Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients

Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES)

The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs = 0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study's results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.

Investigation of the improvement of swallowing function with low-frequency pulse waves or interference waves delivered via cervical electrical stimulation in patients with Parkinson's disease: A randomized controlled study protocol

Parkinson's disease (PD) is associated with a high rate of swallowing dysfunction, which may lead to aspiration pneumonia. This randomized controlled trial aims to investigate the effects of cervical electrical stimulation interventions (interferential current or low-frequency pulse wave stimulation) on swallowing dysfunction in patients with PD. The study will include patients with PD with Hoehn-Yahr stages 2-4 and will assess the swallowing function in a multifaceted manner using tools such as the 1 % citric acid cough test, videofluoroscopic swallowing study (VFSS), Functional Oral Intake Scale score, and Eating Assessment Tool-10 score. The primary endpoint is an improvement in the cough reflex, as measured by the citric acid cough test, whereas the secondary endpoints include changes in the swallowing function, including the VFSS, tongue pressure, and salivary substance P levels. Participants will receive 30 min of cervical stimulation daily for 2 weeks. This study also explores the use of novel instruments such as multichannel surface electromyography and electronic stethoscopes for the detailed assessment of swallowing physiology. By investigating these two electrical stimulation techniques, this study seeks to provide insights into the pathophysiology of swallowing dysfunction in PD and to evaluate the efficacy and safety of these interventions.

Trial registration number

jRCTs062240041; pre-results.

The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.

Swallowing cortical network features under taste stimulation for patients with post stroke dysphagia-Insights from a fNIRS study

The alterations in the swallowing cortical network associated with taste stimulation in patients with post-stroke dysphagia remain unclear. The aim of the study was to investigate the alterations in brain functional activity among individuals with post-stroke dysphagia under taste stimuli using functional near-infrared spectroscopy (fNIRS). We recruited 28 patients with post-stroke dysphagia and 24 age-matched healthy controls in this study. Each of them completed swallowing evaluation, resting-state and swallowing task-related fNIRS test. We found that the brain activation of patients significantly decreased in the left and right supplemental motor area (SMA) for water swallowing task and the left SMA and right primary sensory area (S1) for salty water swallowing, compared with healthy controls, only the left SMA remained significant for salty water swallowing after False Discovery Rate (FDR) correction. Fourteen healthy controls and 13 patients were included in the subgroup analysis, to explore the influences of preferred taste on swallowing network, we observed that the brain activation in the right S1 was significantly reduced during water swallowing in patient group (p = 0.008, with FDR corrected), all channels showed similar strengths in the activation under preferred taste stimulus between the groups. Functional connectivity (FC) between hemispheric sensorimotor areas were significantly decreased in patients compared with healthy controls. Our investigation revealed a noteworthy reduction in the activation of the left SMA during the salty water swallowing task in patients with dysphagia when compared to the healthy control group. The dysphagic patients following stroke exhibited impaired interaction between hemispheric sensorimotor areas associated with swallowing. Sour, sweet, and preferred taste stimulation have the potential to enhance brain plasticity, which may offer new insights for developing novel strategies for post-stroke dysphagia.

Validation of the European Portuguese Version of the Yale Pharyngeal Severity Rating Scale

This study aimed to validate the Yale Pharyngeal Residue Severity Rating Scale's European Portuguese version and investigate the impact of rater experience. The scale measures the severity of residue in the vallecula and pyriform sinus. Ninety Fiberoptic Endoscopic Evaluation of Swallowing images were selected after consensus and proposed to 13 raters who were asked to assess the severity of pharyngeal residue (PR) in each image in two moments with an interval of two weeks. The raters were divided by years of experience conducting the Fiberoptic Endoscopic Evaluation of Swallowing and in experience using severity scales for residues. Construct validity, inter-rater, and intra-rater reliability were assessed by kappa statistics. The original English scale was translated into European Portuguese using a forward-backward method for validation. The scale reliability was strong, with an elevated intra-rater internal consistency for vallecula (Cronbach's alpha = 0.982) and pyriform sinus (Cronbach's alpha = 0.922). Inter-rater reliability for raters was equally significant and high for vallecula (0.613 for first assessment and 0.604 for second assessment) and pyriform sinus (0.558 for first assessment and 0.509 for second assessment) or for raters with experience using Yale Pharyngeal Severity Rating Scale (vallecula with 0.832 for first assessment and 0.717 for second assessment and pyriform sinus with 0.856 for first assessment and 0.714 for second assessment).The European Portuguese version of the Yale Pharyngeal Severity Rating Scale is a valid, reliable instrument for scoring the location and severity of pharyngeal residue in the context of fiberoptic endoscopic evaluation of swallowing.

Five-year long-term functional and quality of life outcomes in total glossectomy survivors

BACKGROUND

Total glossectomy is proven to be a superior treatment option for advanced tongue cancer. Despite its efficacy, the procedure is associated with profound morbidity, notably impacting Speech, swallowing, and overall quality of life. Limited therapeutic benefits and the potential for considerable morbidity render total glossectomy a subject of controversy.

METHODS

We performed a multidimensional quality of life evaluation of long-term (more than 5 yrs.) total glossectomy survivors. In this study, we evaluated 25 total glossectomy survivors with comprehensive functional and quality of life outcomes using objective measures (London Speech Evaluation Scale, FOIS, 100 ml Water Challenge, FEES) and Patient-reported outcomes (SHI, PSS HN, EORTC QLQ 30 & HN35).

RESULTS

EORTC QLQ 30 showed overall good global health status (M = 80 ± 20) and functional scale mean scores ranging from 87 to 91, despite issues in pain (M = 31.6 ± 31), swallowing (M = 23.3 ± 24), and Speech (26.1 ± 1). Speech outcomes revealed 80% with moderate to severe intelligibility impairment. Swallowing outcomes showed 84% requiring special food preparation, 24% exhibiting aspiration, and 72% having pharyngeal residue. Speech outcomes showed 88% having moderate-severe speech impairment, and Patient-reported speech outcomes indicated a mean SHI score of (M = 47.2 ± 42).

CONCLUSION

Patients undergoing total glossectomy report favourable long-term outcomes in global health-related quality of life despite moderate to severe impairments in objective speech and swallowing evaluations. These positive patient-reported outcomes support the consideration of total glossectomy as a viable treatment option if and when required, underscoring the importance of evaluating treatment outcomes through the patient-perceived quality of life.

Adjuvant Proton Radiation Following Transoral Robotic Surgery for HPV-Positive Oropharyngeal Squamous Cell Carcinoma

OBJECTIVE

Advances in the treatment of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) include transoral robotic surgery (TORS) and proton beam therapy (PBT). This study aims to improve understanding of the treatment toxicities associated with adjuvant PBT following TORS for OPSCC.

STUDY DESIGN

A retrospective review.

SETTING

An academic tertiary care center in Baltimore, Maryland.

METHODS

Patients undergoing TORS followed by adjuvant PBT from 2017 to 2023 were reviewed.

RESULTS

Forty-seven patients with HPV-associated OPSCC underwent TORS followed by adjuvant PBT. Forty-one (87.2%) patients were male. The median age at first radiation fraction was 61.7 years. Forty-one (87.2%) identified as white and 6 (12.8%) as African American. Most patients had T1 (23 [48.9%]) or T2 (22 [46.8%]), N1 (41 [87.2%]) disease. The majority (98.3%) of acute toxicities were grade 1 or 2, with only 1 (2.1%) patient developing grade 3 toxicities. Three (6.4%) patients required a feeding tube for nutrition during adjuvant proton radiation treatment. The 3 patients who required feeding tubes during radiation also required postoperative nasogastric tubes for a median of 16 days, compared with 3 days for all other patients (Mann-Whitney U, P = .02). The most common chronic toxicities included xerostomia, dysphagia, dysgeusia, and lymphedema, which decreased over time.

CONCLUSION

HPV-associated OPSCC treated with TORS followed by adjuvant PBT demonstrated a favorable toxicity profile with mostly grade 1 or 2 acute toxicities. Feeding tube requirement during adjuvant PBT was low at 6.4%. Many chronic toxicities appeared to decrease in frequency with time from radiation, although further study is required.

Prognostic Factors Associated with Post-Stroke Dysphagia in Intracerebral Hemorrhage Patients

Spontaneous intracerebral hemorrhage (ICH) constitutes a significant portion of acute stroke incidents worldwide, often leading to post-stroke dysphagia (PSD), affecting 50-77% of survivors and worsening patient morbidity. This study aimed to identify predictive variables for PSD among patients with spontaneous ICH. A retrospective cohort study was conducted on adult patients with acute spontaneous ICH, confirmed by brain computed tomography, from June 2019 to June 2023. We analyzed demographic, neuroimaging, and stroke-specific characteristics and rehabilitation indicators. PSD was evaluated using nasogastric (NG) tube retention and the Functional Oral Intake Scale (FOIS) levels at 4 and 12 weeks post-ICH. Statistical analyses involved univariate and multivariate logistic regression to identify PSD predictors. A total of 310 ICH patients were included in the study. At 4 weeks, significant predictors for NG tube retention included 24-hour National Institute of Health Stroke Scale (NIHSS) scores, estimated glomerular filtration rate and sitting balance. At 12 weeks, hospital stay duration and ICH score were significant predictors for NG tube retention. Regarding the FOIS, significant predictors at 4 weeks included higher 24-hour NIHSS scores, compromised sitting balance, immobility-related complications, initial hematoma volume and intraventricular hemorrhages. At 12 weeks, older age and higher 24-hour NIHSS scores significantly predicted lower FOIS levels. Our findings demonstrate that PSD in ICH patients is influenced by a complex interplay of factors, including stroke severity, renal function, and physical impairment. The study highlights the importance of early neurological assessment, physical function, and comprehensive management in improving swallowing outcomes, emphasizing a multifaceted approach to enhancing outcomes for ICH survivors.

