitudinal study of NF2 with yearly imaging and clinical exams. The patients completed a self-reported questionnaire that included responses regarding subjective swallowing and speech dysfunction. A formal speech-language pathology evaluation and modified barium swallow (MBS) study (reported as American Speech-Language Hearing Association [ASHA] swallowing independency score from 1 through 7) was obtained when a speech/swallowing deficit was reported on the questionnaire. Results Of the 168 enrolled subjects, 55 (33%, median age = 31 years) reported subjective speech and/or swallowing deficits. These patients underwent one ( n = 37) or multiple ( n = 18) MBS studies during 44.8 ± 10.4 months follow-up. During MBS, a majority demonstrated near-normal swallowing (ASHA score >6, 82%), and no evidence of aspiration (aspiration/laryngeal penetration score = 1, 96%). Prior to initial MBS consultation, 38 (69%) patients had undergone relevant neurosurgical procedures. In those with recent (<1 week) posterior fossa surgery ( n = 12), 2 (17%) patients had severe dysphagia and high aspiration risk on postoperative MBS. Both of these patients recovered to functionally independent swallowing status. Unilateral ( n = 10) or bilateral ( n = 6) tongue deficits unrelated to previous history suggestive of hypoglossal nerve injury were detected on clinical examination. There was a correlation between the presence of dysarthria and tongue deficits and tumors associated with the hypoglossal canal noted on imaging. Conclusion A large proportion of patients with NF2 report speech and swallow deficits that are not evident on objective measurements. We also found hypoglossal neuropathy unrelated to prior surgical interventions. Our findings suggest that swallowing and speech problems in NF2 are associated with lower cranial nerve neuropathy, some due to compressive effects of posterior fossa tumors. Adaptation over the course of the disease allows for the compensation of these deficits and subsequent normal findings on objective testing.
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Affiliation(s)
- Sibi Rajendran
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, United States.,Department of Neurosurgery, Houston Methodist, Houston, Texas, United States
| | - Joseph Antonios
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, United States.,Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, United States
| | - Beth Solomon
- Department of Rehabilitation Medicine, Speech-Language Pathology Section, National Institutes of Health Clinical Center, Bethesda, Maryland, United States
| | - H Jeffrey Kim
- National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland, United States
| | - Tianxia Wu
- Clinical Trials Unit, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, United States
| | - James Smirniotopoulos
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland, United States
| | - Gretchen Scott
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, United States
| | - Sarah Benzo
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, United States
| | - Christina Hayes
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, United States
| | - John D Heiss
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, United States
| | - Prashant Chittiboina
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, Maryland, United States.,Neurosurgery Unit for Pituitary and Inheritable Diseases, National Institute of Neurological Diseases and Stroke, Bethesda, Maryland, United States
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14
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Coça KL, Bergmann A, Ferman S, Angelis ECD, Ribeiro MG. Prevalence of communication, swallowing and orofacial myofunctional disorders in children and adolescents at the time of admission at a cancer hospital. Codas 2018. [PMID: 29513872 DOI: 10.1590/2317-1782/20182017123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Describe the prevalence of communication, swallowing and orofacial myofunctional disorders in a group of children and adolescents at the time of registration at a cancer hospital. METHODS A cross-sectional study conducted with children aged ≥2 and adolescents, of both genders, admitted to the Pediatric Oncology Section of the Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) from March 2014 to April 2015 for investigation and/or treatment of solid tumors. A protocol was used to record the sociodemographic and clinical information and findings of the speech-language pathology clinical evaluation, which included aspects of the oral sensorimotor system, swallowing, speech, language, voice, and hearing. RESULTS Eighty-eight children/adolescents (41.3%) presented some type of speech-language disorder. The most frequent speech-language disorders were orofacial myofunctional disorder, dysphonia, and language impairments, whereas the less frequent ones were dysacusis, tongue paralysis, and trismus. Site of the lesion was the clinical variable that presented statistically significant correlation with presence of speech-language disorders. CONCLUSION High prevalence of speech-language disorders was observed in children and adolescents at the time of admission at a cancer hospital. Occurrence of speech-language disorders was higher in participants with lesions in the central nervous system and in the head and neck region.
