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Gascon L, Bryson PC, Benninger M, Brodsky MB. Assessing Dysphagia in the Adult. Otolaryngol Clin North Am 2024; 57:523-530. [PMID: 38632000 DOI: 10.1016/j.otc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
This article explores the landscape of dysphagia assessment in adults. Dysphagia, a complex condition affecting the lifespan and many health conditions, significantly compromises individuals' quality of life. Dysphagia is often underdiagnosed, emphasizing the need for comprehensive assessment methods to ensure timely and accurate intervention. It encompasses clinical history, physical examination, clinical and instrumental swallow evaluations. Procedures within each of these modalities are reviewed, highlighting strengths, limitations, and contribution toward a complete understanding of dysphagia, ultimately guiding effective intervention strategies for improved patient outcomes.
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Affiliation(s)
- Laurence Gascon
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center.
| | - Paul C Bryson
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center
| | - Michael Benninger
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center
| | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Voice Center; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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2
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Salgado TT, Oliveira CMDS, Gatti M, Silva RGD, Honório HM, Berretin-Felix G. Degree of swallowing impairment in the elderly: clinical and instrumental assessment. Braz J Otorhinolaryngol 2024; 90:101426. [PMID: 38608636 PMCID: PMC11016858 DOI: 10.1016/j.bjorl.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/11/2023] [Accepted: 02/27/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVE To classifying the degree of swallowing impairment in the elderly, comparing clinical and instrumental assessment. METHODS This is a cross-sectional study with quantitative and qualitative analysis of clinical and instrumental assessment of 37 elderly, aged 60-82 years, of both genders without neurological, oncological or systemic diseases, participated in this study. All participants were submitted to clinical evaluation and their results compared through fiberoptic endoscopic evaluation of swallowing considering liquid, pudding and solid food consistencies. Data were analyzed descriptively and statistically using the analysis of variance test (two-way ANOVA) and Tukey's post hoc test (p < 0.05). RESULTS In the clinical evaluation there was a higher occurrence of moderate swallowing impairment, followed by functional swallowing, while in fiberoptic endoscopic evaluation of swallowing the severity of the impairment was greater for moderate and mild degrees. There was no statistical difference between the clinical and instrumental evaluation methods. However, there was a significant interaction between the variables, with a difference for liquid consistency in the instrumental evaluation method. CONCLUSION Healthy elderly have different degree of swallowing impairment according to food consistency. The clinical assessment using a scale that considers the physiological changes of the elderly, presented results similar to those found in the instrumental examination. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Marina Gatti
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Bauru, SP, Brazil
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3
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Yamano T, Nishi K, Kimura S, Omori F, Wada K, Tanaka M, Tsutsumi T. Oral Health and Swallowing Function of Nursing Home Residents. Cureus 2024; 16:e62600. [PMID: 39027772 PMCID: PMC11256971 DOI: 10.7759/cureus.62600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE Although a good oral environment helps reduce the risk of pneumonia in the elderly, repeated pneumonia can occur even with frequent oral care. The actual risk of pneumonia during oral intake, the choice of whether oral intake is possible, and the choice of food form are often determined using video fluorography (VF), which can provide detailed information on swallowing function. However, few reports have compared the oral environment and swallowing function, leaving the relationship unclear. We examined the relationship between the oral environment and swallowing function and the characteristics of swallowing function in elderly nursing home residents. METHODS The subjects were 48 elderly nursing home residents (13 males, 35 females) with a mean age of 89 years who underwent outpatient or inpatient evaluation of their oral environment and swallowing function. There were three groups of residents: those who were evaluated for swallowing as outpatients, those who were hospitalised for pneumonia, and those who were hospitalised for diseases other than pneumonia. The oral environment was assessed by a dentist or dental hygienist using the Oral Health Assessment Tool (OHAT). Swallowing function was assessed by an otorhinolaryngologist using VF. RESULTS There was no correlation between OHAT and VF scores in the outpatient group or the group hospitalised for pneumonia, but there was a correlation in the group hospitalised for reasons other than pneumonia. CONCLUSION In facilities with good oral care, the development of pneumonia may be related to factors other than the oral environment and the OHAT may reflect conditions other than swallowing function. The swallowing function of nursing home residents should be evaluated by VF, which allows observation of all stages of swallowing.
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Affiliation(s)
- Takafumi Yamano
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, JPN
| | - Kensuke Nishi
- Section of Otolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, JPN
| | - Shoichi Kimura
- Section of Otorhinolaryngology, Department of Medicine, Fukuoka Dental College, Fukuoka, JPN
| | - Fumitaka Omori
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, JPN
| | - Kaori Wada
- Department of Otorhinolaryngology, Fukuoka Dental College Hospital, Fukuoka, JPN
| | - Miho Tanaka
- Department of Nursing, Fukuoka Dental College Hospital, Fukuoka, JPN
| | - Takashi Tsutsumi
- Department of General Dentistry, Fukuoka Dental College, Fukuoka, JPN
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Molino C, Bergantini L, Santucci S, Pitinca MT, d'Alessandro M, Cameli P, Taddei S, Bargagli E. SARS-CoV-2 and Dysphagia: A Retrospective Analysis of COVID-19 Patients with Swallowing Disorders. Dysphagia 2024:10.1007/s00455-024-10715-0. [PMID: 38782803 DOI: 10.1007/s00455-024-10715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND COVID-19 can lead to impairment of neural networks involved in swallowing, since the act of swallowing is coordinated and performed by a diffuse brain network involving peripheral nerves and muscles. Dysphagia has been identified as a risk and predictive factor for the severest form of SARS-CoV-2 infection. OBJECTIVES To investigate the association between swallowing disorders and COVID-19 in patients hospitalized for COVID-19. METHODS We collected demographic data, medical information specific to dysphagia and data on medical treatments of patients with COVID-19. RESULTS A total of 43 hospitalized COVID-19 patients were enrolled in the study. Twenty (46%) were evaluated positive for dysphagia and 23 (54%) were evaluated negative. Neurocognitive disorders and diabetes were mostly associated with patients who resulted positive for dysphagia. Respiratory impairment caused by COVID-19 seems to be a cause of dysphagia, since all patients who needed oxygen-therapy developed symptoms of dysphagia, unlike patients who did not. In the dysphagic group, alteration of the swallowing trigger resulted in the severest form of dysphagia. An association was found between the severest form of COVID-19 and dysphagia. This group consisted predominantly of males with longer hospitalization. CONCLUSIONS Identification of COVID-19 patients at risk for dysphagia is crucial for better patient management.
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Affiliation(s)
- Christopher Molino
- Department of Medical Sciences, Surgery and Neurosciences, Respiratory Disease and Lung Transplant Unit, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena University, Viale Bracci, Siena, 53100, Italy
| | - Laura Bergantini
- Department of Medical Sciences, Surgery and Neurosciences, Respiratory Disease and Lung Transplant Unit, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena University, Viale Bracci, Siena, 53100, Italy.
| | | | | | - Miriana d'Alessandro
- Department of Medical Sciences, Surgery and Neurosciences, Respiratory Disease and Lung Transplant Unit, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena University, Viale Bracci, Siena, 53100, Italy
| | - Paolo Cameli
- Department of Medical Sciences, Surgery and Neurosciences, Respiratory Disease and Lung Transplant Unit, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena University, Viale Bracci, Siena, 53100, Italy
| | | | - Elena Bargagli
- Department of Medical Sciences, Surgery and Neurosciences, Respiratory Disease and Lung Transplant Unit, University Hospital of Siena (Azienda Ospedaliera Universitaria Senese, AOUS), Siena University, Viale Bracci, Siena, 53100, Italy
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Nakamori M, Imamura E, Maetani Y, Yoshida M, Yoshikawa M, Nagasaki T, Masuda S, Kayashita J, Mizoue T, Wakabayashi S, Maruyama H, Hosomi N. Prospective Observational Study for the Comparison of Screening Methods Including Tongue Pressure and Repetitive Saliva Swallowing With Detailed Videofluoroscopic Swallowing Study Findings in Patients With Acute Stroke. J Am Heart Assoc 2024; 13:e032852. [PMID: 38293925 PMCID: PMC11056116 DOI: 10.1161/jaha.123.032852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/20/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Simple, noninvasive, and repeatable screening methods are essential for assessing swallowing disorders. We focused on patients with acute stroke and aimed to assess the characteristics of swallowing screening tests, including the modified Mann Assessment of Swallowing Ability score, tongue pressure, and repetitive saliva swallowing test (RSST), compared with detailed videofluoroscopic swallowing study (VFSS) findings to contribute as a helpful resource for their comprehensive and complementary use. METHODS AND RESULTS We enrolled first-ever patients with acute stroke conducting simultaneous assessments, including VFSS, modified Mann Assessment of Swallowing Ability score, tongue pressure measurement, and RSST. VFSS assessed aspiration, laryngeal penetration, oral cavity residue, vallecular residue, pharyngeal residue, and swallowing reflex delay. Screening tests were compared with VFSS findings, and multiple logistic analysis determined variable importance. Cutoff values for each abnormal VFSS finding were assessed using receiver operating characteristic analyses. We evaluated 346 patients (70.5±12.6 years of age, 143 women). The modified Mann Assessment of Swallowing Ability score was significantly associated with all findings except aspiration. Tongue pressure was significantly associated with oral cavity and pharyngeal residue. The RSST was significantly associated with all findings except oral cavity residue. Receiver operating characteristic analyses revealed that the minimum cutoff value for all VFSS abnormal findings was RSST ≤2. CONCLUSIONS The modified Mann Assessment of Swallowing Ability is useful for broadly detecting swallowing disorders but may miss mild issues and aspiration. The RSST, with a score of ≤2, is valuable for indicating abnormal VFSS findings. Tongue pressure, especially in oral and pharyngeal residues, is useful. Combining these tests might enhance accuracy of the swallowing evaluation.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Eiji Imamura
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Yuta Maetani
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
- Department of NeurologySuiseikai Kajikawa HospitalHiroshimaJapan
| | - Mitsuyoshi Yoshida
- Department of Dentistry and Oral‐Maxillofacial Surgery, School of MedicineFujita Health UniversityToyoakeAichiJapan
- Department of Advanced ProsthodonticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Mineka Yoshikawa
- Department of Advanced ProsthodonticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial RadiologyHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Shin Masuda
- Department of Children SensoryHiroshima Prefectural HospitalHiroshimaJapan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and SciencesPrefectural University of HiroshimaHiroshimaJapan
| | - Tatsuya Mizoue
- Department of NeurosurgerySuiseikai Kajikawa HospitalHiroshimaJapan
| | | | - Hirofumi Maruyama
- Department of Clinical Neuroscience and TherapeuticsHiroshima University Graduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Naohisa Hosomi
- Department of NeurologyChikamori HospitalKochiJapan
- Department of Disease Model, Research Institute of Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
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Ohira M, Ohkubo M, Miura K, Yamashita S, Morimitsu T, Goto Y. Diagnostic Accuracy of Mann Assessment of Swallowing Ability for Predicting Dysphagia in Patients with Psychiatric Disorders. THE BULLETIN OF TOKYO DENTAL COLLEGE 2023; 64:79-87. [PMID: 37599089 DOI: 10.2209/tdcpublication.2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Dysphagia occurs in various diseases and constitutes a major concern in patients with psychiatric disorders. The Mann Assessment of Swallowing Ability (MASA) comprises 24 clinical parameters designed to identify swallowing disorders. One item in MASA, the "gag reflex", involves an unpleasant stimulus, which means that it is often omitted when the test is administered. The aims of this study were to determine the presence/absence of dysphagia in patients with psychiatric disorders using the MASA and determine its diagnostic accuracy when the gag reflex item was excluded in patients with psychiatric disorders. The study participants comprised patients admitted to a hospital psychiatric ward in whom dysphagia had been suspected based on oral intake status. The following items were determined: age, total MASA score (23 out of 24 items, giving a score out of 195 points), body mass index score, milligram equivalents of chlorpromazine, and the Food Intake Level Scale score. The patients were divided into two groups according to the presence or absence of swallowing problems as assessed by videoendoscopic or videofluoroscopic examination. The scores for each item investigated in the MASA, including the total score, were compared between the two groups. Receiver operating characteristic curve analysis was carried out to determine the optimum cut-off value. The total MASA score, which excluded the "gag reflex" item, was lower in the problematic swallowing group than in the non-problematic swallowing group. The MASA scores for cooperation, respiratory, dysphasia, tongue coordination, oral preparation, pharyngeal phase, and pharyngeal response tended to be lower in the problematic swallowing group. Furthermore, an optimum cut-off value of 169 points (sensitivity, 0.92; specificity, 0.68; likelihood ratio, 2.84) was identified. These results indicate that the cut-off MASA score is effective in screening for dysphagia, even when the "gag reflex" item is excluded.
