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Nagoya K, Tsujimura T, Yoshihara M, Watanabe M, Magara J, Kawasaki K, Inoue M. Physiological analyses of swallowing changes due to chronic obstructive pulmonary disease in anesthetized male rats. Front Physiol 2024; 15:1445336. [PMID: 39170764 PMCID: PMC11337103 DOI: 10.3389/fphys.2024.1445336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/18/2024] [Indexed: 08/23/2024] Open
Abstract
Chronic obstructive pulmonary disease (COPD) was previously known as chronic bronchitis and emphysema. It has various main symptoms, such as dyspnea, chronic cough, and sputum, and is often accompanied by dysphagia. Although many published clinical reports have described COPD-related dysphagia, the physiological mechanisms underlying swallowing changes due to COPD remain unclear. Therefore, we analyzed how COPD affects the swallowing reflex using COPD model rats. We performed an electrophysiological study of respiration and swallowing using COPD model induced by intratracheal administration of porcine pancreatic elastase and lipopolysaccharide in Sprague-Dawley male rats. To identify the respiration and swallowing responses, electromyographic activity was recorded from the diaphragm, digastric (Dig), and thyrohyoid (TH) muscles. We confirmed COPD using micro-computed tomography analysis and hematoxylin and eosin staining of the lungs. The duty cycle was defined as the ratio of the inspiration duration to the total respiratory duration. In COPD model rats, the duty cycle was significantly higher than that in control rats. The frequency of the swallowing reflex evoked by electrical stimulation of the superior laryngeal nerve during the inspiration phase was higher in COPD model rats than in control rats. Furthermore, long-term COPD altered Dig and TH muscle activity without pathological muscle change. Our results suggest that COPD increases the frequency of swallowing initiation during the inspiration phase. Furthermore, long-term COPD affects swallowing-related muscle activity without pathological muscle changes. These physiological changes may increase the risk of developing dysphagia. Further studies are necessary to clarify the mechanisms contributing to the functional changes in respiration and swallowing in COPD.
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Affiliation(s)
- Kouta Nagoya
- Division of Oral Functional Rehabilitation Medicine, Department of Oral Health Management, Showa University School of Dentistry, Tokyo, Japan
- 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
| | - Midori Yoshihara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Watanabe
- Department of Hygiene and Oral Health, Showa University School of Dentistry, Tokyo, Japan
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Katsushige Kawasaki
- Division of Oral Anatomy, 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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Govender R, Gilbody N, Simson G, Haag R, Robertson C, Stuart E. Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists. Curr Treat Options Oncol 2024; 25:703-718. [PMID: 38691257 PMCID: PMC11222272 DOI: 10.1007/s11864-024-01198-0] [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: 03/08/2024] [Indexed: 05/03/2024]
Abstract
OPINION STATEMENT Dysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.
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Affiliation(s)
- Roganie Govender
- Head & Neck Academic Centre& UCL Division of Surgery & Interventional ScienceGround Floor Central, University College London Hospital, 250 Euston Road, London, NW1 2PQ, UK.
| | - Nicky Gilbody
- North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - Ceri Robertson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Stuart
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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Kadri W, Halfpenny R, Whiten B, Mulkerrin S, Smith C. Dysphagia therapy in adults with a tracheostomy: A scoping review protocol. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38533839 DOI: 10.1111/1460-6984.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Swallowing impairment (dysphagia) and tracheostomy coexist. Research in this area has often provided an overview of dysphagia management as a whole, but there is limited information pertaining to specific dysphagia therapy in the tracheostomy population. The aim of this scoping review is to provide a detailed exploration of the literature with regard to dysphagia therapeutic interventions in adults with a tracheostomy. The scoping review will describe current evidence and thus facilitate future discussions to guide clinical practice. METHODS A scoping review using the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews guideline will be used. Ten electronic databases from inception to December 2023 and grey literature will be searched. From identified texts forward and backward citation chasing will be completed. Data extraction will compose of population demographics, aetiology and dysphagia therapy (type, design, dose and intensity). A number of citations and papers included in the scoping review will be presented visually. DISCUSSION The scoping review aims to expand upon the existing literature in this field. A detailed description of the evidence is required to facilitate clinical discussions and develop therapeutic protocols in a tracheostomised population. The results of this scoping review will support future research in dysphagia therapy and provide the basis for the development of best practice guidelines. WHAT THIS PAPER ADDS What is already known on this subject There is an abundance of evidence available regarding dysphagia therapy targeting impairments of the swallowing sequence in a variety of populations including stroke, head and neck cancer, progressive neurological conditions and critical illness. However, there is a paucity in the literature with regard to identifying dysphagia therapy for adults with a tracheostomy. What this study adds The study protocol aims to describe the methodological features that need to be extracted from existing studies to outline dysphagia therapy for adults with a tracheostomy. To the researchers' knowledge, this is the first study protocol to describe the methodological features of dysphagia therapy for people with a tracheostomy from the literature using a standardised approach (Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guideline). This will ensure that the protocol is replicable for other researchers to use and demonstrates transparency in research methods. What are the clinical implications of this work? The development of a robust protocol is necessary in order to facilitate the scoping review to describe the current evidence and thus facilitate future discussions to guide clinical practice for speech and language therapists working with adults who have a tracheostomy and dysphagia. The publication of the scoping review protocol allows future clinical researchers in the area of tracheostomy and dysphagia management a blueprint with which to narrow their own research questions and it also enables replicability as the principles of good research practice dictate.
