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Tanrıverdi M, Törpü GC, Öztoprak N. Comparison of the effect of swallowing rehabilitation on two cases with head and neck cancer. J Cancer Res Ther 2024:01363817-990000000-00096. [PMID: 39016298 DOI: 10.4103/jcrt.jcrt_2445_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/21/2024] [Indexed: 07/18/2024]
Abstract
ABSTRACT Complications of head and neck cancers and their treatment can lead to dysphagia. Two fifty-seven-year-old male cases, one with laryngeal cancer and one with tongue cancer, were included in the study. After 16 weeks of swallowing rehabilitation, positive changes were observed in the physical parameters, quality of life, and nutritional status of the patients. In conclusion, patients with head and neck cancer should be evaluated by physiotherapists for dysphagia. The participation and motivation of the patients in the rehabilitation program are highly effective in the outcome of the treatment.
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Affiliation(s)
- Müberra Tanrıverdi
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, İstanbul, Türkiye
| | - Gökhan Can Törpü
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, İstanbul, Türkiye
- Department of Cardiopulmonary Physiotherapy and Rehabilitation, Institute of Health Sciences, Bezmialem Vakıf University, İstanbul, Türkiye
| | - Nahide Öztoprak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bezmialem Vakıf University, İstanbul, Türkiye
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Akhtar RN, Behn N, Morgan S. Understanding Dysphagia Care in Pakistan: A Survey of Current Speech Language Therapy Practice. Dysphagia 2024; 39:484-494. [PMID: 38006420 PMCID: PMC11127846 DOI: 10.1007/s00455-023-10633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/19/2023] [Indexed: 11/27/2023]
Abstract
Dysphagia affects individuals across all ages and has pervasive and potentially life-threatening consequences. Individuals with dysphagia are assessed and treated by speech and language therapists (SLTs), however, little attention has been paid to their practices in Pakistan. This study aimed to explore SLTs practices for dysphagia assessment, signs and symptoms observed during evaluation, and management strategies, alongside barriers and facilitators to service delivery in Pakistan. A 45-item survey was distributed to SLTs online. Responses were received from 101 participants and analyzed descriptively, and open-text responses were analyzed using content analysis. Results revealed that 65.3% SLTs worked across the lifespan, and most (79.4%) had dysphagia-related experience of five years or less. SLTs were an active workforce engaged with varying ages, disorders, and settings, yet dysphagia contributed to a small caseload percentage for most. Analyses found informal clinical exams were more frequently used than instrumental assessments. A variety of service provision facilitators were described, such as supportive teams and accessible resources, and responses about barriers revealed gaps in awareness, education, and guidance. This exploratory study presents novel and unexplored data which provides a deeper understanding of dysphagia-related care in Pakistan.
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Affiliation(s)
- Rohma N Akhtar
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK.
- City University of London, London, UK.
| | - Nicholas Behn
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
| | - Sally Morgan
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
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Dodderi T, Flerisa LM, Fathima N, Balasubramanium RK. Assessing Swallowing and Mastication Using the Swallowing Proficiency for Eating and Drinking Protocol Among Healthy Adults. Indian J Otolaryngol Head Neck Surg 2024; 76:2590-2600. [PMID: 38883485 PMCID: PMC11169404 DOI: 10.1007/s12070-024-04575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/19/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Objective evaluation of swallowing using single bolus consistency are popular among Speech-Language Pathologists (SLPs) but has limited generalization to other bolus consistencies. The Swallowing Proficiency for Eating and Drinking (SPEAD) test assesses the oral and pharyngeal phases of swallowing using three different consistencies. OBJECTIVES The aim of this study was to establish normative data for the SPEAD test among healthy individuals aged 20-79 years. METHOD AND MATERIALS One hundred and twelve healthy adults recruited from the community were divided into three age groups (20-39.11, 40-59.11, & 60-79.11 years). Participants swallowing 100 g of water and thickened Electral, and 6.67 g of Parle Monaco was video recorded for data analysis. RESULTS Cronbachs Alpha test indicated good to excellent internal consistency and inter-class correlation test revealed a high level of inter-rater reliability for all SPEAD parameters. Older adults exhibited a higher number of bites, chews, and swallows, and required more time to swallow compared to younger and middle adults. Similarly, speed of ingestion and SPEAD rate were lowest in older adults. SPEAD indices also showed significant differences across the three consistencies at p < 0.01. CONCLUSION In summary, the SPEAD test was found to be feasible, reliable, and valid in healthy adults of India between 20 and 79 years of age. The age and sex based normative data established in this study will enable SLPs in assessing the presence and / or absence of swallowing difficulties in the oral and pharyngeal phases across different consistencies using one test.