Change in Feeding and Swallowing Function in Elderly Patients with Isolated Hospitalization for COVID-19: A Retrospective Cohort Study

BACKGROUND

Isolation was implemented for elderly patients with coronavirus disease 2019 (COVID-19), which interrupted care including oral intake support.

OBJECTIVE

To assess the changes in feeding and swallowing function measured by the functional oral intake scale (FOIS) and their association with post-discharge mortality in elderly COVID-19 patients.

DESIGN

Single-center retrospective cohort study.

PARTICIPANTS

We included patients aged ≥ 65 years and admitted for COVID-19 between December 1, 2021 and March 31, 2023. Those with FOIS before onset (pre-FOIS) 1-3 were excluded.

MAIN MEASURES

We measured FOIS (1-7, 1: no oral intake, 7: normal) before onset and at discharge, and assessed mortality for 180 days after onset. The primary outcome was decrease in FOIS during hospitalization; in-hospital mortality was assumed as 4-level decreases in FOIS. The secondary outcome was 180-day mortality. Association of each pre-FOIS (6, 5, 4) relative to pre-FOIS 7 with the primary outcome was estimated as adjusted common odds ratios (ORs) and 95% confidence intervals (CIs). Association of decreases in FOIS with 180-day mortality was assessed with Kaplan-Meier curve.

KEY RESULTS

We included 337 patients whose median age was 81 years, and 56% of them were men. The distribution of pre-FOIS was 7 (190 patients), 6 (89), 5 (40), and 4 (18). The severity of COVID-19 was generally similar among pre-FOIS levels. The pre-FOIS was significantly associated with decreases in FOIS: adjusted common OR 2.23 [95%CI 1.27-3.92] for pre-FOIS 6, 2.96 [1.46-6.05] for pre-FOIS 5, 2.89 [1.14-7.40] for pre-FOIS 4. The degree of decrease in FOIS was significantly associated with 180-day mortality: no decrease, 4.7%; 1-level decrease, 1.2%; 2-level decrease, 27.9%; 3-level decrease, 46.0%.

CONCLUSIONS

Lower pre-FOIS was associated with further decreases in FOIS in elderly patients who were isolated due to COVID-19, and the degree of decrease was further associated with post-discharge mortality.

Feasibility of Cerebellar Stimulation for the Treatment of Post-Stroke Dysphagia

Post-stroke dysphagia (PSD) is common and associated with poor outcomes. We aimed to explore the feasibility, safety, and proof of concept of cerebellar rTMS in patients with sub-acute PSD. We intended to recruit 48 participants with PSD. Randomised to: (i) sham treatment twice-daily for five days, (ii) cerebellar rTMS daily for three days, and (iii) cerebellar rTMS twice-daily for five days (1:1:1). Participants were blinded to treatment group. Primary outcomes were feasibility, safety, and functional outcome intake scale (FOIS), dysphagia severity rating scale (DSRS), and feeding status scale (FSS) at two weeks. However, due to lower-than-expected enrolment, the active rTMS groups were combined. We recruited 14 participants in total, (mean 68 years, 57% female). Due to the time-limited funding period, recruitment was adversely affected by the COVID-19 pandemic. DSRS and FSS trended lower in the combined active rTMS groups at two weeks, i.e. less swallowing impairment. However, at death/discharge FOIS was higher/better (mean, (standard deviation)), 4.0 (2.1) vs. 1.8 (1.0) (p = 0.032) with active TMS, with trends to lower/better DSRS and FSS. There was no difference in the acceptability of treatment between groups. High-intensity (n = 5) vs. low-intensity (n = 5) cerebellar rTMS was associated with lower DSRS 3.0 (1.4) vs. 9.4 (2.7) and FSS 0.6 (0.5) vs. 1.6 (0.5) at 2 weeks, and DSRS 3.0 (1.4) vs. 9.0 (3.7) at hospital discharge or death. Cerebellar rTMS is a feasible ward-based treatment for reducing swallowing impairment. Although enrolment was lower than desired, there was evidence for proof of concept, particularly for high-intensity cerebellar rTMS. Larger studies are warranted.

Accurate and Noninvasive Dysphagia Assessment via a Soft High-Density sEMG Electrode Array Conformal to the Submental and Infrahyoid Muscles

Accurate, noninvasive dysphagia assessment is important for rehabilitation therapy but current clinical diagnostic methods are either invasive or subjective. Surface electromyography (sEMG) that monitors muscle activity during swallowing, offers a promising alternative. However, existing sEMG electrode arrays for dysphagia assessment remain challenging in combining the advantages of a large coverage area and strong compliance to the entire swallowing muscles. Here, we report a stretchable, breathable, large-area high-density sEMG (HD-sEMG) electrode array, which enables intimate contact to complex surface of the submental and infrahyoid muscles to detect high-fidelity HD-sEMG signals during swallowing. The electrode array features a 64-channel soft on-skin sensing array for comprehensive data capture, and a stiff connector for simple and reliable connection to an external acquisition setup. Systemically experimental studies revealed the easy operability of the soft HD-sEMG electrode array for effortless integration with the skin, as well as the excellent mechanical and electrical characteristics even subject to substantial skin deformations. By comparing HD-sEMG signals collected from 38 participants, three objective indicators for quantitative dysphagia evaluation were discussed. Finally, a machine learning model was developed to accurately and automatically classify the severity of dysphagia, and the factors affecting the recognition accuracy of the model were discussed in depth.

Association between the Hospital Anxiety and Depression Scale and Swallowing Function in Dysphagic Patients in Japan

OBJECTIVE

Dysphagia affects 2.3 %-16 % of the general population and increases with age. It can lead to malnutrition, weight loss, aspiration pneumonia, and emotional symptoms such as anxiety and depression. Mental health disorders impact appetite and muscle mass, further worsening dysphagia. Additionally, cultural and economic factors influence anxiety and depression, which can either result from or contribute to dysphagia. Studies on the relationship between anxiety, depression, and swallowing function using FEES are limited in Asian populations. The Hospital Anxiety and Depression Scale (HADS) is a useful tool for assessing mood disorders. Therefore, in this study, we aimed to investigate the associations among anxiety, depression, and swallowing function in Japanese patients with dysphagia using HADS.

METHODS

Data on age; sex; HADS; Eating Assessment Tool-10 (EAT-10); Functional Oral Intake Scale (FOIS); tongue pressure; Hyodo score, a scoring system for evaluating the swallowing function determined by flexible endoscopic evaluation of swallowing (FEES); and videofluoroscopic dysphagia scale (VDS), assessed by videofluoroscopic swallowing study, were collected and analyzed from medical records. Hyodo score consists of four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) glottal closure reflex or cough reflex induced by touching the epiglottis or arytenoid; (3) swallowing reflex induced by colored water; and (4) extent of pharyngeal clearance after colored water is swallowed. The Mann-Whitney U test, Fisher's exact test, and multiple logistic regression analyses were used to estimate associations between HADS and swallowing function.

RESULTS

No significant relationships were observed between the EAT-10, FOIS, and VDS with HADS scores. Patients with depression were associated with a significantly higher percentage of anorexia complaints (p = 0.047). Lower tongue pressure was observed in patients with depression than in patients without depression (p = 0.002). Patients with anxiety had better swallowing function, as assessed by the Hyodo score (p = 0.047). Fluid clearance, a component of the Hyodo score, was significantly better in patients with anxiety (p = 0.03) even after propensity score matching adjusted for the effects of age, sex, and fluid clearance.

CONCLUSION

In patients with anxiety, swallowing function assessed by FEES was favorable, whereas a higher proportion of patients with depression reported decreased appetite, and lower tongue pressure. This discrepancy between subjective dysphagia and FEES findings suggests that patients with anxiety may underestimate their swallowing function.

Patient-reported assessment of bulbar function in spinal muscular atrophy (SMA): Validation of a self-report scale

Background: Bulbar dysfunction is a well-recognized burden experienced by individuals with spinal muscular atrophy (SMA). Metrics that capture the impact of these problems are lacking. Objectives: To develop and validate an SMA-Bulbar Scale that captures and quantifies patient-reported experiences with bulbar dysfunction. Methods: Cure SMA database members were invited to complete online surveys and a 31-item Bulbar Scale developed by the authors with reference to both bulbar dysfunction in the literature and consultations with SMA-dedicated health care providers, pharmaceutical companies, and persons affected by SMA. Results: 166 adults with SMA reported a range of bulbar dysfunctions. The most common problems, occurring more than 80% of the time, were prolonged meal times, difficulty with mouth opening, and swallowing pills. In addition, 10% of the respondents reported a worsening feeding function over the course of their lives. Across the diverse array of bulbar functions, exploratory and confirmatory factor analyses of responses identified three coherent dimensions of bulbar dysfunction: Swallowing; Mealtimes and Communication; and Breath Sounds, Speech, Voice, and Secretion Management. Higher scores of overall bulbar dysfunction, (p < .001) and each factor (p < .001), were reported by respondents with any degree of feeding restrictions. Sex, age, or use of SMA disease-modifying treatment did not correlate with bulbar scores. Conclusions: This patient-reported scale of bulbar function in adults with a wide range of SMA severity captures and quantifies the variable manifestations of experienced bulbar impairment. With preliminary evidence of validity, the scale supports efforts to standardize accurate identification of bulbar dysfunction, incorporate the perspectives of people with SMA on key areas of their daily functioning, provide metrics essential for meaningful endpoints in clinical trials, inform practice guidelines, and promote advancement of the regulatory science needed for the evaluation and development of therapeutic interventions. Identification of three coherent dimensions of bulbar dysfunction may improve further investigations.

Factors influencing oropharyngeal dysphagia in individuals with chronic neurological disorders presenting to the outpatient swallowing disorder clinic

BACKGROUND

This study aims to evaluate neurogenic dysphagia in individuals with various neurological disorders.