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Affiliation(s)
- Mariko Ohira
- Department of Removable Partial Prosthodontics, Tokyo Dental College
| | - Mai Ohkubo
- Department of Oral Health and Clinical Science Division of Dysphagia Rehabilitation
| | - Keina Miura
- Department of Oral Health and Clinical Science Division of Dysphagia Rehabilitation
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Nakamori M, Ishikawa R, Watanabe T, Toko M, Naito H, Takahashi T, Simizu Y, Yamazaki Y, Maruyama H. Swallowing sound evaluation using an electronic stethoscope and artificial intelligence analysis for patients with amyotrophic lateral sclerosis. Front Neurol 2023; 14:1212024. [PMID: 37602264 PMCID: PMC10435850 DOI: 10.3389/fneur.2023.1212024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Background and purpose Non-invasive, simple, and repetitive swallowing evaluation is required to prevent aspiration pneumonia in neurological care. We investigated the usefulness of swallowing sound evaluation in patients with amyotrophic lateral sclerosis (ALS) using our new electronic stethoscope artificial intelligence (AI) analysis tool. Methods We studied patients with ALS who provided written informed consent. We used an electronic stethoscope, placed a Bluetooth-enabled electronic stethoscope on the upper end of the sternum, performed a 3-mL water swallow three times, and remotely identified the intermittent sound components of the water flow caused at that time by AI, with the maximum value as the swallowing sound index. We examined the correlation between the swallowing sound index and patient background, including swallowing-related parameters. Results We evaluated 24 patients with ALS (age 64.0 ± 11.8 years, 13 women, median duration of illness 17.5 months). The median ALS Functional Rating Scale-Revised (ALSFRS-R) score was 41 (minimum 18, maximum 47). In all cases, the mean swallowing sound index was 0.209 ± 0.088. A multivariate analysis showed that a decrease in the swallowing sound index was significantly associated with a low ALSFRS-R score, an ALSFRS-R bulbar symptom score, % vital capacity, tongue pressure, a Mann Assessment of Swallowing Ability (MASA) score, and a MASA pharyngeal phase-related score. Conclusion Swallowing sound evaluation using an electronic stethoscope AI analysis showed a correlation with existing indicators in swallowing evaluation in ALS and suggested its usefulness as a new method. This is expected to be a useful examination method in home and remote medical care.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ruoyi Ishikawa
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomoaki Watanabe
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroyuki Naito
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tamayo Takahashi
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yoshitaka Simizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Mélotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Links Between Swallowing and Consciousness: A Narrative Review. Dysphagia 2023; 38:42-64. [PMID: 35773497 DOI: 10.1007/s00455-022-10452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
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Affiliation(s)
- Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group, GIGA, University and University Hospital of Liège, Liège, Belgium
- Otorhinolaryngology Head and Neck Surgery Department, Robert Debré University Hospital, APHP, Paris, France
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
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Almeida VPB, Félix L, Tavares TL, da Silva Castro MM, Tiago RSL. Dysphagia in patients with coronavirus disease undergoing orotracheal intubation. Laryngoscope Investig Otolaryngol 2022; 7:LIO2886. [PMID: 36249087 PMCID: PMC9538553 DOI: 10.1002/lio2.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/06/2022] [Accepted: 07/23/2022] [Indexed: 01/08/2023] Open
Abstract
Objective To assess the incidence and the risk factors for the development of dysphagia in patients with coronavirus disease 2019 (COVID-19) undergoing orotracheal intubation. Study Design Prospective cohort study. Methods In this prospective cohort study, we evaluated consecutive patients diagnosed with COVID-19 and underwent orotracheal intubation were evaluated. During hospitalization, extubated patients were classified as dysphagic and nondysphagic based on bedside functional assessment of swallowing. Patients discharged from hospital were asked to complete the Eating Assessment Tool-10 (EAT-10) questionnaire, followed by an endoscopic examination to identify laryngotracheal lesions, and a fiberoptic endoscopic evaluation of swallowing (FEES). The food consistencies used for FEES were moderately thick, extremely thick, thin, and regular. Results Based on the functional assessment of swallowing, performed a mean of 5.3 days and a median of 4 days after extubation, the incidence of dysphagia in patients with COVID-19 undergoing orotracheal intubation was 53.6%. In the late evaluation, performed a mean of 102 days after extubation, 12.8% of patients had an EAT-10 score >2. Orotracheal intubation (OTI) duration and tracheostomy were risk factors for the development of dysphagia. There was an association between EAT-10 > 2 and the presence of laryngotracheal lesion, with no difference between lesion type and EAT score >2. Conclusions The incidence of dysphagia varied according to the time of assessment, being higher the earlier the assessment after extubation. OTI duration and tracheostomy were risk factors for the development of dysphagia, and the presence of laryngotracheal lesions demonstrated an association with dysphagia. Level of Evidence 3.
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Affiliation(s)
- Vinícius Pereira Barbosa Almeida
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Letícia Félix
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Tracy Lima Tavares
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Mariana Marques da Silva Castro
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
| | - Romualdo Suzano Louzeiro Tiago
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial SurgeryInstitute of Medical Assistance to the State Public Servant (IAMSPE)São PauloBrazil
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Silva RDD, Santos RS, Taveira KVM, Guariza Filho O, Basso IB, Ravazzi GMNC, Zeigelboim BS, Stechman-Neto J, Araujo CMD. Deglutition assessment instruments used in critical patients submitted to orotracheal extubation: a scoping review. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222457222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rayane Délcia da Silva
- Núcleo de Estudos Avançados em Revisão Sistemática e Meta-Análise, Brasil; Universidade Tuiuti do Paraná, Brazil
| | - Rosane Sampaio Santos
- Núcleo de Estudos Avançados em Revisão Sistemática e Meta-Análise, Brasil; Universidade Tuiuti do Paraná, Brazil
| | - Karinna Verissimo Meira Taveira
- Núcleo de Estudos Avançados em Revisão Sistemática e Meta-Análise, Brasil; Universidade Federal do Rio Grande do Norte, Brazil
| | - Odilon Guariza Filho
- Núcleo de Estudos Avançados em Revisão Sistemática e Meta-Análise, Brasil; Pontifícia Universidade Católica do Paraná, Brazil
| | | | | | - Bianca Simone Zeigelboim
- Núcleo de Estudos Avançados em Revisão Sistemática e Meta-Análise, Brasil; Universidade Tuiuti do Paraná, Brazil
| | - José Stechman-Neto
- Núcleo de Estudos Avançados em Revisão Sistemática e Meta-Análise, Brasil; Universidade Tuiuti do Paraná, Brazil
| | - Cristiano Miranda de Araujo
- Núcleo de Estudos Avançados em Revisão Sistemática e Meta-Análise, Brasil; Universidade Tuiuti do Paraná, Brazil
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Characteristics and Prognostic Factors of Swallowing Dysfunction in Patients with Lateral Medullary Infarction. J Stroke Cerebrovasc Dis 2021; 30:106122. [PMID: 34583216 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Lateral medullary infarction mainly impairs the pharyngeal phase of swallowing. We aimed to investigate the utility of the assessment tools of swallowing function in patients with lateral medullary infarction and to determine the factors that could predict the outcomes of swallowing function. MATERIALS AND METHODS 15 patients with lateral medullary infarction who were admitted to Suiseikai Kajikawa Hospital between August 1, 2016, and March 31, 2020 (age 62.7 ± 14.8 years, 5 women) were enrolled in this prospective study. The diagnosis was made using brain magnetic resonance imaging. We analyzed the factors associated with severe swallowing dysfunction, which was defined as the necessity for tube feeding on the 90th day from admission, with multiple logistic regression analysis. RESULTS Multivariate analyses identified the repetitive saliva swallowing test, modified water swallowing test, and vertical spread of stroke lesions as independent significant factors affecting severe swallowing dysfunction (p = 0.002, 0.016, and 0.011, respectively). The sub-scores of the pharyngeal phase of the Mann Assessment of Swallowing Ability were also significantly associated with severe swallowing dysfunction (p < 0.001). However, tongue pressure, severe passage pattern abnormality on videofluoroscopic examination, and vertebral artery dissection were not significantly associated with swallowing dysfunction. CONCLUSIONS Since lateral medullary infarction presents with swallowing dysfunction mainly in the pharyngeal phase, tools that can be used to evaluate the pharyngeal phase of swallowing, such as repetitive saliva swallowing test and modified water swallowing test, are moreuseful than tongue pressure measurement.