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Affiliation(s)
- Thejaswi Dodderi
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Luis Malvika Flerisa
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Nidha Fathima
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Radish Kumar Balasubramanium
- Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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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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Correa-Rodríguez M, Villaverde-Rodríguez MDC, Casas-Barragán A, Tapia-Haro RM, Aguilar-Ferrándiz ME. Nutritional Status, Dietary Intake, Quality of Life, and Dysphagia in Women With Fibromyalgia. Nurs Res 2024; 73:224-231. [PMID: 38329989 DOI: 10.1097/nnr.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Fibromyalgia syndrome (FMS) is an idiopathic chronic disease characterized by widespread musculoskeletal pain, hyperalgesia, and allodynia that has been recently associated with risk of dysphagia. OBJECTIVE We aimed to analyze the association between nutritional status, micro- and macronutrient intake, and quality of life (QoL) in a cohort of women with FMS and risk of dysphagia compared to women with FMS without risk of dysphagia. METHODS A cross-sectional study was conducted in 46 women with FMS. Risk of dysphagia was assessed by the Eating Assessment Tool (EAT-10) and the Volume-Viscosity Swallow Test (V-VST). The Food Frequency Questionnaire and the Swallowing Quality of Life Questionnaire were used to assess dietary intake and QoL, respectively. RESULTS Thirty women with FMS were at risk for dysphagia (65.21%), assessed by the EAT-10. Based on the V-VST, the frequency of risk of dysphagia was 63.04%. Significant differences in body mass index (BMI) were found between women at risk for dysphagia and those without risk. Women at risk for dysphagia had significantly lower overall QoL scores than those women without risk. No significant differences were found for dietary intake and dysphagia risk. DISCUSSION Women with FMS at risk for dysphagia have significantly lower BMI values and worse QoL than women without dysphagia risk, supporting the importance of assessing dysphagia in clinical practice in persons with FMS.
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D'Angelo EC. Clinical Feeding and Swallowing Evaluation for the School-Based Speech-Language Pathologist. Lang Speech Hear Serv Sch 2024; 55:409-422. [PMID: 38029415 DOI: 10.1044/2023_lshss-23-00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
PURPOSE From preschool through high school, eating is part of the school day. Children with feeding and/or swallowing issues are now in our neighborhood schools, our responsibility in our care, and require adequate nutrition and hydration to participate in school and access the curriculum. The whole child is in school, including all of their medical, behavioral, social, and educational needs. This clinical focus article describes a holistic process of evaluating swallowing and feeding in the school setting for the school speech-language pathologist (SLP) leading the team supporting the child. METHOD This clinical focus article explores the evaluation process in the educational setting for the school SLP in identification of pediatric feeding disorders (PFDs), which can involve dysphagia. Detailed descriptions of the related U.S. educational law, PFD, assessment processes for the multiple systems relating to eating, and collaboration with an interdisciplinary team are highlighted. Using the four overlapping domains of PFD (medical, psychosocial, feeding skill-based systems and associated nutritional aspects), medical and background history gathering; integration with instrumental results; and the need to consider the complex interaction of developmental, physical, cognitive, social, behavioral, family, and cultural aspects in the evaluation are detailed. CONCLUSIONS School-age children require safe and adequate nutrition and hydration for learning and social participation. The SLP has a lead role in the school team in evaluating swallowing and feeding, and developing a plan for team implementation. A holistic school-based SLP clinical evaluation process is described.