METHOD

A prospective cross-sectional study was conducted adults with Multiple Sclerosis (MS), stroke, or Parkinson's Disease (PD) who presented with dysphagia. Assessments included the Functional Oral Intake Scale (FOIS) for dietary status, the Flexible Endoscopic Evaluation of Swallowing (FEES) with Penetration-Aspiration Scale (PAS) for swallowing function, and the Eating Assessment Tool (EAT-10) and Swallow Quality of Life Questionnaire (SWAL-QOL) for dysphagia severity and swallowing/eating-related quality of life (SRQoL), respectively. Statistical analyses included ANOVA.

RESULTS

The study included 105 participants with MS, stroke, and PD groups. SWAL-QOL scores were significantly higher in the MS and PD groups compared to the stroke group (p = 0.001). Stroke patients had the most severe overall swallowing difficulties, while MS patients experienced the highest rate of aspiration (37 %). Fatigue levels were significantly higher in the MS and PD groups (p = 0.001), and social function scores were lowest in the stroke group (p = 0.041). No significant differences were observed in eating desire, fear of eating, sleep quality, communication, or EAT-10 scores across the groups.

CONCLUSION

This study highlights the differential impact of neurogenic dysphagia on swallowing function and SRQoL. Although dysphagia is a known issue in acute neurological conditions such as strokes, individuals with progressive diagnoses such as MS should be referred to swallowing clinics at an early stage, keeping in mind that it can lead to serious consequences that can affect their quality of life.

Improved Pharyngeal Contraction and Oral Intake Status After Modified Central-Part Laryngectomy for Late-Stage ALS

OBJECTIVE

To investigate the effects of modified central-part laryngectomy with pharyngeal space reduction (CPL-PR) on patients with weak deglutitive pharyngeal contraction, as seen in late-stage amyotrophic lateral sclerosis (ALS).

STUDY DESIGN

Retrospective case series.

SETTING

Single-institution academic center.

METHODS

Patients with late-stage ALS confined at The University of Tokyo Hospital between 2019 and March 2024 in whom CPL-PR had been performed were identified. Patients who had undergone simultaneous pharyngeal flap surgery or had no preoperative high-resolution manofluorography done were excluded. Preoperatively, penetration-aspiration scale (PAS) scores were determined via videofluoroscopic swallowing study. Functional oral intake scale (FOIS) scores and high-resolution manometric parameters were measured and compared preoperatively and postoperatively.

RESULTS

Eighteen patients were identified with a median age of 66.5 (interquartile range [IQR]: 58.0-74.8). The median preoperative PAS score was 7.5 (IQR: 5.5-8.0), indicating severe dysphagia. There was significant improvement in oral intake status with FOIS scores increasing from 1 (IQR: 1-1) to 3 (IQR: 2-3) at 3 months postoperatively (P = .0002). Significant increases in velopharyngeal closure integral (P = .024) and mesohypopharyngeal contractile integral (P = .0001) were observed. Upper esophageal sphincter (UES) resting pressure was reduced (P = .0002), and UES relaxation time was prolonged during swallowing (P < .0001).

CONCLUSION

There were tangible improvements in pharyngeal contraction, UES bolus passage, and oral intake status following CPL-PR, which contribute to regaining oral intake in late-stage ALS. CPL-PR is an option for patients requiring tracheostomy who wish to prevent aspiration and regain their ability to take food orally.

The Validation of the Italian Version of the Munich Swallowing Score (IT-MUCSS) Against the Fiberoptic Endoscopic Evaluation of Swallowing and Food Intake Modalities in Patients with Neurogenic Dysphagia: A Cross-Sectional Study

Background/Objectives: Oral intake and secretions need to be assessed separately, especially in patients with tracheal tubes, as they are vital for dysphagia treatment and may require different management strategies. This study aims to validate the Italian version of the Munich Swallowing Score (IT-MUCSS) by examining its content and construct validity in relation to the fiberoptic endoscopic evaluation of swallowing (FEES) and oral intake in adults with neurogenic dysphagia, as well as assessing intra- and inter-rater reliability. This tool is clinically and scientifically useful as it includes two subscales: IT-MUCSS-Saliva, which assesses saliva/secretion management and the presence of a tracheal tube, and IT-MUCSS-Alimentazione, which evaluates feeding methods. Methods: In this prospective cross-sectional study, a total of 50 dysphagic patients with a neurological diagnosis were recruited from a neuro-rehabilitation hospital and underwent both clinical and instrumental assessments. The main outcome measures included evaluating food and liquid intake using the Italian versions of the Functional Oral Intake Scale (FOIS-It) and the IT-MUCSS. Pharyngeal residues were assessed using the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and airway penetration/aspiration were evaluated using the Penetration-Aspiration Scale (PAS) during FEES. Results: The IT-MUCSS demonstrated excellent reproducibility (K = 0.91) and internal consistency (Cronbach's alpha = 0.72). Strong correlations were found between IT-MUCSS and the FOIS-It scale, indicating the effective assessment of dysphagia. Test-retest reliability was high (ICC = 0.96 for total score). Construct validity was confirmed through significant correlations with instrumental measures during FEES. Conclusions: The IT-MUCSS is a valid tool for assessing functional oral intake and the management of saliva/secretions, specifically in relation to the level of saliva/secretions management compared to FEES measures of swallowing safety and efficiency in patients with neurogenic dysphagia.

Does swallow rehabilitation improve recovery of swallow function after treatment for advanced head and neck cancer

This study aimed to assess the prevalence, severity, and progression of swallowing impairments in head and neck cancer (HNC) patients before and after treatment, using videofluoroscopy with the Modified Barium Swallow Impairment Profile (MBSImP) protocol. We retrospect survey 90 HNC patients was divided into rehabilitation (receiving swallowing rehabilitation) and non-rehabilitation groups. All participants underwent a videofluoroscopic swallowing study with MBSImP, the Penetration-Aspiration Scale (PAS), and the Swallowing Performance Status (SPS) scale, along with assessments using the EAT-10 and Functional Oral Intake Scale (FOIS) at baseline, and at 1 and 3 months post-treatment. In all patients, MBSImP, PAS, and FOIS scores worsened one month after therapy. However, patients who performed swallow exercises demonstrated statistically significant improvements in swallowing function (FOIS and EAT-10) and related quality of life (EAT-10, Reflux Symptom Index) after three months of rehabilitation. High aspiration rates (poor PAS scores) were observed in all HNC patients post-treatment, peaking at 1 month and persisting over time. Notably, the rehabilitation group showed recovery of swallowing function to pre-treatment levels. Dysphagia is a significant and enduring side effect that impacts the quality of life in HNC patients undergoing multimodal treatment. The study suggests that a proactive swallowing rehabilitation program can positively influence outcomes, particularly after 3 months of rehabilitation.

Face Recognition-Driven Video Game for Dysphagia Rehabilitation in Stroke Patients: A Pilot Randomized Controlled Trial

OBJECTIVE

To explore the feasibility and effectiveness of face recognition-driven video game (FR-VG) swallowing training for stroke patients with dysphagia.

DESIGN

A single-blind pilot randomized controlled trial.

SETTING

A rehabilitation center.

PARTICIPANTS

Stroke patients with dysphagia (N=26).

INTERVENTIONS

Participants in the intervention group were trained using FR-VG, while the control group used the conventional method (ie, lip exercise, tongue exercise, and lower jaw exercise). The training was conducted 5 days a week over 4 weeks.

OUTCOME MEASURES

The swallowing function and swallowing-related quality of life between the 2 groups were observed before and after the intervention. The acceptance of FR-VG in the intervention group and the adherence of the patients in the 2 groups after the intervention were analyzed.

RESULTS

A total of 26 stroke patients with dysphagia were included. The results showed that after the intervention, both groups exhibited significant improvements in swallowing function and swallowing-related quality of life compared to the pre-intervention (P<.05). Patients in the intervention group demonstrated better swallowing function than the control group on the Gugging Swallowing Screen (P=.015) and Functional Oral Intake Scale (P=.004). The intervention group had a high acceptance of the FR-VG training and had significantly better adherence compared to the control group (P=.032).

CONCLUSIONS

FR-VG rehabilitation training can help improve swallowing function, swallowing-related quality of life, and training adherence in stroke patients with dysphagia. Patients have a high acceptance of FR-VG rehabilitation training, which can be used as an adjunctive method to conventional rehabilitation.

Initial calf circumference predicts poor disability outcomes in patients with stroke

BACKGROUND

Calf circumference (CC), which is easy to measure and noninvasive, may be a predictor of functional outcome in patients with acute stroke. However, the association between CC and long-term functional outcome is unclear. The purpose of this study was to investigate whether low CC is associated with functional outcome at 12 months post-stroke.

METHODS

This multicenter retrospective cohort study included patients with acute stroke. Low CC was defined as less than 30 cm for men and 29 cm for women. Poor functional outcome was defined as a modified Rankin Scale (mRS) score of greater than 3 (i.e., 3-6) and the inability to return pre-stroke mRS score at 12 months post-stroke. Multivariate logistic regression analysis was performed with low CC as the independent variable and outcome as the dependent variable.

RESULTS

This study included 445 patients (median age 75 years, 277 men). The prevalence of low CC was 26.7%. Multiple logistic regression analysis showed that low CC was significantly associated with poor functional outcome (OR = 3.036, 95% CI: 1.700-5.422, p < 0.001).

CONCLUSIONS

Low CC at admission in patients with acute stroke is associated with poor functional outcome at 12 months post-stroke. CC, which is easily measured in the acute setting, may serve as a predictor of poor outcomes. Future multicenter prospective interventional studies are needed to clarify the causal relationship between CC and functional outcome.