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Gawryszuk A, Bijl HP, van der Schaaf A, Perdok N, Wedman J, Verdonck-de Leeuw IM, Rinkel RN, Steenbakkers RJHM, van den Hoek JGM, van der Laan HP, Langendijk JA. Relationship between videofluoroscopic and subjective (physician- and patient- rated) assessment of late swallowing dysfunction after (chemo) radiation: Results of a prospective observational study. Radiother Oncol 2021; 164:253-260. [PMID: 34592362 DOI: 10.1016/j.radonc.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Primary (chemo)radiation (CHRT) for HNC may lead to late dysphagia. The purpose of this study was to assess the pattern of swallowing disorders based on prospectively collected objective videofluoroscopic (VF) assessment and to assess the correlations between VF findings and subjective (physician- and patient-rated) swallowing measures. MATERIAL AND METHODS 189 consecutive HNC patients receiving (CH)RT were included. Swallowing evaluation at baseline and 6 months after treatment (T6) encompassed: CTCAE v.4.0 scores (aspiration/dysphagia), PROMs: SWAL QOL/ EORTC QLQ-H&N35 (swallowing domain) questionnaires and VF evaluation: Penetration Aspiration Scale, semi-quantitative swallowing pathophysiology evaluation, temporal measures and oral/pharyngeal residue quantification. Aspiration specific PROMs (aPROMs) were selected. Correlations between late penetration/aspiration (PA_T6) and: clinical factors, CTCAE and aPROMs were assessed using uni- and multivariable analysis. RESULTS Prevalence of PA increased from 20% at baseline to 43% after treatment (p < 0.001). The most relevant baseline predictors for PA_T6 were: PA_T0, age, disease stage III-IV, bilateral RT and baseline aPROM 'Choking when drinking' (AUC: 0.84). In general aPROMs correlated better with VF-based PA than CTCAE scores. The most of physiological swallowing components significantly correlated and predictive for PA (i.e. Laryngeal Vestibular Closure, Laryngeal Elevation and Pharyngeal Contraction) were prone to radiation damage. CONCLUSION The risk of RT-induced PA is substantial. Presented prediction models for late penetration/aspiration may support patient selection for baseline and follow-up VF examination. Furthermore, all aspiration related OARs involved in aforementioned swallowing components should be addressed in swallowing sparing strategies. The dose to these structures as well as baseline PROMs should be included in future NTCP models for aspiration.
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Affiliation(s)
- Agata Gawryszuk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Nathalie Perdok
- Department of Otolaryngology, Speech Language Pathology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan Wedman
- Department of Otolaryngology, Speech Language Pathology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology - Head & Neck Surgery, Amsterdam University Medical Centers, The Netherlands
| | - Rico N Rinkel
- Department of Otolaryngology - Head & Neck Surgery, Amsterdam University Medical Centers, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johanna G M van den Hoek
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Hans Paul van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
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Pillay T, Pillay M. Contextualising clinical reasoning within the clinical swallow evaluation: A scoping review and expert consultation. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2021; 68:e1-e12. [PMID: 34342487 PMCID: PMC8335787 DOI: 10.4102/sajcd.v68i1.832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/08/2022] Open
Abstract
Background This study explored the available literature on the phenomenon of clinical reasoning and described its influence on the clinical swallow evaluation. By exploring the relationship between clinical reasoning and the clinical swallow evaluation, it is possible to modernise the approach to dysphagia assessment. Objectives This study aimed to contextualise the available literature on clinical reasoning and the CSE to low-middle income contexts through the use of a scoping review and expert consultation. Method A scoping review was performed based on the PRISMA-ScR framework. The data was analysed using thematic analysis. Articles were considered if they discussed the clinical swallow evaluation and clinical reasoning, and were published in the last 49 years. Results Through rigorous electronic and manual searching, 12 articles were identified. This review made an argument for the value of clinical reasoning within the clinical swallow evaluation. The results of the study revealed three core themes related to the acquisition, variability and positive impact of clinical reasoning in the clinical swallow evaluation. Conclusion The results of this review showed that the clinical swallow evaluation is a complex process with significant levels of variability usually linked to the impact of context. This demonstrates that in order to deliver effective and relevant services, despite challenging conditions, healthcare practitioners must depend on clinical reasoning to make appropriate modifications to the assessment process that considers these salient factors.
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Affiliation(s)
- Thiani Pillay
- Discipline of Speech-Language Pathology, School of Health Sciences, University of KwaZulu-Natal, Durban.
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Pekacka-Egli AM, Kazmierski R, Lutz D, Kulnik ST, Pekacka-Falkowska K, Maszczyk A, Windisch W, Boeselt T, Spielmanns M. Predictive Value of Cough Frequency in Addition to Aspiration Risk for Increased Risk of Pneumonia in Dysphagic Stroke Survivors: A Clinical Pilot Study. Brain Sci 2021; 11:brainsci11070847. [PMID: 34202226 PMCID: PMC8301865 DOI: 10.3390/brainsci11070847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Post-stroke dysphagia leads to increased risk of aspiration and subsequent higher risk of pneumonia. It is important to not only diagnose post-stroke dysphagia early but also to evaluate the protective mechanism that counteracts aspiration, i.e., primarily cough. The aim of this study was to investigate the predictive value of cough frequency in addition to aspiration risk for pneumonia outcome. METHODS This was a single-center prospective observational study. Patients with first-ever strokes underwent clinical swallowing evaluation, fibreoptic endoscopic evaluation of swallowing (FEES), and overnight cough recording using LEOSound® (Löwenstein Medical GmbH & Co. KG, Bad Ems, Germany ). Penetration-Aspiration Scale (PAS) ratings and cough frequency measurements were correlated with incidence of pneumonia at discharge. RESULTS 11 women (37%) and 19 men (63%), mean age 70.3 years (SD ± 10.6), with ischemic stroke and dysphagia were enrolled. Correlation analysis showed statistically significant relationships between pneumonia and PAS (r = 0.521; p < 0.05), hourly cough frequency (r = 0,441; p < 0.05), and categories of cough severity (r = 0.428 p < 0.05), respectively. Logistic regression showed significant predictive effects of PAS (b = 0.687; p = 0.014) and cough frequency (b = 0.239; p = 0.041) for pneumonia outcome. CONCLUSION Cough frequency in addition to aspiration risk was an independent predictor of pneumonia in dysphagic stroke survivors.
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Affiliation(s)
- Anna Maria Pekacka-Egli
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland;
- Correspondence: (A.M.P.-E.); (M.S.); Tel.: +41-(55)-2566970 (A.M.P.-E.)
| | - Radoslaw Kazmierski
- Department for Neurology and Cerebrovascular Disorders, Poznan University of Medical Sciences, 61701 Poznan, Poland;
- Department of Neurology, University of Zielona Gora, 65046 Zielona Gora, Poland
| | - Dietmar Lutz
- Department for Neurology and Neurorehabilitation, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland;
| | - Stefan Tino Kulnik
- Faculty of Health, Social Care and Education, Kingston University and St George’s University of London, London SW17 0RE, UK;
| | - Katarzyna Pekacka-Falkowska
- Department for History and Philosophy of Medicine, Poznan University of Medical Sciences, 61701 Poznan, Poland;
| | - Adam Maszczyk
- Department for Methodology, Statistics, and Informatics Systems, Institute of Sport Science, Academy of Physical Education in Katowice, 40065 Katowice, Poland;
| | - Wolfram Windisch
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
- Department of Pneumology, Cologne Merheim Hospital Kliniken der Stadt Koeln GmbH, 51109 Koeln, Germany
| | - Tobias Boeselt
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Phillips University Marburg, 35037 Marburg, Germany;
| | - Marc Spielmanns
- Department for Pulmonary Medicine and Sleep Medicine, Zürcher RehaZentren, Klinik Wald, 8636 Wald, Switzerland
- Department for Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, 58455 Witten, Germany;
- Correspondence: (A.M.P.-E.); (M.S.); Tel.: +41-(55)-2566970 (A.M.P.-E.)
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Natta L, Guido F, Algieri L, Mastronardi VM, Rizzi F, Scarpa E, Qualtieri A, Todaro MT, Sallustio V, De Vittorio M. Conformable AlN Piezoelectric Sensors as a Non-invasive Approach for Swallowing Disorder Assessment. ACS Sens 2021; 6:1761-1769. [PMID: 34010558 PMCID: PMC8294609 DOI: 10.1021/acssensors.0c02339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Deglutition disorders (dysphagia) are common symptoms of a large number of diseases and can lead to severe deterioration of the patient's quality of life. The clinical evaluation of this problem involves an invasive screening, whose results are subjective and do not provide a precise and quantitative assessment. To overcome these issues, alternative possibilities based on wearable technologies have been proposed. We explore the use of ultrathin, compliant, and flexible piezoelectric patches that are able to convert the laryngeal movement into a well-defined electrical signal, with extremely low anatomical obstruction and high strain resolution. The sensor is based on an aluminum nitride thin film, grown on a soft Kapton substrate, integrated with an electrical charge amplifier and low-power, wireless connection to a smartphone. An ad-hoc designed laryngeal motion simulator (LMS), which is able to mimic the motions of the laryngeal prominence, was used to evaluate its performances. The physiological deglutition waveforms were then extrapolated on a healthy volunteer and compared with the sEMG (surface electromyography) of the submental muscles. Finally, different tests were conducted to assess the ability of the sensor to provide clinically relevant information. The reliability of these features permits an unbiased evaluation of the swallowing ability, paving the way to the creation of a system that is able to provide a point-of-care automatic, unobtrusive, and real-time extrapolation of the patient's swallowing quality even during normal behavior.