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Affiliation(s)
- Waiza Kadri
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, England
- University College London (UCL), Division of Psychology and Language Sciences, London, England
| | - Rhiannon Halfpenny
- University College London (UCL), Division of Psychology and Language Sciences, London, England
- Great Ormond Street Hospital, London, England
| | - Breege Whiten
- University College London (UCL), Division of Psychology and Language Sciences, London, England
| | - Siofra Mulkerrin
- Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| | - Christina Smith
- University College London (UCL), Division of Psychology and Language Sciences, London, England
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Gómez-García N, Álvarez-Barrio L, Leirós-Rodríguez R, Soto-Rodríguez A, Andrade-Gómez E, Hernández-Lucas P. Transcranial direct current stimulation for post-stroke dysphagia: a meta-analysis. J Neuroeng Rehabil 2023; 20:165. [PMID: 38082316 PMCID: PMC10712182 DOI: 10.1186/s12984-023-01290-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Strokes may cause some swallowing difficulty or associated dysphagia in 25-80% of patients. This phenomenon has been linked to increased morbidity and mortality. Therefore, the aim of this study was to evaluate the efficacy of transcranial direct current stimulation in patients with dysphagia in post-stroke patients. METHODS A systematic search in PubMed, Scopus, Web of Science and MEDLINE was conducted. The articles must have to evaluate an intervention that included transcranial direct current stimulation; the sample had to consist exclusively of patients with post-stroke dysphagia; and the experimental design consisted of randomized controlled trial. Difference in mean differences and their 95% confidence interval were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. RESULTS Of the 9 investigations analyzed, all applied transcranial direct current stimulation in combination with conventional dysphagia therapy to the experimental group. All the studies analyzed identified improvements in swallowing function and meta-analysis confirmed their strong effect on reducing the risk of penetration and aspiration (Hedges's g = 0.55). The results showed that participants who received transcranial direct current stimulation significantly improved swallowing function. CONCLUSIONS Transcranial direct current stimulation has positive effects in the treatment of poststroke dysphagia by improving swallowing function, oral and pharyngeal phase times and the risk of penetration and aspiration. Furthermore, its combination with conventional dysphagia therapy, balloon dilatation with catheter or training of the swallowing muscles ensures improvement of swallowing function. PROSPERO registration ID CRD42022314949.
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Affiliation(s)
- Nerea Gómez-García
- Nursing and Physical Therapy Department, University of Leon, Astorga Ave., 24401, Ponferrada, Spain
| | - Lorena Álvarez-Barrio
- Nursing and Physical Therapy Department, University of Leon, Astorga Ave., 24401, Ponferrada, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Nursing and Physical Therapy Department, University of Leon, Astorga Ave., 24401, Ponferrada, Spain
| | - Anxela Soto-Rodríguez
- Pneumology Service, Ourense Hospital, Galician Health Service, 32005, Ourense, Spain
| | - Elena Andrade-Gómez
- Department of Nursing, University of La Rioja, La Rioja, 26004, Logroño, Spain.
| | - Pablo Hernández-Lucas
- Faculty of Physiotherapy, University of Vigo, Campus A Xunqueira, 36005, Pontevedra, Spain
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Kaylor SA, Singh SA. Clinical outcomes associated with speech, language and swallowing difficulties post-stroke. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e15. [PMID: 37916686 PMCID: PMC10623651 DOI: 10.4102/sajcd.v70i1.957] [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: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND There is a lack of prospective research in South Africa's speech therapy private sector, specifically, in the acute stroke population. There is a need to understand the quality of speech therapy services and outcomes post-stroke in the private sector. OBJECTIVES This prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), and outcomes post-stroke (i.e. length of hospital stay [LOS], degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). METHOD A prospective design was used to determine the incidence of speech, language, and swallowing conditions post-stroke. Convenience sampling was used to select participants (N = 68). Various statistical tests were used and the alpha level was set at Bonferroni correction p 0.01. RESULTS Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to speech therapy later than 24 h post-admission (52.94%) stayed in hospital for a median of 3 days longer than those who were referred within 24 h (p = 0.042). Dysphagia was significantly associated with moderate to severe physical disability (p 0.01). Dysphagia with aspiration was significantly associated with poor functional level of oral intake, at admission and at discharge (p 0.01). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p 0.01, r = 0.70). CONCLUSION In South Africa's private sector, co-occurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed speech therapy referrals.Contribution: This article contributes data on speech therapy services, communication and swallowing disorders post-stroke, and outcomes in South Africa's private sector.
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Affiliation(s)
- Stephanie A Kaylor
- Department of Communication Sciences and Disorders, Faculty of Health and Rehabilitation Sciences, University of Cape Town, Cape Town.
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Vasan V, Hardigan TA, Ali M, Downes M, Devarajan A, Rossitto CP, Schuldt BR, Odland IC, Kellner CP, Fifi JT, Mocco J, Majidi S. Dysphagia after ischemic and hemorrhagic stroke: A propensity-matched 20-year analysis of the national inpatient sample. J Stroke Cerebrovasc Dis 2023; 32:107295. [PMID: 37544059 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107295] [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: 03/27/2023] [Revised: 07/23/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Dysphagia is a common symptom of acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), but little is known surrounding national trends of this post-stroke condition. Hence, this study aimed to identify the risk factors for dysphagia following AIS and ICH and evaluate in-hospital outcomes in these patients. METHODS The 2000-2019 Nationwide Inpatient Sample was queried for patients admitted with AIS (ICD9 433, 43401, 43411, 43491, ICD-10 I63) and ICH (ICD9 431, 432.9, ICD-10 I61, I62.9). Univariate analysis with t-tests or chi-square performed as appropriate. A 1:1 nearest neighbor propensity score matched cohort was generated. Variables with standardized mean differences >0.1 were used in multivariable regression to generate adjusted odds ratios (AOR)/β-coefficients for the presence of dysphagia on outcomes. RESULTS Of 10,415,286 patients with AIS, 956,662 (9.2%) had in-hospital dysphagia. Total of 2,000,868 patients with ICH were identified; 203,511 (10.2%) had in-hospital dysphagia. Patients with dysphagia after AIS were less likely to experience in-hospital mortality (OR 0.61;95%CI: 0.60-0.63) or be discharged home (AOR 0.51;95%CI: 0.51-0.52), had increased length of stay (Beta-coefficient = 0.43 days; 95%CI: 0.36-0.50), and had increased hospital charges ($14411.96;95%CI: 13565.68-15257.44) (all p < 0.001). Patients with dysphagia after ICH were less likely to experience in-hospital mortality (AOR 0.39;95%CI: 0.37-0.4), less likely to be discharged home (AOR 0.59,95%CI:0.57-0.61), have longer hospital stay (Beta-coefficient = 1.99 days;95%CI: 1.78-2.21), and increased hospital charges ($28251.93; 95%CI: $25594.57-30909.28)(all p < 0.001). CONCLUSION This is the first study to report on national trends in patients with dysphagia after AIS and ICH. These patients had longer hospital LOS, worse functional outcomes at discharge, and higher hospital costs.