Impact of Transoral Robotic Surgery Versus Radiation on Swallowing Function in Oropharyngeal Cancer Patients: A Sub-Study From a Randomized Trial

BACKGROUND

This ORATOR sub-study evaluated swallowing physiology in patients treated with transoral robotic surgery (TORS) versus radiotherapy (RT) for early-stage oropharynx cancer.

METHODS

Swallowing physiology was evaluated using videofluoroscopy and outcomes were compared across treatment arms and correlated with MDADI scores.

RESULTS

Of the 68 patients in the ORATOR trial, 21 participated in this sub-study (30.8%), including 15 RT Arm and six TORS Arm patients. Swallowing profiles were not significantly different between the arms. MBSImP pharyngeal scores for RT Arm versus TORS Arm patients were 4.8 (±2.1) versus 4.3 (±1.5) at baseline, 6.2 (±1.2) versus 9.6 (±4.8) at 6 months and 5.9 (±1.8) versus 8.0 (±4.7) at 12 months. MBSImP pharyngeal scores demonstrated weak associations with several MDADI subscales and PAS scores.

CONCLUSIONS

To best describe swallowing outcomes in studies of RT and/or surgery, instrumental swallowing assessments should be strongly considered in addition to quality of life measures.

Impact of inspiratory muscle training on aspiration symptoms in patients with dysphagia following ischemic stroke

OBJECTIVE

To investigate the impact of inspiratory muscle training on lung function and swallowing function in patients with dysphagia-induced aspiration following ischemic stroke and to evaluate the effectiveness of inspiratory muscle training on aspiration symptoms.

METHODS

Fifty-eight inpatients with dysphagia-induced aspiration following ischemic stroke were selected and randomly divided into a control group (n = 29, conventional swallowing therapy) and a treatment group (n = 29, conventional swallowing therapy plus inspiratory muscle training). Both groups received conventional swallowing function training, including oral sensory training, oral motor training, airway safety protection training, and neuromuscular electrical stimulation therapy for 10-20 min per session, twice daily for 2 weeks. The treatment group additionally received inspiratory muscle resistance training using the POWERbreathe device for 20 min per session, twice daily for 2 weeks. Swallowing function was assessed using the Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), and Functional Oral Intake Scale (FOIS) based on the videofluoroscopic swallowing study (VFSS) before and after treatment. Lung function, including maximal peak expiratory flow rate (PEF) and forced vital capacity (FVC), was evaluated using the Miraclink X-SCRIBE cardiac stress testing system.

RESULTS

Before treatment, there were no significant differences in FOIS, FDS, and PAS scores between the two groups (P > 0.05), while post-treatment, both groups showed significant improvements in these indicators (P < 0.05), with the treatment group showing more significant improvements than the control group (P < 0.05). Further, before treatment, there were no significant differences in FVC and PEF scores between the two groups (P > 0.05), whereas post-treatment, the treatment group showed significant improvements in these indicators (P < 0.05) and the control group showed no significant changes (P > 0.05). The treatment group also showed more significant improvements than the control group (P < 0.05). Finally, a correlation analysis revealed a significant linear relationship between FVC and PEF in the post-treatment PAS in the treatment group (P < 0.05).

CONCLUSION

Inspiratory muscle training can improve lung function in patients with dysphagia following ischemic stroke, as it develops swallowing function more effectively than conventional swallowing function training alone. Moreover, inspiratory muscle training is effective in treating aspiration caused by dysphagia, with enhancements in aspiration related to improved lung function.

A Comparative Study of Speech and Swallowing Postoperative Outcomes in Oral Cancer: Impact of Lateral Mandibular Continuity Restoration

BACKGROUND

Surgical resection with mandibulectomy in advanced oral cancer results in complex defects. The influence of reconstruction of mandibular continuity on postoperative speech and swallowing function, though crucial, is not widely studied.

PURPOSE

The purpose of study was to compare the speech and swallowing outcomes of oral squamous cell carcinoma (OSCC) patients with lateral mandibulectomy, with or without the restoration of mandibular continuity.

STUDY DESIGN, SETTING, SAMPLE

This retrospective cohort study was performed at the Malabar Cancer Centre, Kerala, India, on patients who had undergone lateral mandibulectomy for OSCC from January 2016 to December 2021. Patients with recurrent or second primary OSCC, or with psychiatric disorders and cognitive impairment, or in whom any type of glossectomy was done, were excluded from the study.

PREDICTOR VARIABLE

The predictor variable was reconstruction status of mandibular continuity, coded as yes when it is restored and no for vice-versa.

MAIN OUTCOME VARIABLE(S)

The outcome variables were postoperative speech outcome measured with a 7-point rating speech intelligibility scale and swallowing outcome measured with functional oral intake scale.

COVARIATES

Covariates included age, sex, tumor subsite, mandibular defect, and adjuvant treatment.

ANALYSES

Data analyses included χ2, Fisher's exact test, independent t test, Spearman's correlation test, and one-way analysis of variance test. P values < .05 were considered statistically significant.

RESULTS

The study sample had 201 patients, with continuity restored in 74 (36.82%) patients and vice versa in 127 (63.18%) patients. The mean age in the continuity restored group was 54.97 ± 9.68 years, and in the continuity not restored group, it was 59.49 ± 9.95 years (P < .05). Both the groups had more male patients (P = .15). The speech scores in both groups at 1 month (P = .66), 3 months (P = .45), and 6 months (P = .33) of postoperative period were compared and had no statistically significant difference. The swallowing scores in groups at 1 month (P = .5), 3 months (P = .5), and 6 months (P = .7) of postoperative period were also compared and had no statistically significant difference.

CONCLUSION AND RELEVANCE

Reconstruction of lateral mandibular continuity was not associated with improved postoperative speech and swallowing.

Intermittent oro-esophageal tube feeding for cerebral small vessel disease patients with dysphagia: A randomized controlled study

OBJECTIVES

This study reported the clinical effect of intermittent oro-esophageal tube feeding (IOE) versus nasogastric tube feeding (NGT) on cerebral small vessel disease (CSVD) patients with dysphagia.

METHODS

This randomized controlled study included 60 CSVD patients with dysphagia who received routine treatment. Participants were randomly divided into the intervention group (with IOE, n = 30) and the control group (with NGT, n = 30). The study lasted 15 days for each patient and assessments were conducted at baseline and after treatment. The primary outcome was dysphagia including Penetration-Aspiration Scale and Functional Oral Intake Scale. The secondary outcomes were 1) nutritional status, including (i) body mass index, (ii) serum albumin, (iii) hemoglobin, 2) aspiration pneumonia, 3) activities of daily living (ADL), 4) quality of life (QOL).

RESULTS

At admission, there were no significant differences (P > 0.05) in baseline assessment. After treatment, both groups showed significant improvement in dysphagia, nutritional status, ADL, and QOL. There were significant differences (P < 0.05) between the two groups in dysphagia, nutritional status [body mass index: (19.53 ± 1.40) kg/m2 vs. (18.35 ± 1.54) kg/m2; albumin: (42.06 ± 2.64) g/L vs. (39.49 ± 2.77) g/L; hemoglobin: (128.85 ± 6.34) mg/L vs. (123.14 ± 7.92) mg/L], aspiration pneumonia (6.67% vs. 33.33%), ADL [(69.07 ± 6.33) vs. (63.56 ± 6.75)], and QOL [(78.07 ± 8.64) vs. (72.48 ± 7.76)]. There were no severe adverse events during the treatment.

CONCLUSIONS

Compared to NGT, IOE demonstrated advantages in improving dysphagia, nutritional status, ADL, QOL, and aspiration pneumonia in CSVD patients with dysphagia who received routine treatment.

Long-Term Outcomes of Dysphagia Rehabilitation With an Adjustable Resistance Training Device in Laryngectomized Individuals

BACKGROUND

This study investigated long-term outcomes of dysphagia rehabilitation with an adjustable resistance training device (Swallowing Exercise Aid, SEA2.0) in laryngectomized individuals.

METHODS

Seventeen laryngectomized participants who participated in a Clinical Phase II Trial were reevaluated at T3 (approximately 6 months after T2), including an interview, PROMS, oral intake, and swallowing capacity. Results of T3 were compared with the earlier time points T0 (baseline), T1 (after 6 weeks of training), and T2 (after 8 weeks of rest).

RESULTS

All outcomes at T3 remained improved compared to T0. Compared to findings at T2, participants reported some deterioration in swallowing at T3. Swallowing capacity and oral intake slightly decreased. Swallowing-related quality of life slightly improved.

CONCLUSIONS

Benefits of swallowing rehabilitation with the SEA2.0 in laryngectomized individuals are still noticeable long term. The need for continued exercising to fully maintain improved function is likely, but the required intensity and extent should be determined in further research.

Association of Calf Circumference, Hand Grip Strength, and Physical Performance With Serious Adverse Events in Individuals With Subacute Stroke Hospitalized for Rehabilitation: An Observational Study

OBJECTIVE

To determine whether calf circumference, hand grip strength, and physical performance are linked to the incidence of serious adverse events (SAEs) in patients with subacute stroke.

DESIGN

Retrospective cohort study.

SETTING

Single rehabilitation hospital.

PARTICIPANTS

Patients with stroke admitted for rehabilitation hospital.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

The incidence of SAEs, such as death, cardiovascular events including recurrent stroke, and conditions requiring transfer to another hospital for specialized care or immediate treatment for an acute illness during hospitalization.

RESULTS

A total of 341 patients (median age: 74y) participated in this study, with 232 patients (68%) exhibiting low-physical performance. In the adjusted model, low-physical performance was significantly associated with SAEs (hazard ratio [HR], 3.01; 95% confidence interval [CI], 1.04-8.68; P=.042). However, low calf circumference (HR, 1.60; 95% CI, 0.76-3.38; P=.219) and low hand grip strength (HR, 0.98; 95% CI, 0.39-2.42; P=.960) did not show an independent association.