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Affiliation(s)
- Elisabeth C D'Angelo
- Department of Communication Sciences & Disorders, California State University, Sacramento
- Davis Joint Unified School District, CA
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Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
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Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
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Del Carmen Villaverde-Rodríguez M, Correa-Rodríguez M, Casas-Barragán A, Tapia-Haro RM, Aguilar-Ferrándiz ME. Orofacial Pain and Risk of Dysphagia in Women With Fibromyalgia: A Cross-Sectional Observational Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:883-892. [PMID: 38118459 DOI: 10.1044/2023_ajslp-23-00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
OBJECTIVE This study aims to analyze the frequency of dysphagia risk and swallowing-associated quality of life (QoL) in a sample of women with fibromyalgia syndrome (FMS) and examine the potential relationship between risk of dysphagia and chronic orofacial pain (COP) in a sample of women with FMS. METHOD A cross-sectional observational study was conducted in 46 women with FMS. COP was assessed by mouth opening, the orofacial visual analog scale (VAS), and the craniofacial pain and disability inventory (CF-PDI). Risk of dysphagia was assessed using the Eating Assessment Tool (EAT-10) and the volume-viscosity swallowing test (V-VST). Swallowing-associated QoL was determined using the Swallowing Quality of Life (SWAL-QOL) questionnaire. RESULTS Thirty patients were identified as being at risk for dysphagia (65.21%) using the EAT-10 and, according to the SWAL-QOL, 41.30% of patients had alterations in QoL associated with swallowing. The EAT-10 correlated positively with orofacial VAS, CF-PDI-total, CF-PDI-pain and disability, and CF-PDI-jaw-functional status. In relation to SWAL-QOL, negative correlations were observed for orofacial VAS, CF-PDI-total, CF-PDI-pain and disability, and CF-PDI-jaw-functional status. Patients at risk of dysphagia (EAT-10 and V-VST) had significantly higher scores in orofacial VAS (p = .002 and p = .015), CF-PDI-total (p = .006 and p = .014), and CF-PDI-pain and disability (p = .004 and p = .013). CONCLUSIONS In this sample of women with FMS, we identified a high rate of dysphagia risk. Also, a high percentage of these women presented alterations in QoL associated with swallowing. Patients at risk for dysphagia had significantly higher orofacial VAS and CF-PDI-total scores, supporting the relationship between dysphagia risk and COP in FMS. Further research to establish the need for appropriate assessment referrals in clinical practice to determine whether dysphagia is present in this population is needed.
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Affiliation(s)
- María Del Carmen Villaverde-Rodríguez
- PhD Biomedicine Program, Faculty of Health Sciences (Granada), University of Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
| | - María Correa-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
- Department of Nursing, Faculty of Health Sciences (Granada), University of Granada, Spain
| | - Antonio Casas-Barragán
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
- Department of Physiotherapy, Faculty of Health Sciences (Granada), University of Granada, Spain
| | - Rosa María Tapia-Haro
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
- Department of Physiotherapy, Faculty of Health Sciences (Granada), University of Granada, Spain
| | - María Encarnación Aguilar-Ferrándiz
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain
- Department of Physiotherapy, Faculty of Health Sciences (Granada), University of Granada, Spain
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Bice EM, Galek KE, Ward M. Dysphagia and Diets in Skilled Nursing Facilities When Patient's Health Status Changes: The Role of Imaging. J Am Med Dir Assoc 2024; 25:381-386. [PMID: 38109943 DOI: 10.1016/j.jamda.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVES Research suggests that clinical decision making for assessing and treating patients with swallowing dysfunction varies significantly, and decisions may harm patients. The study aimed to investigate clinical practice of speech-language pathologists (SLPs) assessing and treating swallowing in skilled nursing facilities (SNFs). DESIGN Retrospective review of 120 medical records of patients recommended for a flexible endoscopic evaluation of swallowing (FEES). SETTING AND PARTICIPANTS 120 SNF patients. METHODS Records from 25 SNFs were reviewed to determine which patients were receiving swallowing therapy, their diet level pre- and post-FEES, and if they received prior imaging studies. Recordings of FEES were assigned severity ratings based on the Dynamic Imaging Grade of Swallowing Toxicity-FEES scores to determine the relationship between diet and liquid recommendations before and after FEES, how often patients consume a modified diet in the absence of dysphagia, percentage of patients without dysphagia receiving swallowing treatment, percentage of patients receiving alternative means of nutrition without dysphagia, and the percentage of patients with a feeding tube without an imaging assessment. RESULTS Chi-square tests revealed no agreement between pre- and postimaging diet levels. Ordinal regressions indicated preimaging diets did not fit the DIGEST severity rating model; however, investigators found a good fit with postimaging diet recommendations. Descriptive statistics indicated that 67% of the patients receiving a modified solid and/or liquid did not have dysphagia. Treatment was provided to 100% of the patients without dysphagia. Sixty-one percent of patients with feeding tubes had no dysphagia. Forty-five percent of NPO (nothing by mouth) patients had imaging during their acute stay. CONCLUSIONS AND IMPLICATIONS The results strongly suggest that the practice of continuing acute care diet recommendations in a SNF increases cost and may negatively impact patient quality of life. The practice may also lead to negative health consequences. A new imaging assessment is required to inform treatment when medical status changes.