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Affiliation(s)
- Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA.
| | - Trevor A Hardigan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Margaret Downes
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Christina P Rossitto
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Braxton R Schuldt
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Ian C Odland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Christopher P Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
| | - Shahram Majidi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10128, USA
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Tarihci Cakmak E, Sen EI, Doruk C, Sen C, Sezikli S, Yaliman A. The Effects of Neuromuscular Electrical Stimulation on Swallowing Functions in Post-stroke Dysphagia: A Randomized Controlled Trial. Dysphagia 2022; 38:874-885. [PMID: 35986170 DOI: 10.1007/s00455-022-10512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Abstract
The study aimed to evaluate the effects of traditional dysphagia therapy (TDT) and neuromuscular electrical stimulation (NMES) combined with TDT on functionality of oral intake, dysphagia symptom severity, swallowing- and voice-related quality of life, leakage, penetration-aspiration, and residue levels in patients with post-stroke dysphagia (PSD). Thirty-four patients with PSD were included in our prospective, randomized, controlled, and single-blind study. The patients were divided into two groups: (1) TDT only (control group, n = 17) and (2) TDT with NMES (experimental group, n = 17). TDT was applied to both groups for three consecutive weeks, 5 days a week, 45 min a day. Sensory NMES was applied to the experimental group for 45 min per session. Patients were evaluated by the functional oral intake scale (FOIS), the eating assessment tool (EAT-10), the swallowing quality of life questionnaire (SWAL-QOL), and the voice-related quality of life questionnaire (VRQOL) at baseline, immediately post-intervention, and at the 3rd month post-intervention. Fiberoptic endoscopic evaluation of swallowing (FEES) with liquid and semi-solid food was performed pre- and post-intervention. A significant post-intervention improvement was observed on all scales in both groups, and these improvements were maintained 3 months post-intervention. Leakage and penetration-aspiration levels with semi-solid food declined only in the experimental group. In conclusion, TDT is a non-invasive and inexpensive method that leads to improvement in many swallowing-related features in stroke patients; however, NMES as an adjunct therapy is costly but can provide additional benefits for improving features, such as penetration-aspiration and residue levels.
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High-Frequency Cerebellar rTMS Improves the Swallowing Function of Patients with Dysphagia after Brainstem Stroke. Neural Plast 2022; 2022:6259693. [PMID: 35992301 PMCID: PMC9388260 DOI: 10.1155/2022/6259693] [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: 02/08/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To explore the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) of the swallowing motor area of the cerebellum in patients with dysphagia after brainstem stroke. Methods A total of 36 patients with dysphagia after brainstem stroke were recruited and divided into 3 groups. Before stimulation, single-pulse transcranial magnetic stimulation (TMS) was used to determine the swallowing dominant cerebellar hemisphere and the representation of the mylohyoid muscle. The three groups of patients received bilateral cerebellar sham stimulation, dominant cerebellar rTMS + contralateral sham stimulation, or bilateral cerebellar rTMS. The stimulus plan for each side was 10 Hz, 80% resting movement threshold (rMT), 250 pulses, 1 s per stimulus, and 9 s intervals. Sham rTMS was performed with the coil held at 90° to the scalp. The changes in the motor evoked potential (MEP) amplitude and the clinical swallowing function scales of the patients after stimulation were compared among the three groups. Results 34 patients were finally included for statistical analysis. The scores of penetration aspiration scale (PAS) and functional dysphagia scale (FDS) of the patients after 2 weeks of rTMS in the unilateral stimulation group and bilateral stimulation group were better than that in the sham stimulation group, and there was no significant difference between the two groups. The increase in the MEP amplitude of the cerebral hemisphere in the bilateral stimulation group was higher than that in the other two groups, and the increase in the MEP amplitude in the unilateral stimulation group was higher than that in sham stimulation group. There was no correlation between the improvement in patients' clinical swallowing function (PAS scores and FDS scores) and the increase in MEP amplitude in either the unilateral stimulation group or the bilateral stimulation group. Conclusion High-frequency rTMS in the cerebellum can improve swallowing function in PSD patients and increase the excitability of the representation of swallowing in the bilateral cerebral hemispheres. Compared with unilateral cerebellar rTMS, bilateral stimulation increased the excitability of the cerebral swallowing cortex more significantly, but there was no significant difference in clinical swallowing function.
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Umay E, Eyigor S, Bahat G, Halil M, Giray E, Unsal P, Unlu Z, Tikiz C, Vural M, Cincin AT, Bengisu S, Gurcay E, Keseroglu K, Aydeniz B, Karaca EC, Karaca B, Yalcin A, Ozsurekci C, Seyidoglu D, Yilmaz O, Alicura S, Tokgoz S, Selcuk B, Sen EI, Karahan AY, Yaliman A, Ozkok S, Ilhan B, Oytun MG, Ozturk ZA, Akin S, Yavuz B, Akaltun MS, Sari A, Inanir M, Bilgilisoy M, Çaliskan Z, Saylam G, Ozer T, Eren Y, Bicakli DH, Keskin D, Ulger Z, Demirhan A, Calik Y, Saka B, Yigman ZA, Ozturk EA. Best Practice Recommendations for Geriatric Dysphagia Management with 5 Ws and 1H. Ann Geriatr Med Res 2022; 26:94-124. [PMID: 35527033 PMCID: PMC9271401 DOI: 10.4235/agmr.21.0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/26/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ebru Umay
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
- Corresponding Author Ebru Umay, MD Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara 06200, Turkey E-mail:
| | - Sibel Eyigor
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Gulistan Bahat
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Meltem Halil
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Esra Giray
- Department of Physical Medicine and Rehabilitation, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Pelin Unsal
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Zeliha Unlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Canan Tikiz
- Department of Physical Medicine and Rehabilitation, Celal Bayar University, Manisa, Turkey
| | - Meltem Vural
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Asli Tufan Cincin
- Department of Internal Medicine, Marmara University, Istanbul, Turkey
| | - Serkan Bengisu
- Department of Speech and Language Therapy, Uskudar University, Istanbul, Turkey
| | - Eda Gurcay
- Gaziler Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Kemal Keseroglu
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Banu Aydeniz
- Department of Physical Medicine and Rehabilitation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Celik Karaca
- Ministry of Health Eskisehir Provincial Health Directorate, Eskisehir, Turkey
| | - Burak Karaca
- Ministry of Health Inonu Public Health Center, Eskisehir, Turkey
| | - Ahmet Yalcin
- Division of Geriatrics, Department of Internal Medicine, Ankara University, Ankara, Turkey
| | - Cemile Ozsurekci
- Department of Physical Medicine and Rehabilitation, Trabzon Kanuni Training and Research Hospital, University of Health Sciences Turkey, Trabzon, Turkey
| | | | - Ozlem Yilmaz
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Alicura
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Serhat Tokgoz
- Department of General Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Barin Selcuk