CONCLUSIONS

Low-physical performance was independently associated with the occurrence of SAEs during hospitalization for rehabilitation in patients with subacute stroke.

Relation between risk of dysphagia and oral intake level in cancer patients

OBJECTIVE

To relate the self-perceived risk of dysphagia with the level of oral intake in hospitalized oncology patients.

METHODS

This cross-sectional study had a convenience sample of adults and older adults diagnosed with cancer and hospitalized in an oncology hospital in southern Brazil. Data on sex, age, length of hospitalization, comorbidities, oncological diagnosis, treatment, and feeding route were obtained from the participants' medical records. The level of oral intake was classified using the Functional Oral Intake Scale (FOIS), and the risk of dysphagia was identified using the Eating Assessment Tool (EAT-10). The relationship between these variables was analyzed using Spearman's correlation coefficient.

RESULTS

The study included 60 participants - 42 with solid tumors and 18 with hematological tumors; 35 females (58.3%) and 25 males(41.7%), with a mean age of 58.5 ± 13.1 years. Of these, 56 exclusively used the oral route for feeding (93.3%), and 18 were at risk of dysphagia (30%). Older patients were at higher risk for dysphagia than adults (p-value = 0.020). EAT-10 scores (median = 0; IQR = 0-4) were significantly inversely correlated (RHO = -0.463; p-value = 0.000) with FOIS classifications (N: level 2 = 2; level 3 = 2; level 4 = 2; level 5 = 12; level 7 = 42).

CONCLUSION

The study found that lower EAT-10 scores corresponded to higher FOIS levels. In other words, the lower the risk of dysphagia, the lower the susceptibility to using alternative feeding routes.

Performance of swallowing function between older people with and without clinical complaints

PURPOSE

To compare the findings of speech-language-hearing evaluations, signs in fiberoptic endoscopic evaluation of swallowing, and nutritional risk between healthy older adults with and without self-reported swallowing difficulties and correlate the level of oral intake with the severity of pharyngeal residues and nutritional risk.

METHODS

This cross-sectional retrospective study included 71 older people and divided them into two groups based on the presence of swallowing complaints. Data were collected from speech-language-hearing evaluations, oral health status, and videoendoscopy signs with four food consistencies classified by the International Dysphagia Diet Standardisation Initiative (IDDSI) to compare the groups. Pharyngeal residues were analyzed and classified using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), the level of oral intake was assessed using the Functional Oral Intake Scale (FOIS), and nutritional risk was evaluated using the Malnutrition Screening Tool (MST).

RESULTS

Differences were found in speech-language-hearing evaluations, as well as signs of posterior oral spillage and pharyngeal residues with levels 0, 2, and 4 consistencies and laryngeal penetration with level 0 consistency. The level of oral intake was moderately negatively correlated with the severity of pharyngeal residues and nutritional risk.

CONCLUSION

The group of older adults with complaints had differences in speech-language-hearing evaluations, posterior oral spillage, and pharyngeal residues with levels 0, 2, and 4 consistencies, and laryngeal penetration with level 0 consistency. The correlation indicated that the lower the level of oral intake, the greater the severity of pharyngeal residues and nutritional risk in the sample.

Validation of the Polish version of the Functional Oral Intake Scale against flexible endoscopic evaluation of swallowing and the International Dysphagia Diet Standardization Initiative Functional Diet Scale

Introduction

The Functional Oral Intake Scale (FOIS) is a widely used instrument for assessing oral intake in dysphagic patients. Despite its frequent use, a validated version for the Polish population has been lacking.

Methods

This study aimed to validate the Polish adaptation of FOIS (FOIS-PL) by examining its concordance with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) outcomes and the International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) scores across patients with diverse clinical profiles. The primary outcome measures included the Penetration-Aspiration Scale (PAS) score from FEES, pharyngeal residue quantification, and IDDSI-FDS scores. A total of 302 participants with varying clinical conditions were recruited. The cohort included individuals with head and neck malignancies, cerebrovascular incidents, neuromuscular disorders, and other dysphagia aetiologies.

Results

Patients with gastroesophageal reflux disease and those post-thyroidectomy consistently exhibited oral food intake with a FOIS-PL score of ≥5. A strong inverse correlation was found between FOIS-PL scores and PAS scores (rho = -0.739; p < 0.001), indicating that reduced oral intake was associated with increased penetration or aspiration risk. Significant differences in FOIS-PL scores were evident across patient subgroups stratified by PAS severity (PAS ≤ 2, PAS 3-5, PAS > 5) and IDDSI levels. Lower FOIS-PL scores corresponded with more impaired swallowing safety (PAS > 5). The median FOISPL score was 5 for individuals with pharyngeal residue and 6 for those without (p < 0.001). Inter-rater reliability between evaluations conducted by a dietitian (FOIS I) and a speech-language pathologist (FOIS II) demonstrated high consistency (tau = 0.995; p < 0.001). Convergent validity was supported by strong correlations between FOIS-PL and IDDSI-FDS scores (FOIS I vs. IDDSI-FDS I: tau = 0.819; p < 0.001; FOIS II vs. IDDSI-FDS II: tau = 0.815; p < 0.001).

Conclusion

The Polish version of the Functional Oral Intake Scale (FOIS-PL) is a valid and reliable tool for assessing oral intake in dysphagia. The findings demonstrate high accuracy, reliability, and validity, supporting its use across diverse clinical conditions.

Association Between Phase Angle and Tongue Pressure in Older Inpatients with Connective Tissue Diseases

To investigate the association between tongue pressure (TP) and phase angle (PhA) in patients with connective tissue diseases (CTDs) aged 65 years or older. This retrospective cross-sectional study was conducted on 189 patients with CTDs who underwent hospital rehabilitation. TP was measured using a tongue pressure measuring device, and PhA was calculated from the bioimpedance analysis readings. Statistical analyses included multivariate linear regression with TP and receiver operating characteristic curves to determine PhA cutoff values indicative of low TP, defined as < 24.3 kPa for men and < 23.7 kPa for women. A total of 189 patients with CTDs (mean age 75 years; 49 men and 140 women; mean PhA 4.0°; mean TP 27.7 kPa) were included in the analysis. Fifty-five patients had low TP. Patients with low TP had lower PhA values than those with normal TP (mean PhA values 3.5° versus 4.3°). After adjusting for confounding factors, PhA (β = 0.387, p < 0.001) was significantly associated with TP. Cutoff values for PhA predicting low TP were identified as 3.9° for men and 3.5° for women. PhA is associated with TP, independent of other factors, in older inpatients with CTDs. The identified PhA cutoff values could enable the early detection of declining TP.

Validity and Reliability of the Swedish Version of the Gugging Swallowing Screen for use in Acute Stroke Care

The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96 h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29-93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78-0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.

The Impact of Home Enteral Tube-Feeding on the Intent and Experience of Going Out in Public: A Qualitative Study on Patients' and Caregivers' Perspectives

BACKGROUND

Individuals on tube-feeding experience significant lifestyle changes and social isolation, but the barriers and support for travelling out while on tube-feeding to reintegrate into the community have not been studied. This research explores the factors influencing the decisions of individuals on tube-feeding and their carers to travel outside of their homes, their experiences, and perceived barriers and support when performing tube-feeding in public settings.

METHODS

A qualitative design using purposive sampling explored the experiences of three individuals and five carers living at home on long-term tube-feeding. One-to-one semi-structured interviews were conducted and transcribed. Thematic analysis was conducted via open coding and merging of recurring codes to form themes.

RESULTS

Six themes emerged: (1) Motivators and deterrents to going out: Motivators include desire for social normalcy. Deterrents include physical health, logistics and psychosocial considerations, such as fear of negative public perception and the loss of travelling and dining as motivating social activities. (2) Going out requires meticulous preparation and planning. (3) Inadequate tube-feeding facilities in the community contribute to ambivalence and discomfort to tube-feeding outside. Participants must accept potential negative emotions when confronted with public reaction to tube-feeding. (4) Ideal tube-feeding facilities should be private and hygienic, in highly frequented locations. (5) Community support and awareness are needed to support tube-feeding. (6) Adaptability is crucial when satisfactory feeding locations are absent during local and overseas travel.

CONCLUSIONS

Carers and healthcare professionals are pivotal in encouraging patients to disregard public curiosity, planning tube-feeding logistics, and advocating for the right to tube feed in public spaces without shame. Public awareness, carer support, and availability of tube-feeding facilities should be improved for patients to live, work and engage meaningfully in the community.

Effect of artificial intelligence-based video-game system on dysphagia in patients with stroke: A randomized controlled trial

BACKGROUND AND AIMS

Post-stroke dysphagia is highly prevalent and causes complication. While video games have demonstrated potential to increase patient engagement in rehabilitation, their efficacy in stroke patients with dysphagia remains unclear. This aim of this study was to explore the effectiveness of the artificial intelligence-based video-game (AI-VG) intervention in improving swallowing function among stroke patients with dysphagia.

METHODS

A prospective, single blinded, randomized controlled trial (RCT) was conducted in a rehabilitation hospital from October 2023 to July 2024. Participants were randomly assigned to either the AI-VG system group or the usual care group. All participants received training for 30 min per session per day, five times per week for 4 weeks. The primary outcome was change in swallowing function from baseline (T0) to post-intervention (T1) and 1 month follow-up (T2). Secondary outcomes included changes in laryngeal function, oral intake function, nutritional status, and swallowing-related quality of life. The adherence, satisfaction, and acceptance of the two groups were evaluated. Changes in outcomes over time were compared using generalized estimating equation modeling.