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Affiliation(s)
- Lara Natta
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Francesco Guido
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
- Piezoskin S.r.l., Lecce 73100, Italy
| | - Luciana Algieri
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
- Piezoskin S.r.l., Lecce 73100, Italy
| | - Vincenzo M. Mastronardi
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Francesco Rizzi
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Elisa Scarpa
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Antonio Qualtieri
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
| | - Maria T. Todaro
- Consiglio Nazionale delle Ricerche, c/o Campus Ecotekne, Istituto di Nanotecnologia Via Monteroni, Lecce 73100, Italy
| | - Vincenzo Sallustio
- Hospital Unit Phoniatrics and Communication Disorders, Rehabilitation Department, ASL Lecce, Lecce 73100, Italy
| | - Massimo De Vittorio
- Istituto Italiano di Tecnologia, Center for Biomolecular Nanotechnologies, Arnesano 73010, Italy
- Università del Salento, Lecce 73100, Italy
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Reassessment of Poststroke Dysphagia in Rehabilitation Facility Results in Reduction in Diet Restrictions. J Clin Med 2021; 10:jcm10081714. [PMID: 33921185 PMCID: PMC8071486 DOI: 10.3390/jcm10081714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/28/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings. Methods: This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018–2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES. Results: 19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA revealed significant differences (p < 0.001) between dietary prescriptions in an acute care setting and following clinical and endoscopic reassessment in the rehabilitation center. Diet recommendations changed in 41 of 63 (65%) enrolled patients (p < 0.001). Conclusion: Instrumental diagnostic by FEES during the early convalescence period of stroke patients leads to clinically relevant changes to diet restrictions and lower rates of pneumonia. Our findings underline the need for regular and qualitative dysphagia diagnostics in stroke patients participating in neurological rehabilitation.
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Lo Buono V, Palmeri R, De Salvo S, Berenati M, Greco A, Ciurleo R, Sorbera C, Cimino V, Corallo F, Bramanti P, Marino S, Di Lorenzo G, Bonanno L. Anxiety, depression, and quality of life in Parkinson's disease: the implications of multidisciplinary treatment. Neural Regen Res 2021; 16:587-590. [PMID: 32985492 PMCID: PMC7996016 DOI: 10.4103/1673-5374.293151] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Anxiety and depression in Parkinson’s disease (PD) reduce well-being of the patients. Emotional alterations influence motor skills and cognitive performance; moreover, they contribute significantly and independently to worsen rehabilitative treatment response. We investigated anxiety, depression, and quality of life in PD patients subjected to multidisciplinary rehabilitative training. The self-controlled study included 100 PD patients (49 males and 51 females with the mean age of 64.66 years) admitted to 60 days hospitalization rehabilitative program, between January 2017 and December 2018. Motor, cognitive, linguistic abilities, and functional independence were evaluated at admission (T0 baseline visit) and 60 days after (T1) the multidisciplinary rehabilitation including motor exercises, speech therapies, and cognitive intervention. The multidisciplinary rehabilitation improved functional status in PD patients and exerted its positive effects on mood, motor abilities, autonomy in the activities of daily life, perception of quality of life, cognitive performance and speech skills. Non-motor symptoms may worsen severe disability and reduce quality of life. They are often poorly recognized and inadequately treated. Nonetheless, multidisciplinary rehabilitative training represents an optimal strategy to improve disease management. The study was approved by Istituito di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi “Bonino-Pulejo” Ethical Committee (approval No. 6/2016) in June 2016.
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Affiliation(s)
- Viviana Lo Buono
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Rosanna Palmeri
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Simona De Salvo
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Matteo Berenati
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Agata Greco
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Rosella Ciurleo
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Chiara Sorbera
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Vincenzo Cimino
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Francesco Corallo
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Placido Bramanti
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Silvia Marino
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Giuseppe Di Lorenzo
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
| | - Lilla Bonanno
- Department of Neurobioimaging, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-Pulejo, Messina, Italy
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De Stefano A, Dispenza F, Kulamarva G, Lamarca G, Faita A, Merico A, Sardanelli G, Gabellone S, Antonaci A. Predictive factors of severity and persistence of oropharyngeal dysphagia in sub-acute stroke. Eur Arch Otorhinolaryngol 2020; 278:741-748. [DOI: 10.1007/s00405-020-06429-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/07/2020] [Indexed: 12/28/2022]
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20
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Velasco LC, Imamura R, Rêgo APV, Alves PR, da Silva Peixoto LP, de Oliveira Siqueira J. Sensitivity and Specificity of Bedside Screening Tests for Detection of Aspiration in Patients Admitted to a Public Rehabilitation Hospital. Dysphagia 2020; 36:821-830. [PMID: 33052481 DOI: 10.1007/s00455-020-10198-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
Early detection of dysphagia and specifically aspiration is essential to prevent and reduce complications of hospitalized patients in rehabilitation centers. Bedside screening test are often used to evaluate swallowing disorders, but their results may be questionable due to insufficient and inconsistent sensitivity and specificity. To compare the sensitivity and specificity of various bedside screening tests for detecting aspiration in hospitalized rehabilitation patients. A prospective observational study was performed in 150 consecutive patients of a tertiary rehabilitation hospital. Patients were evaluated regarding clinical predictors for aspiration, maximum phonation time (MPT), Eating Assessment Tool 10 (EAT-10) questionnaire, tongue strength and endurance (Iowa Oral Performance Instrument [IOPI]) and a swallowing test (Volume-Viscosity Swallow Test [V-VST]). Flexible Endoscopic Evaluation of Swallowing (FEES) was the reference test. Of the 144 patients included, 22% aspirated on FEES. Previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex were significantly associated with aspiration. The sensitivity, specificity and accuracy for V-VST (83.3%, 72.6%, 74.8%, respectively) and EAT-10 (82.8%, 57.7%, 62.8%, respectively) to detect aspiration were superior than those of other methods. Maximum tongue strength on IOPI and MPT presented high sensitivity but low specificity to detect aspiration. Clinical predictors of aspiration (previous history of pneumonia, dysarthria, wet voice, and abnormal cough reflex) associated with either V-VST or EAT-10 may be good screening methods to detect aspiration in patients hospitalized in a rehabilitation center.
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Affiliation(s)
- Leandro Castro Velasco
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua T-14, número 1529, apartamento 2301, bloco Monet, Goiânia, GO, CEP 74230-130, Brasil.
| | - Rui Imamura
- Department of Otorhinolaryngology, School of Medicine, University of São Paulo, Avenida Padre Pereira de Andrade, 545, apto 153-F, Boacava, São Paulo, 05469-000, Brazil
| | - Ana Paula Valeriano Rêgo
- Department of Otorhinolaryngology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Avenida T-4, número 550, Condomínio Ilhas Do Caribe, apartamento 1303, Bloco A, Setor Bueno, Goiânia, Goiás, 74230030, Brazil
| | - Priscilla Rabelo Alves
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua 230, número 978, Condomínio Quinta Vila Boa, apartamento 303, Bloco C, Setor Vila Jaraguá, Goiânia, Goiás, 74655130, Brazil
| | - Lorena Pacheco da Silva Peixoto
- Department of Speech-Language Pathology and Audiology, Rehabilitation and Readaptation Center Dr. Henrique Santillo (CRER), Rua Vitória, número 265, Residencial Veneza, apartamento 601, Setor Alto da Glória, Goiânia, Goiás, 74815745, Brazil
| | - José de Oliveira Siqueira
- Department of Pathology, School of Medicine, University of São Paulo, Rua Catuaba, número 595, Vila Alpina, São Paulo, 03208000, Brazil
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Mortensen J, Pedersen AR, Nielsen JF, Kothari M. Construct and content validity of the Functional Oral Intake Scale; Analyses from a cohort of patients with acquired brain injury. Brain Inj 2020; 34:1257-1263. [DOI: 10.1080/02699052.2020.1800094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Jesper Mortensen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Asger Roer Pedersen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Mohit Kothari
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
- JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Frajkova Z, Tedla M, Tedlova E, Suchankova M, Geneid A. Postintubation Dysphagia During COVID-19 Outbreak-Contemporary Review. Dysphagia 2020; 35:549-557. [PMID: 32468193 PMCID: PMC7255443 DOI: 10.1007/s00455-020-10139-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 is a global pandemic. Its rapid dissemination and serious course require a novel approach to healthcare practices. Severe disease progression is often associated with the development of the Acute Respiratory Distress Syndrome and may require some form of respiratory support, including endotracheal intubation, mechanical ventilation, and enteral nutrition through a nasogastric tube. These conditions increase the risk of dysphagia, aspiration, and aspiration pneumonia. The data on the incidence and risks of dysphagia associated with COVID-19 are not yet available. However, it is assumed that these patients are at high risk, because of respiratory symptoms and reduced lung function. These findings may exacerbate swallowing deficits. The aim of this review is to summarize available information on possible mechanisms of postintubation dysphagia in COVID-19 patients. Recommendations regarding the diagnosis and management of postintubation dysphagia in COVID-19 patients are described in this contemporary review.
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Affiliation(s)
- Zofia Frajkova
- Department of ENT and HNS, Faculty of Medicine, University Hospital Bratislava, Comenius University, Antolska 11, 811 07, Bratislava, Slovakia
- Department of Communication Disorders, Faculty of Education, Comenius University, Bratislava, Slovakia
| | - Miroslav Tedla
- Department of ENT and HNS, Faculty of Medicine, University Hospital Bratislava, Comenius University, Antolska 11, 811 07, Bratislava, Slovakia.