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Affiliation(s)
- Ed M Bice
- IOPI Medical, LLC, Woodinville, WA, USA.
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Zang J, Witt S, Johannsen J, Weiss D, Denecke J, Dumitrascu C, Nießen A, Quitmann JH, Pflug C, Flügel T. DySMA - an Instrument to Monitor Swallowing Function in Children with Spinal Muscular Atrophy ages 0 to 24 Months: Development, Consensus, and Pilot Testing. J Neuromuscul Dis 2024; 11:473-483. [PMID: 38457144 PMCID: PMC10977442 DOI: 10.3233/jnd-230177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 03/09/2024]
Abstract
Background The manifestation of bulbar symptoms, especially swallowing, is important for evaluating disease-modifying therapies for spinal muscular atrophy (SMA). Due to the lack of instruments, the topic is still underrepresented in research. Objective This study aimed to develop a tool to monitor swallowing development in children aged 0 to 24 months with SMA. Methods The method was guided by the COSMIN guidelines and followed a multi-stage Delphi process. The first step was a rapid review of swallowing outcomes in children with SMA younger than 24 months. In the second step, online group interviews with experts (n = 7) on dysphagia in infants were conducted, followed by an anonymous online survey among experts in infants with SMA (n = 19). A predefined consensus threshold for nominal scaled voting was set at≥75 % and for 5-point Likert scale voting at 1.25 of the interquartile range. The third step was the pilot test of the instrument, performed with three groups (healthy controls n = 8; pre-symptomatic n = 6, symptomatic n = 6). Results Based on the multi-level interprofessional consensus, the DySMA comprises two parts (history and examination), ten categories, with 36 items. Implementation and scoring are clearly articulated and easy to implement. The pilot test showed that swallowing development could be recorded in all groups. Conclusion The DySMA is well suited for monitoring swallowing development in pre-symptomatic and symptomatic treated infants with SMA. It can be performed in a time-efficient and interprofessional manner. The resulting score is comparable to results from other instruments measuring other domains, e.g., motor function.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Witt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jessika Johannsen
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deike Weiss
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Dumitrascu
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Hannah Quitmann
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Reedy EL, Simpson AN, O'Rourke AK, Bonilha HS. Characterizing Swallowing Impairment in a Post-Lung Transplant Population. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1236-1251. [PMID: 37000923 DOI: 10.1044/2023_ajslp-22-00266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Lung transplant recipients carry significant pre- and post-lung transplant dysphagia risk factors related to altered respiratory-swallow coordination as well as acute injury and decompensation resulting in the acute post-lung transplant recovery period. However, we are only beginning to understand the potential physiological contributors to altered swallowing in this population. METHOD A retrospective, cross-sectional, cohort study of post-lung transplant patients was performed. All participants received a modified barium swallow study (MBSS) as part of standard care during their acute hospitalization using the Modified Barium Swallow Impairment Profile (MBSImP) protocol and scoring metric. A combination of MBSImP scores, Penetration-Aspiration Scale (PAS) scores, Functional Oral Intake Scale (FOIS) scores, International Dysphagia Diet Standardization Initiative (IDDSI) scale levels, and the time from lung transplant to MBSS was collected, as well as measures of swallowing impairment and swallowing-related outcomes. Differences in swallowing physiology and swallowing-related outcomes between participants with typical versus atypical PAS were explored. RESULTS Forty-two participants met our prespecified inclusion criteria. We identified atypical laryngeal penetration and/or aspiration in 52.4% of our post-lung transplant cohort. Silent aspiration occurred in 75% of those patients who aspirated. Comparing typical versus atypical PAS scores, we found statistically significant associations with laryngeal elevation (Component 8), p < .0001; anterior hyoid excursion (Component 9), p = .0046; epiglottic movement (Component 10), p = .0031; laryngeal vestibule closure (Component 11), p < .0001; pharyngeal stripping (Component 12), p = .0058; pharyngeal total scores, p = .0001; FOIS scores, p = .00264; and IDDSI liquid levels, p = .0009. CONCLUSIONS Swallowing impairment resulting in abnormal bolus invasion is prevalent in post-lung transplant patients. Airway invasion in this cohort was related to pharyngeal swallow impairment and resulted in modified oral intake. Our findings help expand upon prior literature, which only reported the incidence of aspiration and pathological laryngeal penetration. Our results suggest that the potential for aerodigestive system impairment and negative sequela should not be underestimated in the post-lung transplant population.