- Department of Physical Medicine, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Ali Yavuz Karahan
- Department of Physical Medicine and Rehabilitation, Usak University, Usak, Turkey
| | - Ayse Yaliman
- Department of Physical Medicine and Rehabilitation, Istanbul University, Istanbul, Turkey
| | - Serdar Ozkok
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Birkan Ilhan
- Department of Internal Medicine, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Guner Oytun
- Division of Geriatrics, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | | | - Sibel Akin
- Department Internal Medicine, Erciyes University, Kayseri, Turkey
| | - Betul Yavuz
- Department of Physical Medicine and Rehabilitation, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Gaziantep University, Gaziantep, Turkey
| | - Aylin Sari
- Istanbul Erenkoy Physical Medicine and Rehabilitation Hospital, Istanbul, Turkey
| | - Murat Inanir
- Department of Physical Medicine and Rehabilitation, Kocaeli University, Kocaeli, Turkey
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Zuhal Çaliskan
- Department of Gastroenterology, Umraniye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Guleser Saylam
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Tugce Ozer
- Department of Otolaryngology, Head and Neck Surgery, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Yasemin Eren
- Department of Neurology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | | | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Kirikkale University, Kirikkale, Turkey
| | - Zekeriya Ulger
- Department of Internal Medicine, Kirikkale University, Kirikkale, Turkey
| | - Aylin Demirhan
- Aylin Demirhan Physical Medicine and Rehabilitation Clinic, Izmir, Turkey
| | - Yalkin Calik
- Department of Physical Medicine and Rehabilitation, Bolu Izzet Baysal Training and Research Hospital, Bolu Turkey
| | - Bulent Saka
- Division of Geriatrics, Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Aykin Yigman
- Department of Physical Medicine and Rehabilitation, Polatli City Hospital, Ministry of Health, Ankara, Turkey
| | - Erhan Arif Ozturk
- Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
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10
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Prust ML, Nutakki A, Habanyama G, Chishimba L, Chomba M, Mataa M, Yumbe K, Zimba S, Gottesman RF, Bahouth MN, Saylor DR. Aspiration Pneumonia in Adults Hospitalized With Stroke at a Large Academic Hospital in Zambia. Neurol Clin Pract 2022; 11:e840-e847. [PMID: 34992967 DOI: 10.1212/cpj.0000000000001111] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/06/2021] [Indexed: 01/19/2023]
Abstract
Background and Objectives Preventing complications of stroke such as poststroke aspiration pneumonia (PSAP) may improve stroke outcomes in resource-limited settings. We investigated the incidence and associated mortality of PSAP in Zambia. Methods We conducted a prospective cohort study of adults with stroke at University Teaching Hospital (Lusaka, Zambia) between December 2019 and March 2020. NIH Stroke Scale, Glasgow Coma Scale, and Modified Rankin Scale scores and 9 indicators of possible PSAP were collected serially over each participant's admission. PSAP was defined as ≥4 indicators present, and possible PSAP as 2%-3% present. T tests and χ2 tests were used to compare clinical parameters across PSAP groups. Logistic regression was used to assess the relative effects of age, sex, PSAP status, and initial stroke severity on inpatient mortality. Results We enrolled 125 participants. Mean age was 60 ± 16 years, 61% were female, 55% of strokes were ischemic, and the baseline NIH Stroke Scale score was 19.7 ± 8.7. Thirty-eight (30%) had PSAP, and 32 (26%) had possible PSAP. PSAP was associated with older age and more adverse stroke severity scores. Fifty-nine percent of participants with PSAP died compared with 39% with possible PSAP and 8% with no PSAP. PSAP status independently predicted inpatient mortality after controlling for age, sex, and initial stroke severity. Swallow screening was not performed for any participant. Discussion PSAP is common and life threatening in Zambia, especially among older participants with severe stroke presentations. PSAP was associated with significantly increased mortality independent of initial stroke severity, suggesting that interventions to mitigate PSAP may improve stroke outcomes in Zambia and other resource-limited settings.
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Affiliation(s)
- Morgan L Prust
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aparna Nutakki
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Gloria Habanyama
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lorraine Chishimba
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mashina Chomba
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Moses Mataa
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kunda Yumbe
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stanley Zimba
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mona N Bahouth
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Deanna R Saylor
- Department of Neurology (MLP), Division of Neurocritical Care, Columbia University Medical Center, New York, NY; Rush University Medical College (AN), Chicago, IL; Department of Medicine (GH, LC, MC, MM, DRS), University of Zambia School of Medicine, Lusaka; Department of Medicine (KY, SZ, DRS), University Teaching Hospital, University of Zambia, Lusaka; and Department of Neurology (RFG, MNB, DRS), Johns Hopkins University School of Medicine, Baltimore, MD
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11
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Holdoway A, Arsava E, Ashford S, Cereda E, Dziewas R, Francisco G. Nutrition management across the stroke continuum of care to optimize outcome and recovery. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/ijprm.jisprm-000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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12
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Maniaci A, Lechien JR, D’Amico E, Cancemi F, Patti F, Faia C, La Mantia I, Privitera E, Di Luca M, Iannella G, Magliulo G, Pace A, Di Mauro P, Calvo-Henriquez C, Ferlito S, Motta G, Mannelli G, Zappia M, Vicini C, Cocuzza S. Post-Cerebrovascular Stroke and Early Dysphagia Assessment: A Systematic Review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022263. [PMID: 36043981 PMCID: PMC9534254 DOI: 10.23750/abm.v93i4.12135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/26/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE We performed a systematic review on the early assessment of swallowing function after cerebrovascular stroke. MATERIALS AND METHODS A systematic review of the English language literature of the past 20 years was performed regarding swallowing function and cerebrovascular stroke. All articles reporting swallowing evaluation through clinical examination validated scores, and diagnostic tools were included in the summary. RESULTS The systematic review of the literature identified 1,768 potentially relevant studies with 7 papers retrieved with a total of 589 stroke dysphagic patients. While at the clinical neurological assessment, The National Institutes of Health Stroke Scale was more frequently used as a clinical outcome predictor. The Bedside screening approach was carried out in 6 papers to assess patients with probable swallowing disorders. Among the diagnostic tools, seven studies performed the Flexible Fiberoptic Endoscopic evaluation assessing scoring validated system while two papers reported early swallowing outcomes Videofluoroscopic Swallow Study. CONCLUSIONS Our systematic review revealed the findings significantly associated with dysphagia in post-cerebrovascular patients. Endoscopic evaluation of swallowing proved to be the most used method in the literature, effective in identifying early predictors of dysphagia. Given the presence of different assessing scores employed and reduced study samples enrolled, further studies with large courts are necessary for a greater significance.