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Affiliation(s)
- Kaliani Lima Coça
- Setor de Fonoaudiologia, Instituto Nacional de Câncer José de Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ), Brasil.,Programa de Pós-graduação em Clínica Médica, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ), Brasil
| | - Anke Bergmann
- Programa de Carcinogênese Molecular, Instituto Nacional de Câncer José de Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ), Brasil
| | - Sima Ferman
- Serviço de Oncologia Pediátrica, Instituto Nacional de Câncer José de Alencar Gomes da Silva - INCA - Rio de Janeiro (RJ), Brasil
| | | | - Márcia Gonçalves Ribeiro
- Departamento de Pediatria, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ), Brasil
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15
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One-year outcome of postoperative swallowing impairment in pediatric patients with posterior fossa brain tumor. J Neurooncol 2015; 127:73-81. [DOI: 10.1007/s11060-015-2010-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022]
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16
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Vasant DH, Michou E, Mistry S, Rothwell JC, Hamdy S. High-frequency focal repetitive cerebellar stimulation induces prolonged increases in human pharyngeal motor cortex excitability. J Physiol 2015; 593:4963-77. [PMID: 26316351 DOI: 10.1113/jp270817] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/12/2015] [Indexed: 01/16/2023] Open
Abstract
KEY POINTS Neurostimulation is a rapidly emerging approach to swallowing rehabilitation, but cerebellar stimulation has not been explored as a treatment. Such proposed therapies for post-stroke dysphagia have required confirmation of physiological effects and optimisation of parameters in healthy humans prior to translational progression into patient groups. There is strong evidence for a role of the cerebellum in swallowing physiology, but this relationship has been under-explored. Recently, single pulses of cerebellar magnetic stimulation have been shown to directly evoke responses from pharyngeal musculature and produce short-term enhancement of cortico-pharyngeal motor evoked potentials, suggesting the feasibility of a cerebellar approach to neurostimulation in the swallowing system. We therefore examined multiple parameters of repetitive cerebellar magnetic stimulation and have described the optimal settings to provoke longer-lasting changes in swallowing neurophysiology. Based on evidence from the post-stroke dysphagia neurostimulation literature, these changes may have a therapeutic potential for swallowing rehabilitation. ABSTRACT Brain neurostimulation has been shown to modulate cortical swallowing neurophysiology in post-stroke dysphagia with therapeutic effects which are critically dependent on the stimulation parameters. Cerebellar neurostimulation is, however, a novel, unexplored approach to modulation of swallowing pathways as a prelude to therapy for dysphagia. Here, we randomised healthy human subjects (n = 17) to receive one of five cerebellar repetitive TMS (rTMS) interventions (Sham, 1 Hz, 5 Hz, 10 Hz and 20 Hz) on separate visits to our laboratory. Additionally, a subset of subjects randomly received each of three different durations (50, 250, 500 pulses) of optimal frequency versus sham cerebellar rTMS. Prior to interventions subjects underwent MRI-guided single-pulse transcranial magnetic stimulation (TMS) to co-localise pharyngeal and thenar representation in the cortex and cerebellum (midline and hemispheric) before acquisition of baseline motor evoked potential (MEP) recordings from each site as a measure of excitability. Post-interventional MEPs were recorded for an hour and compared to sham using repeated measures ANOVA. Only 10 Hz cerebellar rTMS increased cortico-pharyngeal MEP amplitudes (mean bilateral increase 52%, P = 0.007) with effects lasting 30 min post-intervention with an optimal train length of 250 pulses (P = 0.019). These optimised parameters of cerebellar rTMS can produce sustained increases in corticobulbar excitability and may have clinical translation in future studies of neurogenic dysphagia.