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Affiliation(s)
- Erin L Reedy
- Health Sciences and Research, The Medical University of South Carolina, Charleston
| | - Annie N Simpson
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
| | - Heather Shaw Bonilha
- Health Sciences and Research, The Medical University of South Carolina, Charleston
- Department of Otolaryngology-Head & Neck Surgery, The Medical University of South Carolina, Charleston
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA
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Mayerl CJ, Gould FDH, Adjerid K, Edmonds C, German RZ. The Pathway from Anatomy and Physiology to Diagnosis: A Developmental Perspective on Swallowing and Dysphagia. Dysphagia 2023; 38:33-41. [PMID: 35441265 PMCID: PMC9579268 DOI: 10.1007/s00455-022-10449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 04/04/2022] [Indexed: 01/29/2023]
Abstract
Dysphagia results from diverse and distinct etiologies. The pathway from anatomy and physiology to clinical diagnosis is complex and hierarchical. Our approach in this paper is to show the linkages from the underlying anatomy and physiology to the clinical presentation. In particular, the terms performance, function, behavior, and physiology are often used interchangeably, which we argue is an obstacle to clear discussion of mechanism of pathophysiology. We use examples from pediatric populations to highlight the importance of understanding anatomy and physiology to inform clinical practice. We first discuss the importance of understanding anatomy in the context of physiology and performance. We then use preterm infants and swallow-breathe coordination as examples to explicate the hierarchical nature of physiology and its impact on performance. We also highlight where the holes in our knowledge lie, with the ultimate endpoint of providing a framework that could enhance our ability to design interventions to help patients. Clarifying these terms, and the roles they play in the biology of dysphagia will help both the researchers studying the problems as well as the clinicians applying the results of those studies.
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Affiliation(s)
- C J Mayerl
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - F D H Gould
- Department of Cell Biology and Neuroscience, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - K Adjerid
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - C Edmonds
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| | - R Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
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Jaghbeer M, Sutt AL, Bergström L. Dysphagia Management and Cervical Auscultation: Reliability and Validity Against FEES. Dysphagia 2023; 38:305-314. [PMID: 35838785 PMCID: PMC9873722 DOI: 10.1007/s00455-022-10468-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/16/2022] [Indexed: 01/28/2023]
Abstract
This study investigated the reliability and validity (sensitivity and specificity) of cervical auscultation (CA) using both swallow and pre-post swallow-respiratory sounds, as compared with Flexible Endoscopic Evaluation of Swallowing (FEES). With 103 swallow-respiratory sequences from 23 heterogenic patients, these swallows sounds were rated by eight CA-trained Speech-Language Pathologists (SLPs) to investigate: (1) if the swallow was safe (primary outcome); (2) patient dysphagia status; (3) the influence of liquid viscosity on CA accuracy (secondary outcomes). Primary outcome data showed high CA sensitivity (85.4%), and specificity (80.3%) with all consistencies for the safe measurement, with CA predictive values of [Formula: see text] 90% to accurately detect unsafe swallows. Intra-rater reliability was good (Kappa [Formula: see text] 0.65), inter rater reliability moderate (Kappa [Formula: see text] 0.58). Secondary outcome measures showed high sensitivity (80.1%) to identify if a patient was dysphagic, low specificity (22.9%), and moderate correlation (rs [Formula: see text] 0.62) with FEES. A difference across bolus viscosities identified that CA sensitivities (90.1%) and specificities ([Formula: see text] 84.7%) for thin liquids were greater than for thick liquids (71.0-77.4% sensitivities, 74.0-81.3% specificities). Results demonstrate high validity and moderate-good reliability of CA-trained SLPs to determine swallow safety when compared with FEES. Data support the use of CA as an adjunct to the clinical swallow examination. CA should include pre-post respiratory sounds and requires specific training. Clinical implications: The authors advocate for holistic dysphagia management including instrumental assessment and ongoing CSE/review [Formula: see text] CA. Adding CA to the CSE/review does not replace instrumental assessment, nor should CA be used as a stand-alone tool.