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Affiliation(s)
- Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Jerome R Lechien
- Research Committee of the Young Otolaryngologists, International Federations of ORL Societies, Paris, France, Department of Human Anatomy and Experimental Oncology, School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium, Department of Otorhinolaryngology-Head and Neck Surgery, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium, Department of Otolaryngology-Head and Neck Surgery, Foch Hospital (University of Paris-Saclay), Paris, France
| | - Emanuele D’Amico
- Department “G.F. Ingrassia”, MS Center, Organization University of Catania, Catania, Italy
| | - Francesco Cancemi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Francesco Patti
- Department “G.F. Ingrassia”, MS Center, Organization University of Catania, Catania, Italy
| | - Claudio Faia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Ignazio La Mantia
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Elio Privitera
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Giannicola Iannella
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy, Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
| | - Giuseppe Magliulo
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Annalisa Pace
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Paola Di Mauro
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Christian Calvo-Henriquez
- Task Force COVID-19 of the Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS); Department of Otolaryngology, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
| | - Gaetano Motta
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuditta Mannelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Mario Zappia
- Department “G.F. Ingrassia”, MS Center, Organization University of Catania, Catania, Italy
| | - Claudio Vicini
- Department of ‘Organi di Senso’, University “Sapienza”, Rome, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Catania, Italy
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13
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Wang CC, Chen YY, Hung KC, Wu SJ, Yen YF, Chen CC, Lai YJ. Association between teeth loss and nasogastric tube feeding dependency in older adults from Taiwan: a retrospective cohort study. BMC Geriatr 2021; 21:640. [PMID: 34772343 PMCID: PMC8588643 DOI: 10.1186/s12877-021-02596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
Background To examine the association between teeth loss and nasogastric tube feeding dependency in older people. Methods The National Health Interview Survey (NHIS) 2005, 2009, and 2013 in Taiwan. Participants were selected by a multistage stratified sampling method and baseline characteristics, including socioeconomic status and health habits, were obtained by well-trained interviewers. The NHIS was linked with the National Health Insurance research database 2000–2016 and the National Deaths Dataset, which contains all the medical information of ambulatory and inpatient care. Cox regression was used to examine the association between the number of teeth lost and nasogastric tube feeding dependency. Results There were 6165 adults older than 65 years old enrolled in the analysis, with 2959 male (48%) and the mean (SD) age was 73.95(6.46) years old. The mean follow-up duration was 6.5(3.3) years. Regarding the teeth loss categories, 1660 (26.93%), 2123 (34.44%), and 2382 (38.64%) of participants were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. During 39,962 person-years of follow-up, new-onset nasogastric feeding dependency was recognized in 220(13.25%), 256(12.06%), and 461(19.35%) participants who were categorized as having no teeth loss, loss of 1–9 teeth, and loss of 10–28 teeth, respectively. Kaplan-Meier curves demonstrated significant findings (Log-rank P < 0.01). After potential confounders were adjusted, compared with those without teeth loss, older adults who had lost 10–28 teeth had significantly increased risks of occurrence nasogastric feeding dependency (AHR, 1.31; 95% CI, 1.05–1.62; p-value = 0.02). Furthermore, a significant dose-response relation between the number of teeth lost and increased risk of nasogastric feeding was found (p for trend< 0.01). Conclusions Older adults who had lost 10–28 teeth had a significantly increased risk of nasogastric tube feeding dependency. Early identification of the oral disease is crucial for the prevention of the occurrence of teeth loss and the following nutrition problems, which would reduce risk of nasogastric tube feeding dependency.
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Affiliation(s)
- Chun-Chieh Wang
- Division of Chest Medicine, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Eldercare, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan.,Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,National Chung Hsing University, Taichung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Shang-Jung Wu
- Department of Nursing, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,College of Nursing Taichung, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yung-Feng Yen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No.365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan.,Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No.365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan.
| | - Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, No.365, Ming-te Road, Peitou District, Taipei City, 112, Taiwan. .,Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan. .,Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, No.1, Rongguang Rd, Puli Township, Nantou County, 545, Taiwan.
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14
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The role of the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke (GLOBE-3S) in the prevention of stroke-associated pneumonia (SAP). Neurol Sci 2021; 43:1167-1176. [PMID: 34269936 PMCID: PMC8789723 DOI: 10.1007/s10072-021-05449-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022]
Abstract
Background and purpose Stroke-associated pneumonia (SAP) affects 10 to 38% of patients in the acute phase of stroke. Stroke patients diagnosed with dysphagia have an 11-fold higher risk of developing SAP. Thus, identifying dysphagic patients through a highly accurate screening tool might be crucial in reducing the incidence of SAP. We present a case–control study designed to evaluate efficacy in reducing the risk of SAP between two swallowing screening tools, the classic water swallow test (WST) and a recently validated tool such as the GLOBE-3S (the Sapienza GLObal Bedside Evaluation of Swallowing after Stroke), which is a highly sensitive swallowing screening tool particularly accurate in detecting silent aspiration as well. Methods We analyzed the occurrence of dysphagia in 100 acute stroke patients distributed in two groups: half were screened with WST and the other half with GLOBE-3S. Results Dysphagia was diagnosed in 28 patients. The main result is that, among patients who passed the dysphagia screenings, none of those screened with the GLOBE-3S method developed pneumonia compared to 31.82% in the WST group. Discriminant function analysis (DFA) showed that NIH Stroke Scale (NIHSS) score and the dysphagia screening method (i.e., GLOBE-3S vs. WST) were the two main factors in the SAP’s predicting model and the only significant ones per se. Conclusions The new GLOBE-3S screening test can reduce the risk of SAP compared to WST.