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Eva Tedlova
- Department of Pneumology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Magda Suchankova
- Institute of Immunology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Ahmed Geneid
- Department of Otorhinolaryngology and Phoniatrics-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ansari NN, Tarameshlu M, Ghelichi L. Dysphagia In Multiple Sclerosis Patients: Diagnostic And Evaluation Strategies. Degener Neurol Neuromuscul Dis 2020; 10:15-28. [PMID: 32273788 PMCID: PMC7114936 DOI: 10.2147/dnnd.s198659] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/18/2019] [Indexed: 12/18/2022] Open
Abstract
Dysphagia after multiple sclerosis (MS) is a common disabling symptom which can lead to serious complications. Regular screening and assessment of dysphagia in patients with MS are important. Using valid and reliable instruments to measure dysphagia in MS patients is a crucial component in clinical practice and of research quality. There are various strategies to diagnose and assess the dysphagia in patients with MS. Screening strategies are for early diagnosis of the dysphagia. Clinical, non-instrumental strategies are used to verify the presence and to determine the severity and cause of dysphagia. Instrumental strategies are complementary to clinical examination to provide objective data on the various aspects of swallowing dysfunctions. This review revealed a few validated tools for dysphagia assessment in MS. The Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) and the Mann Assessment of Swallowing Ability (MASA) are the only validated MS-specific dysphagia tools. Further development of valid and reliable MS-specific screening and assessment tools that can be administered rapidly and scored easily to detect dysphagia and evaluate clinical outcomes in adults with MS is imperative. Until then, validation and metric evaluation of the screening and assessment tools currently available are required.
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Affiliation(s)
- Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Tarameshlu
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Ghelichi
- Department of Speech and Language Pathology, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Kwon S, Sim J, Park J, Jung Y, Cho KH, Min K, Kim M, Kim JM, Im SH. Assessment of Aspiration Risk Using the Mann Assessment of Swallowing Ability in Brain-Injured Patients With Cognitive Impairment. Front Neurol 2019; 10:1264. [PMID: 31866926 PMCID: PMC6906202 DOI: 10.3389/fneur.2019.01264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/14/2019] [Indexed: 11/27/2022] Open
Abstract
Objectives: The purposes of this study are to determine whether there is a correlation between the Mann Assessment of Swallowing Ability (MASA) and modified MASA (mMASA) according to various cognitive status and to investigate whether the cognitive status of patients with brain damage affects the prediction of aspiration using the MASA. Methods: We retrospectively assessed 146 dysphagic patients with brain lesion due to various causes. Dysphagia was assessed using the MASA and mMASA. According to the videofluoroscopic swallowing study results, patients were divided into two groups: aspirators and non-aspirators. Patients were classified into four groups according to cognitive function according to the Korean version of Mini-mental State Examination scores: normal (>24), mild (21–24), moderate (10–20), and severe (<10) cognitive impairment. The correlation between the MASA and mMASA scores according to cognitive function were analyzed. The sensitivity, specificity, and positive and negative predictive values of the MASA scores for predicting aspiration were assessed. Results: The MASA and mMASA scores showed a significant positive correlation in all cognition groups. In patients with more severe cognitive impairment MASA scores had high sensitivity and low specificity for prediction of aspiration. On the other hand, the MASA scores had low sensitivity and high specificity for prediction of aspiration in the normal and mild cognitive impairment groups. Conclusions: The MASA and mMASA scores correlated with each other in patients with various levels of cognitive function. Interestingly, this study results demonstrated that patients with good cognitive function may have false negative results of MASA screening due to low sensitivity. Thus, when interpreting the MASA results, the impact of cognitive status should be taken into consideration.
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Affiliation(s)
- Shinyoung Kwon
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Jaehoon Sim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Joonhyun Park
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Youngsoo Jung
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Kye Hee Cho
- Department of Rehabilitation Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Jong Moon Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.,Rehabilitation and Regeneration Research Center, CHA University, Seongnam, South Korea
| | - Sang Hee Im
- Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Cimoli M, Oates J, McLaughlin E, Langmore SE. Exploring Consistency and Variation in Fibreoptic Endoscopic Evaluation of Swallowing Practice in Australia. Folia Phoniatr Logop 2019; 72:429-441. [PMID: 31639815 DOI: 10.1159/000503132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fibreoptic endoscopic evaluation of swallowing (FEES) is an imaging technique used by speech-language pathologists (SLPs) and some other health professionals to assess swallowing. OBJECTIVES The primary aim was to gain an insight into FEES practices in Australia by characterising SLPs who use FEES and identifying areas of consistency and variation in practice. The secondary aim was to explore factors associated with variation in practice. METHOD Cross-sectional survey methodology was used. The link to a web-based survey was e-mailed to 351 SLPs who practised in adult dysphagia. RESULTS The participation rate for the study was 18.8% (n = 66). Twenty-two SLPs (38.6%) used FEES. These SLPs represented a cross-section of workplace settings, caseloads, clinical and training experiences. Consistency and variation in FEES procedural and assessment practices were identified. Some procedural aspects of FEES varied according to whether a medical practitioner was present, type of FEES training, and number of FEES conducted per month. CONCLUSION This research represents a benchmark in the knowledge of how FEES is used in Australia. Despite the small number of participants, the findings provide a foundation from which future research questions can be generated. More extensive examination of the use of FEES by SLPs is warranted. Further research is also required to establish methods for attaining and maintaining competency and to achieve consensus on which aspects of swallowing are assessed when using FEES and how the examination should be conducted.
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Affiliation(s)
- Michelle Cimoli
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia, .,Speech Pathology Department, Austin Health, Heidelberg, Victoria, Australia,
| | - Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Emma McLaughlin
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Speech Pathology Department, Castlemaine Health, Castlemaine, Victoria, Australia
| | - Susan E Langmore
- Department of Otolaryngology, School of Medicine, Boston University, Boston, Massachusetts, USA
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Oliveira ACMD, Friche AADL, Salomão MS, Bougo GC, Vicente LCC. Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation. Braz J Otorhinolaryngol 2018; 84:722-728. [PMID: 28951127 PMCID: PMC9442818 DOI: 10.1016/j.bjorl.2017.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/11/2017] [Accepted: 08/20/2017] [Indexed: 10/25/2022] Open
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Psychometric Properties of Visuoperceptual Measures of Videofluoroscopic and Fibre-Endoscopic Evaluations of Swallowing: A Systematic Review. Dysphagia 2018; 34:2-33. [DOI: 10.1007/s00455-018-9918-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/04/2018] [Indexed: 01/29/2023]
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Field M, Wenke R, Sabet A, Lawrie M, Cardell E. Implementing Cough Reflex Testing in a Clinical Pathway for Acute Stroke: A Pragmatic Randomised Controlled Trial. Dysphagia 2018; 33:827-839. [PMID: 29766275 DOI: 10.1007/s00455-018-9908-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/05/2018] [Indexed: 11/30/2022]
Abstract
Silent aspiration is common after stroke and can lead to subsequent pneumonia. While standard bedside dysphagia assessments are ineffective at predicting silent aspiration, cough reflex testing (CRT) has shown promise for identifying patients at risk of silent aspiration. We investigated the impact of CRT on patient and service outcomes when embedded into a clinical pathway. 488 acute stoke patients were randomly allocated to receive either CRT or standard care (i.e. bedside assessment). Primary outcomes included confirmed pneumonia within 3 months post stroke and length of acute inpatient stay. Secondary outcomes related to the feasibility of implementing a CRT pathway and clinician and patient satisfaction. There was a non-significant reduction in pneumonia rates by 2.2% points in the CRT group (OR 0.32, 95% CI 0.06-1.62). There was a non-significant difference of 0.7 days (95% CI - 0.29 to 1.71 days) in length of stay between the standard care group and the CRT group. The CRT took on average 3 min longer to complete (p < 0.01) and resulted in a significant 6.7% increase in videofluoroscopic referrals (p = 0.02); however, these results are clinically insignificant. High patient and clinician satisfaction with CRT was found, with clinicians reporting additional knowledge and confidence in decision making for dysphagia management. Post hoc subgroup analyses according to stroke types were conducted and revealed no significant differences in pneumonia rates after adjustment for multiple comparisons. In conclusion, it was possible to implement a CRT pathway with minimal increases in clinician resources. While clinicians perceived CRT as beneficial in clinical decision making, the efficacy of CRT for reducing pneumonia rates in acute stroke remains to be established.Clinical Trial Registration-URL: http://www.anzctr.org.au . Unique identifier: ACTRN12616000724471.