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Affiliation(s)
- Mariam Jaghbeer
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- , Alian Al Aajalain Street, Amman, Jordan
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Adult Intensive Care Services, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Liza Bergström
- Remeo Stockholm, Torsten Levenstamsväg 8, Stockholm, Sweden.
- Division of Neurology, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden.
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Zang J, Johannsen J, Denecke J, Weiss D, Koseki JC, Nießen A, Müller F, Nienstedt JC, Flügel T, Pflug C. Flexible endoscopic evaluation of swallowing in children with type 1 spinal muscular atrophy. Eur Arch Otorhinolaryngol 2023; 280:1329-1338. [PMID: 36209319 PMCID: PMC9547642 DOI: 10.1007/s00405-022-07685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to report on implementing flexible endoscopic evaluation of swallowing (FEES) in infants and toddlers with type 1 spinal muscular atrophy (SMA). In addition, a comparison of FEES results and clinical scores was carried out. METHODS A prospective pilot study was conducted including ten symptomatic children with SMA type 1 (two SMN2 copies). They started treatment with one of the three currently approved therapies for SMA at a median age of 3.8 months (range 0.7-8.9). FEES was performed according to a standard protocol using Penetration-Aspiration Scale (PAS) and Murray Secretion Scale as a primary outcome. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) for motor function, Neuromuscular Disease Swallowing Status Scale (NdSSS), Oral and Swallowing Abilities Tool (OrSAT), and single clinical swallowing-related parameters were also assessed. RESULTS Distinct swallowing disorders were already evident in eight children at inclusion. The most common findings from FEES were pharyngeal secretion pooling, penetration, and aspiration of saliva and food as well as delayed initiation of swallowing. Despite an average increase in motor function, no comparable improvement was found in swallowing function. None of the surveyed clinical scores showed a significant dependence on PAS in a mixed linear model. CONCLUSIONS Valuable information regarding the status of dysphagia can be gathered endoscopically, particularly concerning secretion management and when oral intake is limited. Currently available clinical tools for children with type 1 may represent a change in nutritional status but are not yet mature enough to conclude swallowing ability. Further development is still required.
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Affiliation(s)
- Jana Zang
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jessika Johannsen
- grid.13648.380000 0001 2180 3484Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonas Denecke
- grid.13648.380000 0001 2180 3484Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Deike Weiss
- grid.13648.380000 0001 2180 3484Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana-Christiane Koseki
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Frank Müller
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- grid.13648.380000 0001 2180 3484Department of Voice, Speech and Hearing Disorders, University Dysphagia Center, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Smith LS, Barkmeier-Kraemer JM. Conceptual Framework Behind the Development of a Level of Confidence Tool: The Pediatric Videofluoroscopic Swallow Study Value Scale. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:689-704. [PMID: 35201847 DOI: 10.1044/2021_ajslp-20-00295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The videofluoroscopic swallow study (VFSS) is the most commonly used instrumental procedure for evaluating swallowing in pediatric populations suspected of having dysphagia. Assessment and interpretation of a VFSS in pediatric populations is frequently challenged by testing-specific factors that can raise concerns regarding the representativeness of swallow events observed during testing compared to daily feeding/swallowing physiology. When VFSS findings do not represent typical swallowing patterns, treatment recommendations can result in suboptimal outcomes. To address this current challenge to pediatric VFSS interpretation and associated treatment recommendations, the pediatric VFSS Value Scale (pVFSS Value Scale) was developed within a tertiary regional pediatric medical center. This clinical focus article summarizes the initial scale development phases and resulting conceptual framework for rating clinical testing factors that influence a clinician's level of confidence regarding pediatric VFSS findings. Future goals for scientific evaluation and clinical utilization of this new rating scale are also reported. CONCLUSIONS The pVFSS Value Scale was developed to assist clinicians with interpretation of pediatric VFSS assessment outcomes and to efficiently communicate factors influencing impressions and treatment recommendations with team members and caregivers. This clinical concept article summarizes potential uses of this tool to inform treatment planning as well as future clinical research to evaluate its psychometrics and clinical utility.