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15
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Park HY, Kim Y, Oh HM, Kim TW, Park GY, Im S. Potential Prognostic Impact of Dopamine Receptor D1 ( rs4532) Polymorphism in Post-stroke Outcome in the Elderly. Front Neurol 2021; 12:675060. [PMID: 34276537 PMCID: PMC8277925 DOI: 10.3389/fneur.2021.675060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Single-nucleotide polymorphisms (SNPs) may affect post-stroke motor recovery, and some SNPs have been implicated in swallowing disturbances after stroke. Certain SNPs may also have altered influences according to different age. Objective: This post-hoc study investigated whether SNPs have different effects on dysphagia recovery between the elderly vs. young stroke patients. Methods: Analysis was conducted from a previous study including 218 stroke subjects with dysphagia. They were stratified into two groups, aged <65 and aged ≥65 years. The primary outcome was persistence of nil per mouth (NPM) at 3 months post-stroke onset. Association between outcome and nine different SNPs were investigated. Results: The elderly group (50%, n = 103) showed poorer swallowing outcomes than the young group. The minor allele of the dopamine receptor D1 (DRD1, rs4532) polymorphism showed potential association (p = 0.022) with an increased risk of NPM at 12 weeks post-stroke in the elderly, both in the additive (OR, 2.94; 95% CI, 1.17-7.37) and dominant models (OR, 2.93; 95% CI, 1.04-8.23) but did not reach statistical significance after Bonferonni correction. Logistic regression analysis showed that in those aged ≥65 years, models including the minor allele of rs4532 predicted the risk of the poor outcome with good accuracies even after adjustment of clinical factors, such as previous pneumonia episodes (AUROC, 0.86; 95% CI, 0.79-0.93) or the National Institutes of Health Stroke Scale (AUROC, 0.82; 95% CI, 0.67-0.92). In contrast, those aged <65 years seemed not to be affected by the presence of the rs4532 polymorphism, and models that included intubation history (AUROC, 0.81; 95% CI, 0.73-0.90) or previous pneumonia episodes (AUROC, 0.77; 95% CI, 0.68-0.87) showed modest levels of accuracies in predicting NPM at 12 weeks poststroke. Conclusions: Our study suggests a possible association between the rs4532 and post-stroke swallowing recovery, primarily in those aged ≥65 years. Certain SNPs may lead to less favorable outcomes in the elderly. The gene-age interaction should be considered in post-stroke swallowing recovery. Clinical Trial Registration: https://www.clinicaltrials.gov, Unique identifier [NCT03577444].
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Affiliation(s)
- Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, South Korea.,Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, South Korea.,Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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16
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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part I: Management, Diagnosis, and Follow-up. Dysphagia 2021; 37:217-236. [PMID: 33687558 DOI: 10.1007/s00455-021-10273-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome after acute stroke and may become chronic after the acute period and continues to affect all aspects of the patient's life. Patients with stroke may encounter any of the medical branches in the emergency room or outpatient clinic, and as in our country, there may not be specialists specific for dysphagia, such as speech-language pathologists (SLP), in every hospital. This study aimed to raise awareness and create a common opinion of medical specialists for stroke patients with dysphagia. This recommendation paper has been written by a multidisciplinary team and offers 45 recommendations for stroke patients with dysphagia. It was created using the eight-step Delphi round via e-mail. This study is mostly specific to Turkey. However, since it contains detailed recommendations from the perspective of various disciplines associated with stroke, this consensus-based recommendation paper is not only a useful guide to address clinical questions in practice for the clinical management of dysphagia in terms of management, diagnosis, and follow-up, but also includes detailed comments for these topics.
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17
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Bai AV, Agostini F, Bernetti A, Mangone M, Fidenzi G, D'Urzo R, Ruggiero M, Murgia M, Santilli V, Paoloni M, Ruoppolo G, Masiero S. State of the evidence about rehabilitation interventions in patients with dysphagia. Eur J Phys Rehabil Med 2021; 57:900-911. [PMID: 33541045 DOI: 10.23736/s1973-9087.21.06716-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Rather than a separate nosological entity, dysphagia must be considered as a symptom of other pathological conditions, which afflicts patients admitted to numerous medical departments (rehabilitation, neurology, geriatrics, internal medicine, etc.) These disorders share the need for timely access to quality care and multidisciplinary treatment, including rehabilitation. The purpose of this study was to conduct a review of the current guidelines' recommendations in the literature and provide recommendations on the rehabilitative management of the patient with dysphagia. EVIDENCE ACQUISITION The search was carried out through the main databases (Medline, PEDro, Cochrane Database and Google Scholar). All the articles concerning rehabilitation management of dysphagia, published in the last 10 years, have been included. EVIDENCE SYNTHESIS Bibliographic research has provided thirteen guidelines. The literature analysed focuses mainly on the screening, the evaluation and the planning of multidisciplinary treatment. The literature agrees in recommending as cornerstones in the treatment of the dysphagic patient dietary changes, rehabilitation training (particularly muscle strengthening exercises and coordination) and early use of alternative nutrition in patients severely compromised. CONCLUSIONS The dysphagic patient requires the deployment of a range of skills by a multiprofessional and multi-disciplinary team. Speech and language pathologists in cooperation with specialists of rehabilitation have the task of managing the various stages, ranging from the early identification of the symptom to the setting of the treatment plan. Due to the lack of standardized protocols, it is necessary to implement the research path, especially regarding rehabilitation intervention.
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Affiliation(s)
- Arianna V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy -
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Gabriele Fidenzi
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Rossella D'Urzo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Ruggiero
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Murgia
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ruoppolo
- Department of Sensorial Organs, Sapienza University of Rome, Rome, Italy
| | - Stefano Masiero
- Department of Neuroscience, University of Padua, Padua, Italy
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18
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Oh HM, Kim TW, Park HY, Kim Y, Park GY, Im S. Role of rs6265 BDNF polymorphisms and post-stroke dysphagia recovery-A prospective cohort study. Neurogastroenterol Motil 2021; 33:e13953. [PMID: 32776402 DOI: 10.1111/nmo.13953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies suggest that specific genes may predispose some to increased risk of dysphagia in the geriatric population, but whether these genes may affect swallowing recovery after a stroke is unknown. This study investigated whether single-nucleotide polymorphisms (SNP) of the brain-derived neurotrophic factor (BDNF), catechol-O-methyl transferase, apolipoprotein E, interleukin-1 receptor antagonist, and dopamine, which have been linked to swallowing, could adversely affect the prognosis of post-stroke dysphagia. METHODS In this study, 218 subjects with confirmed post-stroke dysphagia were enrolled. The primary endpoint was failed recovery from nil per mouth (NPM) status with the first 3 months post-stroke. KEY RESULTS The Val/Val group from the rs6265, BDNF, showed higher score changes on the Functional Oral Intake Scale at 1 month. The proportion of patients with recovery from NPM status within the first 1 month was 60.8% in the Val/Val group, which was statistically higher than those in the Met allele groups (38.1%, P = .017). At 3 months, the BDNF rs6265 showed significant group differences in Modified Barium Swallow Impairment Profile© score changes with the Val/Val allele leading to greater improvement. However, no single SNP was associated with increased risk of poor recovery with persistence of NPM at 3 months post-stroke. CONCLUSIONS AND INFERENCES Those with the dominant Val/Val phenotype of BDNF manifested with faster and greater improvement than the Met-phenotypes. Based on our results, the BDNF Val allele may play a positive role with faster score improvement and rapid recovery from NPM than the Met allele. Clinical Trials gov: NCT03577444 (https://clinicaltrials.gov/ct2/show/study/NCT03577444).