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Affiliation(s)
- Makaela Field
- Gold Coast University Hospital, 1 Hospital Blvd., Southport, QLD, 4215, Australia.
| | - Rachel Wenke
- Gold Coast University Hospital, 1 Hospital Blvd., Southport, QLD, 4215, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Arman Sabet
- Gold Coast University Hospital, 1 Hospital Blvd., Southport, QLD, 4215, Australia
| | - Melissa Lawrie
- Gold Coast University Hospital, 1 Hospital Blvd., Southport, QLD, 4215, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Elizabeth Cardell
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
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Checklin M, Pizzari T. Impaired Tongue Function as an Indicator of Laryngeal Aspiration in Adults with Acquired Oropharyngeal Dysphagia: A Systematic Review. Dysphagia 2018; 33:778-788. [DOI: 10.1007/s00455-018-9902-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/19/2018] [Indexed: 01/03/2023]
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30
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ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37:354-396. [DOI: 10.1016/j.clnu.2017.09.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
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31
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Gilmore-Bykovskyi AL, Rogus-Pulia N. Temporal Associations between Caregiving Approach, Behavioral Symptoms and Observable Indicators of Aspiration in Nursing Home Residents with Dementia. J Nutr Health Aging 2018; 22:400-406. [PMID: 29484354 PMCID: PMC5830143 DOI: 10.1007/s12603-017-0943-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Dysphagia, or impaired swallowing, is common in nursing home (NH) residents with dementia and contributes to malnutrition and diminished quality of life. Dysphagia also commonly leads to aspiration or passage of food or fluids into the airway, which can result in aspiration pneumonia-a leading cause of death for people with dementia. Currently available interventions for dysphagia aim to modify the risk of aspiration events primarily by modifying diet and positioning to improve the safety of an individual's swallow. However other potentially modifiable contextual factors relevant to mealtime care within NH settings that may influence the occurrence of aspiration events, such as the nature of caregiving interactions or occurrence of dementia-related behavioral symptoms, have not been examined. To address this gap, we examined the temporal associations between caregiving approach and behavioral symptoms as antecedents to observable indicators of aspiration among nursing home (NH) residents with dementia. DESIGN Secondary analysis of coded, timed-event behavioral data from 33 video-recorded observations of mealtime interactions between NH residents with dementia and caregivers. SETTING/PARTICIPANTS Residents with dementia who required assistance with mealtime care (n=12) and nursing assistants (n=8) from Memory Care Units (MCU) in 2 Midwestern NHs. RESULTS Observable indicators of aspiration were significantly more likely to occur during or following task-centered caregiver actions than person-centered actions (12% likelihood; Yule's Q 0.89; OR 95% CI 12.70-23.75) and 15-30 seconds after a behavioral symptom (5% likelihood; Yule's Q 0.65; OR 95% CI 4.18-8.57). CONCLUSIONS These findings provide compelling preliminary evidence that caregiver approach may influence the occurrence of aspiration. Provided the urgent need for more approaches to mitigate the complications associated with dysphagia in people with dementia, even a moderate reduction in aspiration events may be clinically meaningful. Further, well-designed observational studies with individuals with well-characterized dysphagia are needed to better understand and characterize these relationships, their temporal structures and their impacts on other relevant outcomes such as eating performance and malnutrition.
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Affiliation(s)
- A L Gilmore-Bykovskyi
- Andrea Gilmore-Bykovskyi, PhD, RN, UW-Madison School of Nursing, 3173 Cooper Hall, 701 Highland Avenue, Madison, WI 53705, Phone: (608) - 262-3057, E-mail:
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32
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Rajappa AT, Soriano KR, Ziemer C, Troche MS, Malandraki JB, Malandraki GA. Reduced Maximum Pitch Elevation Predicts Silent Aspiration of Small Liquid Volumes in Stroke Patients. Front Neurol 2017; 8:436. [PMID: 28890708 PMCID: PMC5574871 DOI: 10.3389/fneur.2017.00436] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/09/2017] [Indexed: 01/09/2023] Open
Abstract
Background and purpose Preliminary evidence has shown that reduced ability to maximally raise vocal pitch correlates with the occurrence of aspiration (i.e., airway invasion by food or liquid). However, it is unclear if this simple task can be used as a reliable predictor of aspiration in stroke patients. Our aim was to examine whether maximum vocal pitch elevation predicted airway invasion and dysphagia in stroke. Methods Forty-five consecutive stroke patients (<1 month poststroke) at a rehabilitation setting participated in a videofluoroscopic swallow study and two maximum vocal pitch elevation tasks. Maximum pitch was evaluated acoustically [maximum fundamental frequency (max F0)] and perceptually. Swallowing safety was rated using the Penetration/Aspiration Scale and swallowing performance was assessed using components of the Modified Barium Swallow Impairment Profile (MBSImPTM©). Data were analyzed using simple regression and receiver operating characteristics curves to test the sensitivity and specificity of max F0 in predicting aspiration. Correlations between max F0 and MBSImP variables were also examined. Results Max F0 predicted silent aspiration of small liquid volumes with 80% sensitivity and 65% specificity (p = 0.023; area under the curve: 0.815; cutoff value of 359.03 Hz). Max F0 did not predict non-silent aspiration or penetration in this sample and did not significantly correlate with MBSImP variables. Furthermore, all participants who aspirated silently on small liquid volumes (11% of sample) had suffered cortical or subcortical lesions. Conclusion In stroke patients (<1 month poststroke), reduced maximum pitch elevation predicts silent aspiration of small liquid volumes with high sensitivity and moderate specificity. Future large-scale studies focusing on further validating this finding and exploring the value of this simple and non-invasive tool as part of a dysphagia screening are warranted.
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Affiliation(s)
- Akila Theyyar Rajappa
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Kristie R Soriano
- Department of Speech Pathology and Audiology, JFK Rehabilitation Institute, Edison, NJ, United States
| | - Courtney Ziemer
- Department of Speech Pathology and Audiology, JFK Rehabilitation Institute, Edison, NJ, United States
| | - Michelle S Troche
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Jaime Bauer Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
| | - Georgia A Malandraki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, IN, United States
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Zamora Mur A, Palacín Ariño C, Guardia Contreras AI, Zamora Catevilla A, Clemente Roldán E, Santaliestra Grau J. [Importance of the detection of dysphagia in geriatric patients]. Semergen 2017; 44:168-173. [PMID: 28457769 DOI: 10.1016/j.semerg.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/22/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. MATERIAL AND METHODS A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. RESULTS The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. CONCLUSIONS Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported.
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Affiliation(s)
- A Zamora Mur
- Unidad de Valoración Sociosanitaria (UVSS), Servicio de Geriatría, Hospital de Barbastro, Huesca, España.
| | | | | | | | - E Clemente Roldán
- Dirección de Atención Primaria, Hospital de Barbastro, Huesca, España
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Warnecke T, Im S, Kaiser C, Hamacher C, Oelenberg S, Dziewas R. Aspiration and dysphagia screening in acute stroke - the Gugging Swallowing Screen revisited. Eur J Neurol 2017; 24:594-601. [PMID: 28322006 DOI: 10.1111/ene.13251] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The Gugging Swallowing Screen (GUSS) is a tool to screen aspiration risk in acute stroke. We aimed to replicate its validity in a larger second cohort of patients with acute stroke, including the more severe with a National Institutes of Health Stroke Scale (NIHSS) ≥ 15. METHODS In a prospective, double-blind design, the GUSS was validated with the Fiberoptic Endoscopic Evaluation of Swallowing scale. Patients were categorized into different stroke severities as assessed by the NIHSS, and the diagnostic properties were calculated separately for each subgroup. RESULTS A total of 100 patients with acute stroke were evaluated consecutively at a mean 1.7 ± 2.2 days after stroke. With the GUSS cut-off value of 14 points, the GUSS screened aspiration risk with a 96.5% sensitivity and 55.8% specificity (area under the curve, 0.76; 95% CI, 0.67-0.84), which corresponded well with the original publication. In the NIHSS < 5 group, the sensitivity and specificity levels were 71.4% and 88.8%, respectively. In the NIHSS ≥ 15 group, these levels changed to 100% and 20%, respectively. The high failure rate in completing the first part of the GUSS in the latter group was related to the low specificity. Diet recommendations following the GUSS were more conservative than those after Fiberoptic Endoscopic Evaluation of Swallowing. In particular, the GUSS overestimated the need for nasogastric tube feeding. CONCLUSIONS This is the first time that a swallowing screening tool for patients with acute stroke has been revalidated in a larger population from another stroke center. The validity of a swallow screening test may vary according to different stroke severities.
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Affiliation(s)
- T Warnecke
- Department of Neurology, University Hospital of Münster, Münster, Germany
| | - S Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - C Kaiser
- Department of Neurology, University Hospital of Münster, Münster, Germany
| | - C Hamacher
- Department of Neurology, University Hospital of Münster, Münster, Germany
| | - S Oelenberg
- Department of Neurology, University Hospital of Münster, Münster, Germany
| | - R Dziewas
- Department of Neurology, University Hospital of Münster, Münster, Germany
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Blyth KM, McCabe P, Madill C, Ballard KJ. Ultrasound in dysphagia rehabilitation: a novel approach following partial glossectomy. Disabil Rehabil 2016; 39:2215-2227. [DOI: 10.1080/09638288.2016.1219400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katrina M. Blyth
- Speech Pathology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Patricia McCabe
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Catherine Madill
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Kirrie J. Ballard
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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36
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Characterization of Swallowing Sound: Preliminary Investigation of Normal Subjects. PLoS One 2016; 11:e0168187. [PMID: 27959902 PMCID: PMC5154546 DOI: 10.1371/journal.pone.0168187] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/29/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to characterize the swallowing sound and identify the process of sound generation during swallowing in young healthy adults. METHODS Thirty-three healthy volunteers were enrolled and allocated into three experimental groups. In experiment 1, a microphone was attached to one of eight cervical sites in 20 subjects, participants swallowed 5 ml water, and the sound waveform was recorded. In experiment 2, 10 subjects swallowed either 0, 5, 10, or 15 ml water during audio recording. In addition, participants consumed the 5 ml bolus in two different cervical postures. In experiment 3, the sound waveform and videofluoroscopy were simultaneously recorded while the three participants consumed 5 ml iopamidol solution. The duration and peak intensity ratio of the waveform were analyzed in all experimental groups. RESULTS The acoustic analysis of the waveforms and videofluoroscopy suggested that the swallowing sound could be divided into three periods, each associated with a stage of the swallowing movement: the oral phase comprising posterior tongue and hyoid bone movement; the pharyngeal phase comprising larynx movement, hyoid bone elevation, epiglottis closure, and passage of the bolus through the esophagus orifice; and the repositioning phase comprising the return of the hyoid bone and larynx to their resting positions, and reopening of the epiglottis. CONCLUSION Acoustic analysis of swallowing sounds and videofluoroscopy suggests that the swallowing sound could be divided into three periods associated with each process of the swallowing movement: the oral phase comprising the posterior movement of the tongue and hyoid bone; the pharyngeal phase comprising the laryngeal movement, hyoid bone elevation, epiglottis closure, and the bolus passage to the esophagus orifice; and the repositioning phase comprising the repositioning of the hyoid bone and larynx, and reopening of the epiglottis.