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Affiliation(s)
- Dipesh H Vasant
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Emilia Michou
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - Satish Mistry
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK
| | - Shaheen Hamdy
- Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK
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Wadhwa R, Toms J, Chittiboina P, Tawfik T, Glenn C, Caldito G, Guthikonda B, Nanda A. Dysphagia Following Posterior Fossa Surgery in Adults. World Neurosurg 2014; 82:822-7. [DOI: 10.1016/j.wneu.2013.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 09/15/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
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18
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Muzumdar D, Ventureyra ECG. Treatment of posterior fossa tumors in children. Expert Rev Neurother 2014; 10:525-46. [DOI: 10.1586/ern.10.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Ram Z, Grossman R. Dysphagia as a complication of posterior fossa surgery in adults. World Neurosurg 2013; 82:625-6. [PMID: 23454178 DOI: 10.1016/j.wneu.2013.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Zvi Ram
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.
| | - Rachel Grossman
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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20
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Quintana LM. Dysphagia--a complicated complication of posterior fossa pathologies. World Neurosurg 2013; 82:623-4. [PMID: 23376385 DOI: 10.1016/j.wneu.2013.01.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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21
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Taylor OD, Ware RS, Weir KA. Speech Pathology Services to Children With Cancer and Nonmalignant Hematological Disorders. J Pediatr Oncol Nurs 2012; 29:98-108. [DOI: 10.1177/1043454212438963] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children with cancer and nonmalignant hematological disorders may require speech pathology (SP) support; however, limited evidence is available describing prevalence and severity of swallowing/feeding and communication impairments in this population. A retrospective chart review of 70 children referred to SP at the newly formed Queensland Children’s Cancer Centre was conducted to describe the prevalence and severity of swallowing/feeding and communication dysfunction, and the association between impairment, oncology and hematology diagnosis, and service utilization (time and occasions of service). Swallowing/feeding disorders were the most commonly observed impairments at initial assessment (58.6%). Children with central nervous system tumors ( P = .03) and nonmalignant hematological disorder ( P = .03) had significantly higher rates of feeding impairment than other oncology and hematology diagnostic groups. Children with central nervous system tumors had the highest rates of oral phase ( P = .01) and pharyngeal phase ( P = .01) dysphagia (swallowing disorder). No significant difference was found between diagnostic groups for intensity of SP service delivery. Prospective research is required to examine prevalence and severity of disorders, and service utilization in a more established clinic, and to investigate interactions between cancer treatment and swallowing/feeding and communication dysfunction.
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Affiliation(s)
| | - Robert S. Ware
- University of Queensland, Brisbane, Queensland, Australia
| | - Kelly A. Weir
- Royal Children’s Hospital, Herston, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
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Jayasekeran V, Rothwell J, Hamdy S. Non-invasive magnetic stimulation of the human cerebellum facilitates cortico-bulbar projections in the swallowing motor system. Neurogastroenterol Motil 2011; 23:831-e341. [PMID: 21838728 DOI: 10.1111/j.1365-2982.2011.01747.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Animal and human brain imaging studies suggest that the cerebellum plays an important role in the control of swallowing. In this study, we probed the interaction between cerebellar and pharyngeal motor cortical activity with transcranial magnetic stimulation (TMS) to determine if the cerebellum can modulate cortical swallowing motor circuitry. METHODS Healthy volunteers (n=16, eight men, mean age=32, range 19-57years) underwent TMS measurements of pharyngeal electromyography (EMG) recorded from a swallowed intraluminal catheter to assess cortical and cerebellar excitability. Subjects then underwent a paired pulse paradigm, where active or sham TMS conditioning pulses over the cerebellum and control sites were followed by suprathreshold TMS over the cortical pharyngeal area. Paired pulses were delivered at varying inter-stimulus intervals (ISIs) with the cortical response amplitudes being assessed. KEY RESULTS Stimulation of the cerebellum over its midline or hemispheres evoked distinct pharyngeal EMG responses. There was no difference in EMG amplitudes following cerebellar hemispheric or midline stimulation (mean 55.5±6.9 vs 42.8±5.9μV, P=0.08). In contrast, after cerebellar preconditioning, the cortically evoked responses underwent maximal facilitation at ISIs of 50-200ms (P<0.05), an effect not seen with sham or trigeminal nerve preconditioning. CONCLUSIONS & INFERENCES Posterior fossa stimulation excites the cerebellum and evokes direct motor responses within the pharynx. When conditioned with TMS, the cerebellum strongly facilitates the cortical swallowing motor pathways. This finding suggests that the cerebellum exerts a modulatory effect on human swallowing and raises the possibility that excitatory neurostimulation of the cerebellum may be therapeutically useful in promoting recovery of dysphagia after neural damage.