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Affiliation(s)
- Hyun Mi Oh
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi-do, Republic of Korea.,Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Tae-Woo Kim
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi-do, Republic of Korea.,Department of Rehabilitation Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Schwarz M, Ward EC, Cornwell P, Coccetti A, D'Netto P, Smith A, Morley-Davies K. Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1944-1955. [PMID: 32780593 DOI: 10.1044/2020_ajslp-19-00060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs (n = 7) and SLPs (n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase (n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
| | - Petrea Cornwell
- Menzies Health Institute, School of Allied Health Sciences, Griffith University, Mount Gravatt, Queensland, Australia
| | - Anne Coccetti
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
| | - Pamela D'Netto
- Speech Pathology Department, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Aimee Smith
- Speech Pathology Department, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Katharine Morley-Davies
- Speech Pathology Department, QEII Hospital, Metro South Hospital and Health Service, Coopers Plains, Queensland, Australia
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20
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Effectiveness of Different Application Parameters of Neuromuscular Electrical Stimulation for the Treatment of Dysphagia after a Stroke: A Systematic Review. J Clin Med 2020; 9:jcm9082618. [PMID: 32806675 PMCID: PMC7463982 DOI: 10.3390/jcm9082618] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/04/2020] [Accepted: 08/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Dysphagia causes severe complications among people with a stroke. Physiotherapy allows the cure of this pathology, and among the tools it offers is neuromuscular electrical stimulation. However, this is a technique that has not been protocolized. Therefore, it was considered necessary to carry out a systematic review on the efficacy of the various parameters of application of the neuromuscular electrical stimulation in dysphagia generated after a stroke. Methods: A systematic search for publications was conducted in March 2020 in the Pubmed, Cinahl, Medline, Web of Science and Scopus databases, using as search terms: Electric stimulation therapy, Deglutition disorders and Stroke. Results: 21 articles were obtained in which the application of neuromuscular electrical stimulation was applied in isolation (n = 7) or in combination with other techniques such as strengthening exercises and manual therapy techniques (n = 14), with this second modality of treatment having greater benefits for patients. Conclusion: The greatest efficacy of this technique is reached when applied at 60-80 Hz, 700 μs of pulse duration, at the motor intensity threshold and in sessions of 20–30 min.
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21
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Validation of the German Version of Functional Oral Intake Scale (FOIS-G) for Flexible Endoscopic Evaluation of Swallowing (FEES). Dysphagia 2020; 36:130-139. [PMID: 32342178 PMCID: PMC7803872 DOI: 10.1007/s00455-020-10114-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
The Functional Oral Intake Scale (FOIS) is the most frequently used scale for the evaluation of functional oral intake by dysphagia patients. FOIS was validated using data from Videofluoroscopic Swallowing Study (VFSS). Until now, a validated German version of FOIS for Flexible Endoscopic Evaluation of Swallowing (FEES) is lacking. The aim of this study was a cross-cultural validation of the German version of FOIS (FOIS-G) for FEES. The translation of the original FOIS was carried out according to the Translation, Review, Adjudication, Pretesting, Documentation (TRAPD) translation methodology. For the validation process, six experienced language therapists (SLT) retrospectively analyzed charts of 93 stroke patients. Inclusion criteria were comprised of stroke, clinical examination by an SLT within 24 h of admission, and FEES within 72 h of admission. The validity was calculated by comparison with Modified Rankin Scale (MRS), Barthel Index (BI), the Penetration-Aspiration-Scale (PAS), and a water swallow test. Spearman rank correlation of all paired raters ranged from rs = 0.96 to rs = 0.99, and percentage agreement ranged from 81 to 94%. The overall agreement between all raters was calculated by Fleiss kappa (0.83) (s.e. 0.02). There is a significant correlation between the BI and the MRS with the FOIS-G (rs = 0.301, p = 0.003 for BI; rs = – 0.366, p < 0.001 for MRS), between the PAS and the FOIS-G (rs = − 0.758, p < 0.001), as well as between the 70 ml-water-test and the FOIS-G (rs = 0.470, p < 0.001). FOIS-G is a valid instrument for the evaluation of the functional oral intake of food and liquids in dysphagia patients.
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22
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Fairfield CA, G. Smithard D. Assessment and Management of Dysphagia in Acute Stroke: An Initial Service Review of International Practice. Geriatrics (Basel) 2020; 5:geriatrics5010004. [PMID: 31972979 PMCID: PMC7151229 DOI: 10.3390/geriatrics5010004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/10/2020] [Accepted: 01/19/2020] [Indexed: 11/23/2022] Open
Abstract
The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management tended to be similar within, but not between, countries. Relationships were found between the use of instrumental assessment and the compensatory management techniques that were employed. The variation in practice that was found, may reflect the lack of an available robust evidence base to develop care pathways and identify the best practice. Further investigation and identification of the impact on dysphagia outcome is needed.
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Affiliation(s)
| | - David G. Smithard
- Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, Stadium Road, London SE18 4HQ, UK;
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23
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Ghammam M, Houas J, Bellakhdher M, Abdelkefi M. A huge retropharyngeal lipoma: a rare cause of dysphagia: a case report and literature review. Pan Afr Med J 2019; 33:12. [PMID: 31303957 PMCID: PMC6607450 DOI: 10.11604/pamj.2019.33.12.18541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022] Open
Abstract
Dysphagia is commonly seen after a cerebral vascular accident. It is rarely caused by lipomas of the retropharyngeal region which are rare benign mesenchymal neoplasms. We report a case of a 53-year-old man who presented with a history of ptyalism and dysphagia occurring after a brain stroke. Flexible nasal endoscopy revealed a pooling of saliva in both pyriform sinuses. Cervical and neurological examinations were unremarkable. Computed tomography (CT) scan suggested the diagnosis of retropharyngeal lipoma. The mass was resected by trans-cervical approach. The histological examination confirmed the diagnosis of a retropharyngeal lipoma. The postoperative course was unremarkable. Although lipomas in the retropharyngeal space are rare, clinicians should evoke this diagnosis when treating a patient presenting with dysphagia, even if there is a medical history of cerebral vascular accident.