RESULTS

A total of 84 participants (AI-VG group = 42, age = 65.00 ± 9.70 years, 57.10 % male; usual care group = 42, age = 66.40 ± 13.10 years, 69.00 % male) were included in this study. Compared with the usual care group, the AI-VG group showed significantly improved swallowing function, with a mean group difference of 4.02 (95 % CI = from -6.16 to -1.89, P < 0.001) at T1 and 4.14 (95 % CI = from -6.16 to 2.12, P < 0.001) at T2. Oral intake function, nutritional status, and swallowing-related quality of life improved significantly (P < 0.001 for overall group × time interaction). Adherence was significantly higher in the intervention group than in the control group (median [IQR], 18.00 [17.00-20.00] vs. 16.00 [15.00-17.00], P < 0.001). The intervention group had higher levels of acceptance and satisfaction of AI-VG (103.00 [100.50-104.00] and 73.00 [72.00-74.00], respectively). No significant difference was observed in laryngeal function (P > 0.05).

CONCLUSIONS

The AI-VG intervention is an effective method for enhancing swallowing function in patients with post-stroke dysphagia. Future validation through multicenter, large-sample RCTs are warranted to confirm the findings and explore broader clinical applications.

CLINICAL TRIAL REGISTRATION

ClinicalTrials. Gov Identifier: NCT05978700, https://clinicaltrials.gov/study/NCT05978700.

Volume-viscosity swallow test to facilitate individualized dietary modifications for dysphagia following intracerebral hemorrhage

PURPOSE

This study examined the effects of individualized dietary modifications based on the volume-viscosity swallow test (V-VST) on functional oral intake, incidence of pneumonia, and swallowing-related quality of life in individuals with intracerebral hemorrhage.

METHODS

One hundred and seven participants with signs of dysphagia in the acute and early subacute phases of stroke following intracerebral hemorrhage were randomly assigned into an experimental group for individualized dietary modifications based on V-VST plus routine standard care (n = 53), and a control group for routine care alone (n = 54). Incidence of pneumonia, functional oral intake scale (FOIS) ratings and Eating Assessment Tool (EAT-10) scores before and after intervention were evaluated.

RESULTS

A significantly lower incidence of pneumonia was found in the experimental group than in the control group (p < 0.05). Significant group differences were found in functional oral intake and in quality of life, with significantly higher FOIS ratings and significantly lower EAT-10 scores in the experimental group post-intervention (p < 0.001).

CONCLUSION

These findings suggested that despite being a noninstrumental screening tool, V-VST could facilitate individualized dietary modifications and could be an effective clinical option for reducing the risk of pneumonia, improving functional oral intake and enhancing quality of life in individuals with dysphagia following intracerebral hemorrhage. Future studies should explore how dietary modifications could be more precisely implemented based on the International Dysphagia Diet Standardization Initiative framework.

Exploratory Research: Patient-Reported Factors Contributing to Decreased Oral Intake During Radiotherapy in Head and Neck Cancer

BACKGROUND

Radiotherapy (RT) in head and neck cancer (HNC) can cause multiple side effects such as nausea, pain, taste loss, fatigue, oral mucositis, xerostomia, and acute radiation-associated dysphagia (RAD). These factors threaten patients' oral intake (OI) during this RT. Reduced OI can cause weight loss, dehydration, malnutrition, and various comorbidities. On top, reduced OI significantly affects quality of life and may contribute to RAD through the disuse of swallowing muscles. With the aim of maximizing the retention of a patient's OI, it is important to gain an insight into the factors that have the greatest impact. Therefore, this study aims to identify the impact of contributing factors on decreased OI during RT.

METHODS

During their treatment, 55 HNC patients completed an OI questionnaire at 5 different time points: during weeks 1, 2, 3, and 4 and at the end of RT (week 7). First, patients rated the OI compared to pre-RT on a 100 mm visual analogue scale (VAS). Subsequently, patients reported on separate VAS the degree to which pain, fatigue, loss of taste, loss of smell, loss of interest in food, nausea, and loss of hunger contributed to the decrease in OI (0: no contribution; 100: complete contribution). SPSS version 27 was used to analyze the results.

RESULTS

OI decreased over time during RT, with the lowest OI at the end of RT. During the first 4 weeks of RT, the impact of all factors with pain, loss of taste, loss of interest in food, and loss of hunger pointed out as strongest contributing factors to a decreased OI. The most important patient-reported impacting factor on OI was loss of taste. At the end of RT, the importance of pain and nausea still increases, while the contribution of the other factors drops slightly.

CONCLUSION

This cohort study shows that several factors contribute to a decreased OI in HNC patients during RT. This study is the first prospective analysis to identify self-reported factors contributing to reduced OI. Results demonstrate that taste has the greatest impact on OI followed by loss of interest in food, loss of hunger, and pain.

Predictors and lesion patterns of dysphagia and swallowing outcomes after acute intracerebral hemorrhage

Background

Dysphagia is a common complication following intracerebral hemorrhage (ICH) and is associated with an increased risk of aspiration pneumonia and poor outcomes.

Objectives

This study aimed to explore associated lesion patterns and contributing factors of post-ICH dysphagia, and predict dysphagia outcomes following ICH.

Design

A multicenter, prospective study.

Methods

Patients with ICH from two stroke centers within 72 h of symptom onset received baseline bedside swallowing evaluations. Dysphagia-related lesion patterns were identified using support-vector regression-based lesion-symptom mapping. Predictors of swallowing impairment on the 7th and 30th day, as well as stroke-associated pneumonia (SAP), were determined through multiple logistic regression analyses, and nomograms were developed.

Results

A total of 153 patients were included in the final analysis. Of those, 28 had dysphagia. Dysphagia-related lesions predominantly affected bilateral subcortical and adjacent cortical regions. Stroke severity, hematoma expansion, and basal ganglia hemorrhage were significantly associated with initial dysphagia. Baseline aspiration risk and age were identified as independent predictors of impaired swallowing function on days 7 and 30, and SAP. Moreover, ICH volume was significantly correlated with swallowing impairment on day 7 and SAP occurrence. Midline shift and basal ganglia hematoma remained independent predictors of impaired swallowing on day 30. Predictive models for swallowing impairment on days 7 and 30, as well as SAP, demonstrated strong calibration and discriminatory ability, with C indices of 0.867, 0.895, and 0.773, respectively.

Conclusion

Post-ICH dysphagia can be predicted based on stroke severity, hematoma expansion, and basal ganglia hemorrhage. Incorporating aspiration risk and imaging evaluation can further improve the identification of patients at high risk for swallowing impairment at both 1 week and 1 month after ICH.

Long-term feeding outcomes after infant tracheostomy

OBJECTIVE

To characterize long-term feeding outcomes in infants who underwent tracheostomy prior to their first birthday.

STUDY DESIGN

Retrospective review of feeding outcomes at initial hospital discharge and age 5 in a cohort of infants who underwent tracheostomy at a children's hospital over a 16-year period.

RESULTS

145 infants met inclusion criteria. In this cohort, 117 were feeding tube dependent at time of initial hospital discharge and 71 were feeding tube dependent age 5. Cardiovascular comorbidities (p = 0.009), long-term tracheostomy dependence (p < 0.001), higher birth weight (p = 0.011), older age at tracheostomy decannulation (p < 0.001) and older gestational age (p = 0.007) were factors associated with feeding tube dependence at age 5.

CONCLUSION

The long-term feeding outcomes of infants who require tracheostomy demonstrate high levels of feeding impairment at age 5.

Integrated analysis of the prevalence and influencing factors of poststroke dysphagia

OBJECTIVES

Poststroke dysphagia (PSD) is a common complication after stroke but there is limited information on its global prevalence and influencing factors, such as spatial, temporal, demographic characteristics, and stroke-related factors. Our study seeks to fill this knowledge gap by exploring the overall prevalence of PSD and its influencing factors.

METHODS

A search of English-language literature from database inception from 2005 until May 2022 was performed using PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We used the Joanna Briggs Institute Critical Appraisal Instrument to estimate study quality and calculated the pooled prevalence of PSD with a 95% confidence interval (CI) using an inverse-variance weighted random-effects meta-analysis. A subgroup analysis was performed to identify sources of heterogeneity, and the relationship between PSD and various clinical features was examined using binary logistic regression.

RESULTS

Among 95 studies of 1,059,969 patients, the overall pooled estimated prevalence of PSD was 38.57% (95% CI 35.45-41.69%). Subgroup analysis reveals that South America has the highest prevalence of PSD at 52.30% (95% CI 41.15-63.46%). In rehabilitation units, this rate is 42.42% (95% CI 34.20-50.64%). Women are notably affected, with a prevalence of 41.17% (95% CI 36.97-45.36%) and a higher risk (OR: 1.376, 95% CI 1.315-1.439) than men. Individuals over 65 years exhibit a higher prevalence of 40.26% (95% CI 35.68-44.84%). Fiberoptic endoscopic evaluation of swallowing test shows a striking prevalence of 64.27% (95% CI 55.72-72.81%), and Video fluoroscopic Swallowing Study is 46.93% (95% CI 41.99-51.87%). The the Speech Language Physiotherapist group accounts for 41.36% (95% CI 36.61-46.11%), and a positive correlation between the prevalence of PSD and the NIHSS score. The prevalence of PSD is higher in non-acute strokes, the hemorrhagic strokes, right hemisphere strokes, as well as in the cardioembolism group and the total anterior circulation syndrome (TACS) group. Hemorrhagic strokes [OR: 2.111 (95% CI 1.781-2.503)], the CARDIOEMBOLISM GROUP [OR: 1.531 (95% CI 1.381-1.698)], and TACS group [OR: 2.895 (95% CI 1.495-5.607)] were associated with higher risk of PSD.

CONCLUSIONS

We found that various factors, including spatial, temporal, demographic characteristics, and stroke-related factors, all influence the prevalence of PSD. More high-quality epidemiological research is needed to explore the links between PSD, demographic characteristics, and stroke-related factors. Caution is advised when interpreting our study results due to the included studies' heterogeneity.