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Nakamori M, Hosomi N, Ishikawa K, Imamura E, Shishido T, Ohshita T, Yoshikawa M, Tsuga K, Wakabayashi S, Maruyama H, Matsumoto M. Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements. PLoS One 2016; 11:e0165837. [PMID: 27802333 PMCID: PMC5089549 DOI: 10.1371/journal.pone.0165837] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/18/2016] [Indexed: 01/12/2023] Open
Abstract
Swallowing dysfunction caused by stroke is a risk factor for aspiration pneumonia. Tongue pressure measurement is a simple and noninvasive method for evaluating swallowing dysfunction. We have hypothesized that low tongue pressure may be able to predict pneumonia occurrence in acute stroke patients. Tongue pressure was measured using balloon-type equipment in 220 acute stroke patients. The modified Mann Assessment of Swallowing Ability (MASA) score was evaluated independently on the same day. Tongue pressure was measured every week thereafter. An improvement in tongue pressure was observed within the first 2 weeks. Receiver operating curve analysis was performed to determine the ability of tongue pressure to predict modified MASA score <95, which suggests swallowing dysfunction. The optimal cutoff for tongue pressure was 21.6 kPa (χ2 = 45.82, p<0.001, sensitivity 95.9%, specificity 91.8%, area under the curve = 0.97). The tongue pressure was significantly lower in patients with pneumonia than in those without pneumonia. Using a Cox proportional hazard model for pneumonia onset with a cutoff tongue pressure value of 21.6 kPa and adjustment for age, sex, and National Institutes of Health Stroke Scale score at admission, the tongue pressure had additional predictive power for pneumonia onset (hazard ratio, 7.95; 95% confidence interval, 2.09 to 52.11; p = 0.0013). In the group with low tongue pressure, 27 of 95 patients showed improvement of tongue pressure within 2 weeks. Pneumonia occurred frequently in patients without improvement of tongue pressure, but not in patients with improvement (31/68 and 2/27, p<0.001). Tongue pressure is a sensitive indicator for predicting pneumonia occurrence in acute stroke patients.
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Affiliation(s)
- Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- * E-mail:
| | - Kenichi Ishikawa
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Takeo Shishido
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohiko Ohshita
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Masayasu Matsumoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Abstract
Oropharyngeal dysphagia is a frequent consequence of several medical aetiologies, and even considered part of the normal ageing process. Early and accurate identification provides the opportunity for early implementation of dysphagia treatments. This Review describes the current state of the evidence related to dysphagia therapies - focusing on treatments most clinically utilized and of current interest to researchers. Despite successes in select studies, the level of evidence to support the efficacy of these treatments remains limited. Heterogeneity exists across studies in both how interventions are administered and how their therapeutic value is assessed, thereby making it difficult to establish external validation. Future work needs to address these caveats. Also, to be most efficacious, dysphagia therapies need to account for influences from pre-morbid patient characteristics as these factors have potential to increase the risk of dysphagia and the resulting complications of aspiration, malnutrition and psychological burden. Dysphagia therapies therefore need to incorporate the medical aetiology that is at its root, the resulting swallow physiology captured from comprehensive clinical and/or instrumental assessments, and the existing needs and supports of patients.
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Affiliation(s)
- Rosemary Martino
- Departments of Speech Language Pathology, Rehabilitation Sciences Institute, and Otolaryngology-Head and Neck Surgery, University of Toronto, 160-500 University Avenue, Ontario M5G 1V7, Canada.,Krembil Research Institute, University Health Network, 399 Bathurst Street (MP 11-331), Toronto, Ontario M5T 2S8, Canada
| | - Timothy McCulloch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, Wisconsin 53792, USA
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Implications of Variability in Clinical Bedside Swallowing Assessment Practices by Speech Language Pathologists. Dysphagia 2016; 31:650-62. [PMID: 27405423 DOI: 10.1007/s00455-016-9724-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
Speech language pathology (SLP) clinical bedside swallowing assessments (CBSA) are a cornerstone of quality care for patients in acute hospitals who have dysphagia. The CBSA informs clinical diagnosis and decisions regarding further instrumental assessment, and is used to develop a management plan and monitor progress. However, self-report and retrospective research shows that SLPs are highly variable in their use of assessment components considered by experts to be important for quality CBSA, casting doubt on the validity and reliability of CBSA. This prospective study describes the components included by SLPs when designing a standardised evidence based dysphagia assessment protocol for acute care patients and observed patterns of component use. The findings confirm that SLPs use the CBSA for multiple purposes beyond diagnosis of aspiration risk and dysphagia presence/severity. They are highly variable in their use of certain components, but also demonstrate consistent use of a core set. It is apparent that SLPs prioritise the application of clinical reasoning to tailor their CBSA to the patient over following a highly structured item-based protocol. The variability in component use likely reflects a complex clinical reasoning process that draws on a wide variety of information combined with expert knowledge as is also observed in many other medical specialties. Rather than promoting the standardisation of CBSA protocols that constrain SLP practice to strict item-based assessment protocols, consideration should be given to promoting the value and facilitating the clinical reasoning process that supports the utility of the CBSA for diagnosis, patient centred management and treatment planning.
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40
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Jiang JL, Fu SY, Wang WH, Ma YC. Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review. Tzu Chi Med J 2016; 28:41-48. [PMID: 28757720 PMCID: PMC5442897 DOI: 10.1016/j.tcmj.2016.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/22/2016] [Accepted: 04/29/2016] [Indexed: 12/13/2022] Open
Abstract
Dysphagia following neurological impairment increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death. Screening for dysphagia has been reported to change negative outcomes. This review evaluated the validity and reliability of measurement tools for screening dysphagia in patients with neurological disorders to identify a feasible tool that can be used by nurses. Electronic databases were searched for studies from 1992 to 2015 related to dysphagia screening measurements. The search was applied to the Pubmed, CINAHL, Cochrane, Medline, EBSCO host, and CEPS + CETD databases. A checklist was used to evaluate the psychometric quality. The tools were evaluated for their feasibility for incorporation into routine care by nurses in hospitals. A total of 104 papers were retrieved, and eight articles finally met the inclusion criteria. The sensitivity and specificity of the screening tools ranged from 29% to 100% and from 65% to 100%, respectively. The interrater reliability ranged from good to excellent agreement. On the basis of quality evaluations, all the included studies had a risk of bias because of inadequate methodological characteristics. The Standardized Swallowing Assessment is the most suitable tool for detecting dysphagia because its psychometric properties and feasibility are higher than those of other screening tools that can be administered by nurses.
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Affiliation(s)
- Jiin-Ling Jiang
- Department of Nursing, Tzu Chi University, Hualien, Taiwan.,Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Shu-Ying Fu
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Wan-Hsiang Wang
- Department of Nursing, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Taiwanese Centre for Evidence-based Health Care, Hualien, Taiwan
| | - Yu-Chin Ma
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
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Ohira M, Ishida R, Maki Y, Ohkubo M, Sugiyama T, Sakayori T, Sato T. Evaluation of a dysphagia screening system based on the Mann Assessment of Swallowing Ability for use in dependent older adults. Geriatr Gerontol Int 2016; 17:561-567. [PMID: 27195778 DOI: 10.1111/ggi.12755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/23/2015] [Accepted: 01/04/2016] [Indexed: 11/28/2022]
Abstract
AIM Dysphagia is common in dependent older adults. Thus, a method of evaluating eating and swallowing functions that can be used to diagnose and manage dysphagia in a simple and robust manner is required. In 2002, the Mann Assessment of Swallowing Ability (MASA) was introduced to identify dysphagia in acute-stage stroke patients. As the MASA enables easy screening, it might also be applicable to dependent older adults if appropriate MASA cut-off values and the most useful assessment items could be determined. In the present study, we attempted to determine suitable MASA cut-off values, and the most useful assessment items for predicting aspiration and pharyngeal retention in dependent older adults. METHODS Using the MASA, we evaluated the eating and swallowing functions of 50 dependent older adults with dysphagia. All of the patients also underwent videoendoscopic-based swallowing evaluations to detect aspiration and pharyngeal retention. The participants' characteristics and the utility of each assessment item were compared between various groups. Using the patients' videoendoscopic findings as a reference, receiver operating characteristic curve analysis was carried out to determine appropriate cut-off values for predicting aspiration and pharyngeal retention in dependent older adults. RESULTS The optimal MASA cut-off values for predicting aspiration and pharyngeal retention were 122 points and 151 points, respectively. A total of 17 of the 24 clinical items assessed by the MASA were found to be associated with aspiration in dependent older adults. CONCLUSIONS The MASA is a useful screening tool for evaluating eating and swallowing functions in dependent older adults. Geriatr Gerontol Int 2017; 17: 561-567.
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Affiliation(s)
- Mariko Ohira
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | - Ryo Ishida
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | - Yoshinobu Maki
- Tokyo Dental College Department of Social Dentistry, Chiba, Japan
| | - Mai Ohkubo
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | - Tetsuya Sugiyama
- Tokyo Dental College Department of Dysphagia Rehabilitation and Community Dental Care, Chiba, Japan
| | | | - Toru Sato
- Tokyo Dental College Department of Crown & Bridge Prosthodontics, Tokyo Dental College, Chiba, Japan
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Blyth KM, Mccabe P, Madill C, Ballard KJ. Ultrasound visual feedback in articulation therapy following partial glossectomy. JOURNAL OF COMMUNICATION DISORDERS 2016; 61:1-15. [PMID: 26994583 DOI: 10.1016/j.jcomdis.2016.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 02/23/2016] [Accepted: 02/28/2016] [Indexed: 06/05/2023]
Abstract
UNLABELLED Disordered speech is common following treatment for tongue cancer, however there is insufficient high quality evidence to guide clinical decision making about treatment. This study investigated use of ultrasound tongue imaging as a visual feedback tool to guide tongue placement during articulation therapy with two participants following partial glossectomy. A Phase I multiple baseline design across behaviors was used to investigate therapeutic effect of ultrasound visual feedback during speech rehabilitation. Percent consonants correct and speech intelligibility at sentence level were used to measure acquisition, generalization and maintenance of speech skills for treated and untreated related phonemes, while unrelated phonemes were tested to demonstrate experimental control. Swallowing and oromotor measures were also taken to monitor change. Sentence intelligibility was not a sensitive measure of speech change, but both participants demonstrated significant change in percent consonants correct for treated phonemes. One participant also demonstrated generalization to non-treated phonemes. Control phonemes along with swallow and oromotor measures remained stable throughout the study. This study establishes therapeutic benefit of ultrasound visual feedback in speech rehabilitation following partial glossectomy. LEARNING OUTCOMES Readers will be able to explain why and how tongue cancer surgery impacts on articulation precision. Readers will also be able to explain the acquisition, generalization and maintenance effects in the study.