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Affiliation(s)
- Monia Ghammam
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
| | - Jihene Houas
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
| | - Mouna Bellakhdher
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
| | - Mohamed Abdelkefi
- ENT Department and Cervical Surgery Farhat Hached Hospital, Medicine University, Sousse, Tunisia
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Braun T, Juenemann M, Viard M, Meyer M, Fuest S, Reuter I, Kaps M, Prosiegel M, Tanislav C. What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study. BMJ Open 2018; 8:e019016. [PMID: 29511010 PMCID: PMC5855308 DOI: 10.1136/bmjopen-2017-019016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Fibre-endoscopic evaluation of swallowing (FEES) to detect dysphagia is gaining more and more importance as a diagnostic tool. Therefore, we have investigated the impact of FEES in neurological patients in a clinical setting. DESIGN Cross-sectional hospital-based registry. SETTING Primary acute care in a neurological department of a German university hospital. PARTICIPANTS 241patients with various neurological diseases who underwent FEES procedure. PRIMARY AND SECONDARY OUTCOME MEASURES Dysphagia and related comorbidities. RESULTS 267 FEES were performed in 241 patients with various neurological diagnoses. Dysphagia was diagnosed in 68.9% of the patients. In only 33.1% of the patients, appropriate oral diet was chosen prior to FEES. A relevant dysphagia occurred more often in patients with structural brain lesions (83.1% vs 65.3%, P=0.001), patients with dysphagia had a longer hospitalisation (median 18 (IQR 12-30) vs 15 days (IQR 9.75-22.75), P=0.005) and had a higher mortality (8.4% vs 1.3%, P=0.041). When the oral diet was changed, we observed a lower pneumonia rate (36% vs 50%, P=0.051) and a lower mortality (3.7% vs 11.3%, P=0.043) in comparison to no change of oral diet. A restriction of oral diet was identified more often in older patients (median 75 years (IQR 66.3-82 years) vs median 72 years (IQR 60-79 years), P=0.01) and in patients with structural brain lesions (86.8% vs 73.1%, P=0.05). CONCLUSION On clinical investigation, dysphagia was misjudged for the majority of the patients. FEES might help to compensate this drawback, revising the diet regime in nearly 70% of the patients.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Marco Meyer
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Sven Fuest
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Iris Reuter
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Mario Prosiegel
- Institute of German Linguistics, Ludwig-Maximilians-University, Giessen, Germany
| | - Christian Tanislav
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
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25
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Kim SB, Lee SJ, Lee KW, Lee JH, Kim DW. Usefulness of Early Videofluoroscopic Swallowing Study in Acute Stroke Patients With Dysphagia. Ann Rehabil Med 2018; 42:42-51. [PMID: 29560323 PMCID: PMC5852228 DOI: 10.5535/arm.2018.42.1.42] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/19/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To demonstrate the usefulness of early videofluoroscopic swallowing study (VFSS) and to investigate change patterns in dietary methods in stroke patients with dysphagia. Methods The VFSS was performed within 7 days of stroke onset in neurologically stable patients. The patients were divided into three groups according to type of brain lesion: cortical lesion (CL), subcortical lesion (SCL), and brainstem/cerebellar lesion (BCL). Based on the VFSS results, this study investigated change patterns in feeding method and discrepancies in the aspiration risk predicted by the Water Swallowing Test (WST) and the VFSS. Complications, such as aspiration pneumonia, were also evaluated. Results A total of 163 patients met the inclusion criteria and the VFSS was performed within 7 days of stroke. Patients considered at risk for aspiration (Penetration-Aspiration Scale [PAS] scores of 6 to 8) were found in all three groups using the VFSS (47.5% of the CL group, 59.3% of the SCL group, and 47.9% of the BCL group). After early VFSS, 79.7% of the patients were assessed to require restricted feeding methods. A 19.0% discrepancy was found between the WST and VFSS results. At 3-week follow-up after the VFSS, aspiration pneumonia was observed in 12 patients (7.4%) with restricted feeding methods. Conclusion Early VFSS during the acute period can facilitate determination of the most appropriate feeding method, and support effective dysphagia management for stroke patients.
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Affiliation(s)
- Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Dong Won Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
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Management of Acute Stroke in the Older Person. Geriatrics (Basel) 2017; 2:geriatrics2030027. [PMID: 31011037 PMCID: PMC6371128 DOI: 10.3390/geriatrics2030027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/21/2017] [Accepted: 07/31/2017] [Indexed: 12/27/2022] Open
Abstract
The majority of people who suffer a stroke are older adults. The last two decades have brought major progress in the diagnosis and management of stroke, which has led to significant reductions in mortality, long-term disability, and the need for institutional care. However, acute, interventional and preventative treatments have mostly been trialled in younger age groups. In this article we will provide an overview of the evidence for acute stroke treatments in relation to age, discuss special considerations in the older person, and contemplate patient choice, quality of life, and end-of-life-decisions.
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Schwarz M, Coccetti A, Murdoch A, Cardell E. The impact of aspiration pneumonia and nasogastric feeding on clinical outcomes in stroke patients: A retrospective cohort study. J Clin Nurs 2017; 27:e235-e241. [PMID: 28618137 DOI: 10.1111/jocn.13922] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To determine presence of clinical complications related to dysphagia and to explore their operational outcomes. BACKGROUND Dysphagia is a common complication of stroke. The management of poststroke dysphagia is multidisciplinary with nurses playing a key role in screening for dysphagia risk, monitoring tolerance of food and fluids and checking for the development of complications such as fever, dehydration and change in medical status. Dysphagia often results in further complications including aspiration pneumonia and the need for nasogastric feeding. Dysphagia-related complications have been shown to have a significant impact on morbidity and mortality, length of stay and cost of admission. DESIGN Retrospective cohort study. METHODS A total of 110 patients presenting with an ischaemic stroke were chart-audited. RESULTS Aspiration pneumonia poststroke was found to be significantly associated with increased overall length of stay, poorer functional outcomes poststroke as well as being associated with a high risk of mortality. The presence of a nasogastric tube was also associated with reduced functional outcomes poststroke and increased risk of death. CONCLUSION High prevalence and cost of complications associated with stroke highlight the complexity of providing nursing and allied health care to this patient population. This provides a snapshot of dysphagia-related complications experienced by stroke patients. RELEVANCE TO CLINICAL PRACTICE This paper highlights that poststroke complications can significantly impact on patient outcomes and operational factors such as cost of admission; therefore, poststroke care requires a multidisciplinary approach to management. Furthermore, preventing and managing complications poststroke is a key element of nursing care and has the potential to significantly reduce incidence of mortality, length of stay and cost of hospital admission.
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Affiliation(s)
| | | | | | - Elizabeth Cardell
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Southport, Qld, Australia
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