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Affiliation(s)
- V Jayasekeran
- Inflammation Sciences Research Group, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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23
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Mei C, Morgan AT. Incidence of mutism, dysarthria and dysphagia associated with childhood posterior fossa tumour. Childs Nerv Syst 2011; 27:1129-36. [PMID: 21442268 DOI: 10.1007/s00381-011-1433-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 03/08/2011] [Indexed: 11/27/2022]
Abstract
PURPOSE Dysarthria and dysphagia are known complications following posterior fossa tumour (PFT) surgery. Outcome studies for these disorders, however, have focused on a select sub-group of children with mutism. Little is known regarding the incidence or features of these impairments in a consecutively admitted sample of children with PFT. This study describes the incidence and features of mutism, dysarthria and dysphagia during the acute post-surgical phase in a consecutive sample of children with PFT, unselected for the presence of mutism. METHODS A retrospective medical chart review of children aged 2 to 18 years consecutively admitted with PFT between January 2003 and January 2008 was conducted. RESULTS Twenty-seven children with PFT were identified. Post-surgical mutism, dysarthria and dysphagia were recorded in 9/27 (33%), 8/27 (30%) and 9/27 (33%) cases, respectively. Dysarthria most commonly involved deficits in articulation; however, impairments in respiration, phonation and prosody were also reported. Dysphagia involved all stages of swallowing (i.e., pre-oral anticipatory, oral preparatory, oral and pharyngeal). Eighty-nine percent of children (8/9) presented with dysphagia at hospital discharge. CONCLUSIONS The incidence of acute presentation of mutism, dysarthria and dysphagia post-surgery was relatively high, affecting around one in three cases. This incidence rate, considered together with the fact that over half of all cases had co-morbid communication or swallowing impairments, suggests that health professionals should be aware of the likelihood of dysarthria and dysphagia presentation in the acute period and consider speech pathology referral where necessary.
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Affiliation(s)
- Cristina Mei
- Healthy Development Theme, Murdoch Childrens Research Institute, Parkville, 3052, Melbourne, Australia.
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Morgan AT, Skeat J. Evaluating service delivery for speech and swallowing problems following paediatric brain injury: an international survey. J Eval Clin Pract 2011; 17:275-81. [PMID: 21029267 DOI: 10.1111/j.1365-2753.2010.01436.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Little is documented about contemporary management of speech and swallowing disorders associated with paediatric acquired brain injury (ABI). It is therefore challenging for clinicians in this field to benchmark their clinical management against current evidence or practices undertaken in other centres. To address this issue, we aimed to provide much-needed baseline data on speech and language pathology management of speech and swallowing disorders associated with childhood ABI. Key objectives were to: (i) determine whether clinicians use formalized referral criteria, clinical guidelines, protocols or care pathways; and (ii) to document the specific assessment and treatment approaches used. METHODS Speech and language pathology managers and clinicians at 31 major paediatric rehabilitation centres across Australia, New Zealand, the UK and Ireland were invited to participate in an online survey. RESULTS Fifty-one speech and language pathologists responded representing 26 centres (84% response rate). Routine referrals of ABI patients to speech and language pathology occurred relatively infrequently in these centres (12%). Centres utilized assessment protocols (23%) and guidelines (35%) more frequently than treatment guidelines (8%). Multidisciplinary care pathways were applied by 31%. Most centres used adult-based motor speech assessments and informal ('in-house developed') swallowing assessment tools. CONCLUSIONS The limited use of referral criteria, protocols, care pathways and guidelines invites the possibility of unequal care, and less than optimal outcomes. Reliance on adult-based or in-house assessments is inappropriate, yet frequently a necessity due to an absence of paediatric-specific tools in this field. Further research is required in parallel with the formation of consensus groups to support the development of: (i) paediatric-specific assessment tools and management approaches; and (ii) clinical protocols and guidelines.
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Affiliation(s)
- Angela T Morgan
- Healthy Development Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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