Predictors of drooling severity in people with Parkinson's disease

BACKGROUND

Drooling, defined as the unintentional loss of saliva from the anterior oral cavity, remains poorly understood in terms of the underlying clinical factors in people with Parkinson's disease (PwP). This study aims to clarify these factors by analyzing predictors and secondarily the correlates with the severity of drooling in PwP.

METHODS

We conducted a cross-sectional study involving 42 PwP with drooling and 59 without drooling. Clinical assessments were performed, and the primary outcome was the item 2.2 Saliva and drooling of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale. The Mann-Whitney test was used to compare the distribution differences in clinical variables between PwP with and without drooling. The Spearman test was used to examine correlations with drooling, and ordinal logistic regression was used to examine predictors of drooling.

RESULTS

PwP with drooling showed significantly greater impairments in axial signs, posture, facial expression, speech, swallowing, oromotor, motor and non-motor domains than PwP without drooling. Longer disease duration, higher disease severity, levodopa equivalent daily dose, axial signs, unstimulated salivary flow rate, and impairments in speech, posture, facial expression, swallowing, oromotor, motor and non-motor domains were significantly correlated with a higher score on the item 2.2. Male sex, poorer swallowing, oromotor and speech functions were strong predictors of higher scores on the item 2.2 Saliva and drooling.

CONCLUSIONS

Male PwP with swallowing disorders, oromotor and speech impairments are significantly more likely to have severe drooling. Targeted interventions aimed at these swallowing, oromotor, and speech impairments may offer promising approaches to reducing drooling severity in PwP.

Changes in swallowing response on patients undergoing chemoradiotherapy for head and neck cancer

PURPOSE

Chemoradiotherapy (CRT) for head and neck cancer (HNC) often causes dysphagia. The risk of dysphagia increases during CRT tends to become more severe after finishing CRT, and persists for a few weeks thereafter. Thus, understanding the changes in swallowing physiology during and immediately after CRT is essential. This study aimed to clarify the changes in the swallowing response during and early after CRT and identify associated factors.

METHODS

This retrospective study enrolled 107 patients with HNC who underwent CRT. We measured pharyngeal delay time (PDT) and laryngeal elevation delay time (LEDT) as indicators of the timing of the swallowing response at three time points: at CRT initiation (baseline), at 40-Gy irradiation during CRT (mid-CRT) and within 2 weeks following the completion of CRT (early post-CRT) as primary outcomes; and subgroup analyses based on clinical parameters, such as tumor sites, T stage, N stage, and opioid use at 40-Gy irradiation as secondary outcomes.

RESULTS

Both PDT and LEDT were significantly prolonged between baseline and mid-CRT (PDT: p = 0.003, LEDT: p = 0.002) and between baseline and early post-CRT (PDT, p = 0.001; LEDT, p < 0.001). N2c/N3 and opioid use at 40-Gy irradiation showed prolonged PDT and LEDT at mid-CRT and early post-CRT.

CONCLUSION

PDT and LEDT were prolonged at mid-CRT irradiation and further extended at early post-CRT. Additionally, N2c/N3 involvement, which typically necessitates bilateral neck irradiation fields and opioid use at mid-CRT, may constitute as risk factors for a delayed swallowing response.

Pilot Trial of a Speech-Language Pathology Telehealth Service to Enhance Postdischarge Dysphagia Care in Singapore

PURPOSE

Patients and caregivers in Singapore experience issues managing dysphagia care at home following hospital discharge, and they prioritized improving access to postdischarge dysphagia care and support. Hence, a postdischarge dysphagia telehealth service was developed. This study aimed to evaluate the feasibility of this service by examining patient and service outcomes, preliminary costs, and consumer satisfaction.

METHOD

Patients with dysphagia and their caregivers attended one or more telehealth sessions over the initial month post-hospital discharge. Reviews of dietary adherence and preparation, swallowing function, and therapy progress were conducted. If needed, clinical support and intervention were provided. Data related to patient and service outcomes, preliminary costs, and consumer satisfaction were collected and analyzed using descriptive statistics and content analysis.

RESULTS

Twenty patients attended 42 telehealth sessions. No support was provided during 10 sessions, minor support was provided during 13 sessions, and major support and intervention were provided to address patient and swallowing safety during 19 sessions. Out of 20 patients, 19 required support and intervention during the first week postdischarge, but they experienced fewer issues with each subsequent session. They were highly satisfied with the service. The average session duration was 29.6 min. No sessions were cancelled. This service can be delivered with minimal additional health service resources and at a low cost to consumers.

CONCLUSIONS

This service is feasible, cost-effective, and well accepted by consumers. It facilitates early identification and management of swallowing and patient safety during the initial month post-hospital discharge. Wider implementation of this service model should be considered.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27327345.

Effect of pre-hospital living setting on nutritional intake route upon discharge in older adults with aspiration pneumonia: a prospective cohort study

BACKGROUND

Aspiration pneumonia, which often recurs due to dysphagia, worsens as patients move between homes, facilities, and hospitals. The impact of pre-hospital living setting on oral intake at discharge remains unclear. The purpose of this study was to identify the effects of the pre-hospital living setting on the nutritional intake route upon discharge in older patients with aspiration pneumonia.

METHODS

This prospective cohort study included patients aged ≥ 65 years who were admitted to an acute care hospital and diagnosed with aspiration pneumonia. Patients were followed up until discharge or death during hospitalisation. Patient demographic information, pre-hospital living setting (home or nursing facility), functional oral intake scale (FOIS) score, pneumonia severity index, clinical frailty scale score, history of aspiration pneumonia, and pneumonia recurrence during hospitalisation were recorded. Binary logistic regression was used to assess the impact of the pre-hospital living setting on oral intake at discharge as the primary outcome.

RESULTS

Among the 89 included patients (52 males (58.4%); mean age, 84.8 ± 7.9 years), 39.3% (n = 35) had pneumonia recurrence during hospitalisation. The average follow-up period was 44.0 ± 36.6 days. The pre-hospital living setting was independently associated with the nutritional intake route upon discharge (odds ratio = 7.72, 95% confidence interval (95%CI) = 1.70-35.1, p = 0.008).

CONCLUSIONS

The pre-hospital living setting could serve as a good indicator of the nutritional intake route upon discharge. It is essential to optimize care in both nursing facilities and hospital settings when caring for older patients with aspiration pneumonia.

Swallowing, speech and voice impairments in head and neck cancer patients treated at a multidisciplinary integrated patient unit

BACKGROUND

Head and neck cancer (HNC) is amongst the 10 most common cancers worldwide and has a major effect on patients' quality of life. Given the complexity of this unique group of patients, a multidisciplinary team approach is preferable. Amongst the debilitating sequels of HNC and/or its treatment, swallowing, speech and voice impairments are prevalent and require the involvement of speech-language pathologists (SLPs). In 2018, an integrated patient unit (IPU) for HNC patients was established which includes healthcare professionals from diverse fields including SLPs.

AIMS

To characterize the demographic and clinical profiles of HNC patients and assess SLP therapy efficacy in these patients with respect to swallowing, speech and voice functionality.

METHODS & PROCEDURES

Demographic and clinical information was collected for the first 100 HNC patients referred to SLP evaluation in the IPU. In addition, different measures of swallowing, speech and voice functionality were taken pre- and post-SLP therapy to estimate if and how the therapy improved the patients' performance in these aspects.

OUTCOMES & RESULTS

Analysis revealed that 84%, 36.2% and 33% of the patients suffered from swallowing, speech and voice impairments, respectively. Treatment types (surgery and radiation, chemotherapy and radiation) and the prevalence of speech and voice impairments varied amongst tumour locations (larynx, oral cavity, pharynx), whilst swallowing impairments were highly prevalent across all tumour locations. Speech impairments were more common in patients treated with a combination of surgery and radiation. Comparison between pre- and post-SLP therapy-related measures revealed that swallowing, speech and voice functionality significantly improved following SLP therapy.

CONCLUSIONS & IMPLICATIONS

The holistic, multidisciplinary approach in the IPU contrasts with the more segmented care typically provided in out-patient/community clinics, making SLP therapy within the IPU uniquely integrated and effective. The protocol established at the IPU provides a valuable framework for SLP assessment and therapy in HNC patients exhibiting swallowing, speech and voice impairments with the ultimate goal of improving their quality of life.

WHAT THIS PAPER ADDS

What is already known on the subject Many HNC patients suffer from swallowing, speech and voice impairments which have a substantial impact on their quality of life. Nevertheless, many current clinical practices do not include SLPs as an integral part of the healthcare team. Moreover, there are no common guidelines for SLP therapy in this unique group of patients. What this paper adds to the existing knowledge In this study we provide a detailed demographic and clinical profile of a large cohort of HNC patients that were referred to SLP evaluation in a newly developed and designated IPU. We provide a comprehensive description of clinical interventions that were applied based on the location of the tumour and specific impairments related to it. Additionally, SLP therapy outcomes are described, showing a significant improvement in swallowing, speech and voice functionality. What are the potential or actual clinical implications of this work? Study results support the inclusion of an SLP in HNC patients' IPUs. The multidisciplinary healthcare approach enabled the provision of a tailored SLP therapy to the specific tumour types and impairments and proved efficient, resulting in favourable outcomes.

Time-course assessment of oral intake function and its impact on end-of-life in older individuals over 90 years with frailty

AIM

The study investigates end-of-life trajectories, focusing on the degree of oral intake function in older individuals with frailty aged over 90 years.

METHODS

This retrospective observational study examined individuals aged 90 years and older who passed away at a long-term chronic care hospital and related facilities in Japan. We assessed their Clinical Frailty Scale (CFS) and Function Oral Intake Scale (FOIS), categorizing them into two groups-"preserved CFS" (CFS score ≤7) and "poor CFS" (CFS score ≥8)-considering evaluations conducted 6 months before death. We examined the transitional progression of their CFS and FOIS scores, along with a time-course assessment of low FOIS scores (≤3) in each group at various intervals.