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Affiliation(s)
- Katrina M Blyth
- Royal Prince Alfred Hospital, Sydney, Australia; The University of Sydney, Australia.
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43
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Dziewas R, Glahn J, Helfer C, Ickenstein G, Keller J, Ledl C, Lindner-Pfleghar B, G Nabavi D, Prosiegel M, Riecker A, Lapa S, Stanschus S, Warnecke T, Busse O. Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC MEDICAL EDUCATION 2016; 16:70. [PMID: 26911194 PMCID: PMC4766659 DOI: 10.1186/s12909-016-0587-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 02/08/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has not yet been established. RESULTS The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational programme is applicable to other clinicians and speech-language therapists with expertise in dysphagia as well. CONCLUSION The systematic education in carrying out FEES across a variety of different professions proposed by this curriculum will help to spread this instrumental approach and to improve dysphagia management.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.
| | - Jörg Glahn
- Department of Neurology, Johannes Wesling Klinikum Minden, Minden, Germany.
| | - Christine Helfer
- ENT and Neurology Departments, Vivantes Klinikum Neukölln, Berlin, Germany.
| | - Guntram Ickenstein
- Department of Neurology and Stroke Unit, HELIOS Klinikum Aue, Aue, Germany.
| | - Jochen Keller
- St. Martinus Hospital, Clinic for Acute Geriatrics, Düsseldorf, Germany.
| | | | | | - Darius G Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany.
| | | | - Axel Riecker
- Department of Neurology, University of Ulm, Ulm, Germany.
- Reha Nova, Clinic for neurological and neurosurgical rehabilitation, Cologne, Germany.
| | - Sriramya Lapa
- Department of Neurology, ZNN, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
| | | | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Otto Busse
- DSG and DGN Office, Reinhardtstraße 27 C, 10117, Berlin, Germany.
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45
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Abstract
More than 80 % of patients with Parkinson's disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Although the underlying pathophysiology is poorly understood, it has been shown that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in PD. Clinical assessment of dysphagia in PD patients is challenging and often delivers unreliable results. A modified water test assessing maximum swallowing volume is recommended to uncover oropharyngeal dysphagia in PD. PD-specific questionnaires may also be useful to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study are both considered to be the gold standard for evaluation of PD-related dysphagia. In addition, high-resolution manometry may be a helpful tool. These instrumental methods allow a reliable detection of aspiration events. Furthermore, typical patterns of impairment during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of dysphagia in PD consists of pharmacological interventions and swallowing treatment by speech and language therapists (SLTs). Fluctuating dysphagia with deterioration during the off-state should be treated by optimizing dopaminergic medication. The methods used during swallowing treatment by SLTs shall be selected according to the individual dysphagia pattern of each PD patient. A promising novel method is an intensive training of expiratory muscle strength. Deep brain stimulation does not seem to have a clinical relevant effect on swallowing function in PD. The goal of this review is giving an overview on current stages of epidemiology, pathophysiology, diagnosis, and treatment of PD-associated dysphagia, which might be helpful for neurologists, speech-language therapists, and other clinicians in their daily work with PD patients and associated swallowing difficulties. Furthermore areas with an urgent need for future clinical research are identified.
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Gee E, Lancaster E, Meltzer J, Mendelsohn AH, Benharash P. A Targeted Swallow Screen for the Detection of Postoperative Dysphagia. Am Surg 2015; 81:979-82. [DOI: 10.1177/000313481508101014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. A simple and sensitive screening test to identify patients requiring objective dysphagia evaluation is presently lacking. In this study, we evaluated the efficacy of a novel targeted swallow screen evaluation. This was a prospective trial involving all adult patients who underwent elective cardiac surgery with cardiopulmonary bypass at our institution over an 8-week period. Within 24 hours of extubation and before the initiation of oral intake, all postsurgical patients were evaluated using the targeted swallow screen. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. During the study, 50 postcardiac surgery patients were screened. Fifteen (30%) failed the targeted swallow screen, and ten of the fifteen (66%) failed the subsequent fiberoptic endoscopic evaluation of swallowing exam and were confirmed to have dysphagia. The screening test had 100 per cent sensitivity for detecting dysphagia in our patient population, and a specificity of 87.5 per cent. The overall incidence of dysphagia was 20 per cent. We have shown that a targeted swallow evaluation can efficiently screen patients during the postcardiac surgery period. Furthermore, we have shown that the true incidence of dysphagia after cardiac surgery is significantly higher than previously recognized in literature.
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Affiliation(s)
- Erica Gee
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Elizabeth Lancaster
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jospeh Meltzer
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Abie H. Mendelsohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Peyman Benharash
- Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Guillén-Solà A, Chiarella SC, Martínez-Orfila J, Duarte E, Alvarado-Panesso M, Figueres-Cugat A, Bas N, Marco E. Usefulness of Citric Cough Test for Screening of Silent Aspiration in Subacute Stroke Patients: A Prospective Study. Arch Phys Med Rehabil 2015; 96:1277-83. [DOI: 10.1016/j.apmr.2015.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/23/2015] [Accepted: 02/27/2015] [Indexed: 11/25/2022]
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Oh JC, Park JH, Jung MY, Yoo EY, Chang KY, Lee TY. Relationship between Quantified Instrumental Swallowing Examination and Comprehensive Clinical Swallowing Examination. Occup Ther Int 2015; 23:3-10. [PMID: 25988485 DOI: 10.1002/oti.1391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to identify the correlation between the Mann Assessment of Swallowing Ability (MASA) and the Videofluoroscopic Dysphagia Scale (VDS) to investigate the applicability of the MASA as a follow-up test of swallowing function. Criterion validity was assessed for MASA results versus VDS scores of tests administered to 54 patients who had a stroke and dysphagia. A significant correlation was found between the MASA and the VDS (correlation coefficient = -0.509). In analyses of test-re-test reliability and inter-rater reliability of the scoring scale, intraclass correlation coefficients (2, 1) were high (0.98, 0.99). In conclusion, the results of the present study indicate that the MASA holds adequate clinical test-re-test and inter-rater reliabilities and criterion validity for measuring the swallowing abilities of Korean patients who had a stroke and dysphagia. The MASA could contribute to more systematic management of swallowing problems and efficient therapeutic service.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Doowon Technical University College, Paju, Gyeonggi-do, Korea
| | - Ji-Hyuk Park
- Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, Korea
| | - Min-Ye Jung
- Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, Korea
| | - Eun-Young Yoo
- Department of Occupational Therapy, Yonsei University, Wonju, Gangwon-do, Korea
| | - Ki-Yeon Chang
- Department of Occupational Therapy, Woosong University, Daejeon Metropolitan City, Korea
| | - Teak-Young Lee
- Department of Occupational Therapy, Hanseo University, Seosan, Chungcheongnam-do, Korea
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Mortensen J, Jensen D, Kjaersgaard A. A validation study of the Facial-Oral Tract Therapy Swallowing Assessment of Saliva. Clin Rehabil 2015; 30:410-5. [PMID: 25920675 DOI: 10.1177/0269215515584381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/04/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the validity and reliability of the Swallowing Assessment of Saliva in detection of aspiration risk. DESIGN Validation study. SETTING Inpatient neurorehabilitation centre. SUBJECTS Adult patients with acquired brain injury. A total of 43 patients for concurrent validity and 33 other patients for inter-rater reliability. INTERVENTIONS Concurrent validity was established with blinded Swallowing Assessment of Saliva and endoscopic evaluation within a 24-hour time interval. Inter-rater reliability was established with two blinded Swallowing Assessments of Saliva within a one-hour time interval. MAIN MEASURES The Swallowing Assessment of Saliva is a seven-item scale with a combination of swallowing and non-swallowing items. It is based on the Facial-Oral Tract Therapy approach. RESULTS The Swallowing Assessment of Saliva had a sensitivity of 91%, 95% confidence interval (CI) (59; 100), a specificity of 88% %, 95% CI (71; 97) and a kappa coefficient of 0.87 ±0.17 in detection of aspiration risk. Furthermore, analyses showed that experienced and inexperienced occupational therapists performed equally in detection of aspiration risk. CONCLUSION The Swallowing Assessment of Saliva is a simple, sensitive and reliable assessment for detecting aspiration risk in patients with acquired brain injury.
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Affiliation(s)
- Jesper Mortensen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Jensen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Annette Kjaersgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
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50
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Blyth KM, McCabe P, Heard R, Clark J, Madill C, Ballard KJ. Cancers of the tongue and floor of mouth: five-year file audit within the acute phase. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 23:668-678. [PMID: 25089517 DOI: 10.1044/2014_ajslp-14-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/23/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE The impact of patient, surgical, and rehabilitation factors on speech and swallowing in the acute phase for patients following tongue and/or floor of mouth cancer surgery has not been reported to date. This study reviewed functional outcomes over a 5-year period at an Australian tertiary hospital. METHOD Patient medical files from July 2006 through 2011 were audited. Patient demographics, tumor and treatment, along with speech-language pathology (SLP) intervention details were examined. RESULTS Speech and swallow function were significantly different between those with primary closure and those requiring reconstruction, with significantly higher referral rate to SLP following reconstruction. The clinical speech and swallow function at SLP assessment following reconstruction was a predictor for the number of SLP intervention sessions provided. The number of intervention sessions provided to these patients significantly correlated with upgrade in fluids during hospitalization. CONCLUSION This is the first published study to report a relationship between function and dosage of clinical SLP intervention with this population. It is also the first known study to audit comprehensive functional outcomes in the acute phase of recovery with an Australian cohort. The findings contribute to establishing evidence-based SLP practice with this population.
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