RESULTS

Among 66 cases, 38 were in the preserved CFS group, and 28 were in the poor CFS group. The CFS and FOIS scores of the preserved CFS group declined rapidly towards the end-of-life, with approximately half experiencing significant declines within 3 months. In contrast, both the CFS and the FOIS scores of the poor CFS group declined gradually within 6 months. The percentage of low FOIS score (≤3) was lower at 12 and 6 months than at 1 month prior to death in the preserved CFS group.

CONCLUSIONS

The end-of-life trajectories in older individuals with frailty aged over 90 years were heterogeneous. Clinicians should carefully monitor the degree of frailty and changes in food intake as crucial indications of the end-of-life phase, providing optimal support to manage potential vicious cycles. Geriatr Gerontol Int 2025; 25: 96-101.

Submandibular Gland Flap Reconstruction for Oropharyngeal Defects After Transoral Robotic Surgery (TORS)

BACKGROUND

To describe utilization and outcomes of submandibular gland flap (SGF) reconstruction after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).

METHODS

A multi-institutional retrospective case series of patients who underwent TORS for OPSCC followed by SGF reconstruction with harvest via transcervical approach from 1/1/2016 to 4/1/2023.

RESULTS

In total, 14 patients underwent SGF reconstruction after TORS for OPSCC. All patients had HPV-positive disease, predominantly in early local (N = 10 with pT1/pT2 disease, 71%) and regional stages (N = 11 with pN0/pN1 disease, 79%). Most patients received adjuvant radiation treatment (N = 9, 64%). Median hospital LOS after surgery was 4 days (IQR 2 days) with median functional oral intake scale (FOIS) score of 5 (IQR 0.8) at 1-3 weeks after surgery.

CONCLUSIONS

SGF reconstruction is a useful technique for closure of appropriately selected TORS defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue but not large enough to warrant free flap reconstruction.

Nutritional Status, Frailty, Oral Health, and Oral Motor Functions in Long-Term Care Residents with Swallowing Dysfunction

Background: Swallowing dysfunction is a prevalent but often overlooked problem in long-term care facilities. This study investigated the relationships between nutritional deficits, frailty, oral health, and swallowing dysfunction. Additionally, we explored the associations between oral muscle weakness, frailty markers, and swallowing dysfunction. Methods: We recruited 373 participants from seven long-term care facilities across Taiwan. Swallowing function, frailty, nutrition status, and oral health were assessed by research staff. Oral muscle function was evaluated through tongue strength measurements, cheek bulging function tests, the Repetitive Saliva Swallowing Test (RSST), and a diadochokinetic task. Frailty was assessed through grip strength as well as mid-upper arm and calf circumference measurements. Results: The Functional Oral Intake Scale revealed that 97 participants (26%) had swallowing dysfunction. Participants with swallowing dysfunction had poorer nutritional status, higher frailty levels, and worsened oral health. Frailty was the factor most strongly associated with swallowing dysfunction. Participants with swallowing dysfunction also exhibited lower tongue pressure, decreased cheek-bulging ability, fewer repetitions in the diadochokinetic task, lower scores on the RSST, lower calf circumferences, and lower grip strength. Logistic regression demonstrated that cheek bulging was most strongly associated with swallowing dysfunction. Furthermore, lower grip strength was significantly associated with swallowing dysfunction. Conclusions: Frailty was most strongly associated with swallowing dysfunction, followed by poorer nutritional status and worsened oral health. These factors should be thoroughly assessed in long-term care residents. Participants with swallowing dysfunction also experienced oral muscle weakness, particularly in cheek bulging. Grip strength, which represents frailty, was directly associated with swallowing dysfunction and could serve as a crucial indicator of swallowing dysfunction.

Associations of malnutrition factors with dysphagia mediated by ADL among nursing home residents

OBJECTIVE

The potential link between malnutrition and dysphagia along with its underlying mechanisms remains unknown. This study aimed to investigate the association between malnutrition factors and dysphagia mediated by a decline in activities of daily living (ADL) among nursing home residents.

METHODS

This cross-sectional study used data from 705 nursing home residents. The primary factors were risk of malnutrition and dysphagia. A body mass index (BMI) of < 18.5 and insufficient energy and protein intakes were also collected as factors related to malnutrition. The causal mediation analysis was used with malnutrition factors as the exposure, dysphagia as the outcome, and ADL as the mediation factor.

RESULTS

In total, 391 residents (55.5%) were at risk of malnutrition and 451 residents (64.0%) had dysphagia. The average causal mediation effect (ACME) of risk of malnutrition on dysphagia was 0.07 (95% confidence interval, C, 0.07-0.08), and the ACME of BMI < 18.5 was 0.05 (95% CI 0.04-0.05, P < 0.001 for both). For insufficient nutritional intake, the ACME of low energy intake was 0.07 (95% CI 0.07-0.07), and the ACME of low protein intake was 0.03 (95% CI 0.02-0.04, P < 0.001 for both). The total effects of all these exposures on dysphagia were significant (P = 0.002 for low protein intake and P < 0.001 for the others).

CONCLUSION

Malnutrition factors were associated with dysphagia, mediated by a decline in ADL among nursing home residents. The results of this study suggest the importance of nutritional management along with approaches to ADL to prevent dysphagia.

The Influence of Strength and Skill Parameters on the Evolution of Dysphagia Post Stroke: A Prospective Study

The role of pathophysiological deficits in the evolution of dysphagia post-stroke is unclear. This observational, longitudinal study aimed to document the evolution and relationship between strength and precision of submental contraction, and swallowing outcomes at six months. Participants were recruited from a tertiary acute hospital after a first acute stroke. Sociodemographic data and stroke typology were documented. Outcome measures were collected five times across six months. These included: oral diet (FOIS, IDDSI), functional ingestion (TOMASS, TWST), self-reported swallowing-related quality of life (SWAL-QOL), and submental muscle strength and precision contraction as assessed using surface electromyography coupled with biofeedback during saliva swallowing and jaw-opening tasks. Mixed effects models and multiple regressions analyses were conducted. Participants (N = 22, mean age 73.9 ± 14.4 years, 9 males) were recruited at a mean time of 2.8 ± 1.5 days after stroke. Strength parameters (effortful swallow hit rate) improved between ten days and one month post-stroke (p = 0.04). Swallowing temporal precision improved significantly between one and six months (p < 0.01). At six months, participants with decreased swallowing precision also had decreased quality of life (p = 0.04) and increased ingestion time of fluids (p = 0.002). This study is a novel step in exploring the nature and evolution of strength and precision parameters of swallowing muscle activation, and their impact on dysphagia recovery. As swallowing precision was associated with poorer functional outcomes, further studies are warranted to improve early differential diagnosis of patients at risk of chronic dysphagia.

Systematic literature review of the impact of spinal muscular atrophy therapies on bulbar function

BACKGROUND

Improvement and maintenance of bulbar function are important goals of disease-modifying treatments (DMTs) for spinal muscular atrophy (SMA), but standardized and validated measures for assessing bulbar function do not exist, nor does a widely accepted definition of bulbar function in SMA. As such, the impact of DMTs on bulbar function has not yet been comprehensively evaluated.

OBJECTIVE

We conducted a systematic literature review (SLR) to identify evidence about the impact of DMTs for SMA on bulbar function.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to conduct this review. Embase® and MEDLINE® databases were searched through August 10, 2023. Eligible studies included patients with SMA who were treated with any DMT and reported bulbar function outcomes. Non-English studies were excluded.

RESULTS

We identified 51 studies (across 83 publications) that evaluated SMA DMTs and bulbar function for more than 1600 patients. The ability to feed orally, the ability to tolerate liquids, and the need for nutrition support were commonly reported. Most infants treated with any DMT before SMA symptom onset preserved bulbar function. Infants, children, and adults treated after SMA symptom onset experienced variable results in terms of bulbar function outcomes.

CONCLUSIONS

The definition and assessment of bulbar function are not standardized. Therefore, the tools, scales, methods, and timing used for bulbar function assessments varied among studies. Larger prospective studies using standardized and age-based assessments with longer follow-up periods are needed to assess the clinical stability of bulbar function for patients with SMA who receive DMTs.

Effect of osteosarcopenia on feeding status in hospitalized patients with suspected dysphagia

OBJECTIVES

Osteosarcopenia is a combination of sarcopenia and osteoporosis that increases mortality rates among older people compared with either alone. This study aimed to identify the contribution of osteosarcopenia to the development and severity of dysphagia.

METHODS

We retrospectively reviewed the medical charts of 211 patients aged ≥ 65 years who were referred to the dysphagia rehabilitation team. Based on Functional Oral Intake Scale (FOIS) scores, we classified the patients with (FOIS scores 1-5) and without (FOIS scores 6, 7) dysphagia as Type A and those with (FOIS scores 1, 2) and without (FOIS score 3-7) enteral feeding as Type B. Based on chest computed tomography (CT) findings we then defined patients with T4 (MI) and pectoralis (PMI) muscle indexes, L1 attenuation, and T4MI, PMI, and L1 attenuation below the cutoff values as having sarcopenia, osteoporosis, and osteosarcopenia, respectively.

RESULTS

The FOIS scores were significantly lower among patients with osteosarcopenia than among those without sarcopenia or osteoporosis. Moreover, PMI and FOIS scores significantly and positively correlated, and PMI was significantly lower in the group with, than without, enteral feeding. Osteoporosis and osteosarcopenia were significant in the patients who were fed enterally (p = 0.032 and 0.047, respectively).

CONCLUSIONS

Patients with sarcopenia and osteoporosis undergoing swallowing rehabilitation tended to have severe dysphagia that required much medical attention.