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Affiliation(s)
- Leann Schow Smith
- Department of Rehabilitation, Primary Children's Hospital, Salt Lake City, UT
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Viviers M, Edwards L, Asir M, Hibberd J, Rowe R, Phillips S, Thomas V, Keesing M, Sugar A, Allen J. Enhanced rapid review of the applicability of ultrasound in the assessment of sucking, swallowing and laryngeal function in the paediatric population. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:422-440. [PMID: 35060665 DOI: 10.1111/1460-6984.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/26/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has renewed interest in the use of ultrasound (US) amongst dysphagia-trained clinicians working with infants and children. US is a portable, minimally intrusive tool which carries reduced risk of aerosol-generation provoked by other instrumental swallowing assessment tools such as fibreoptic endoscopic evaluation of swallowing (FEES). For this reason, US could be a valuable addition to the dysphagia assessment toolkit. A recently published rapid review of US evidence for the assessment of swallowing and laryngeal function in the adult population provided a framework for this neonatal and paediatric review. AIMS This enhanced rapid review aimed to establish the applicability of US as an instrumental assessment tool for sucking, swallowing and laryngeal function in the neonatal and paediatric populations. METHODS & PROCEDURES A rapid review of six electronic databases was conducted to identify articles using US to assess sucking, swallowing or laryngeal function in the selected populations, compared with varied reference tests. Abstract screening was completed according to pre-defined inclusion/exclusion criteria with 10% of articles assessed by a second screener. Data was extracted from the included studies using a pre-developed form. A modified QUADAS-2 tool was used to assess study quality. Results from the included studies were summarised and grouped into sucking, swallowing and laryngeal function data. OUTCOMES & RESULTS Twelve studies using US in the assessment of swallowing and/or laryngeal function met inclusion criteria. No studies using US for assessment of sucking met the inclusion criteria. All were peer-reviewed, primary studies across a range of clinical populations and with a wide geographical spread. Five studies had an overall low risk of bias. Seven studies had at least one domain where risk of bias was judged as high. All studies had high applicability. The two studies assessing swallowing differed in terms of aims and use of US. The studies assessing laryngeal function predominately investigated vocal fold movement and laryngeal pathology. Sensitivity and specificity data were provided or calculated from raw data for nine of the laryngeal function studies (respective ranges of 75%-100% and 80%-100%). CONCLUSIONS & IMPLICATIONS Emerging evidence exists to support the use of US as adjunct to clinical assessment of swallowing and laryngeal function in the neonatal and paediatric population. A paucity of evidence to support use of US in the assessment of sucking exists. Further research is needed to establish evidence-based assessment and analysis protocols as well as development of paediatric data.
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Affiliation(s)
- Mari Viviers
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Maya Asir
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Rebecca Rowe
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Sophie Phillips
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Melissa Keesing
- Nelson Marlborough District Health Board, Nelson, New Zealand
| | - Analou Sugar
- Chelsea and Westminster Hospital, Chelsea & Westminster Hospital Foundation Trust, London, UK
| | - Jodi Allen
- The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Webler K, Carpenter J, Hamilton V, Rafferty M, Cherney LR. Dysphagia Characteristics of Patients Post SARS-CoV-2 During Inpatient Rehabilitation. Arch Phys Med Rehabil 2022; 103:336-341. [PMID: 34757074 PMCID: PMC8555115 DOI: 10.1016/j.apmr.2021.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/12/2021] [Accepted: 10/21/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate dysphagia in patients recovering from SARS-CoV-2 admitted to acute inpatient rehabilitation by summarizing clinical swallow evaluation and videofluoroscopic swallow study findings. DESIGN Retrospective cohort study. SETTING Urban inpatient rehabilitation hospital. PARTICIPANTS The first inpatients admitted with SARS-CoV-2 (N=40) who participated in a videofluoroscopic swallow study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient characteristics upon admission (duration of intubation, tracheostomy status, comorbidities, videofluoroscopic swallow study (VFSS) completion at previous level of care); admission International Dysphagia Diet level (IDDSI); Mann Assessment of Swallowing Ability (MASA), Functional Oral Intake Scale (FOIS), dysphagia severity rating; penetration aspiration scale (PAS) rated during VFSS; and IDDSI level recommended after completion of VFSS. RESULTS Twenty percent of patients had been evaluated by videofluoroscopy in acute care. Nineteen of 37 (51%) individuals were upgraded to IDDSI level 7 regular diet with level 0 thin liquids and achieved a FOIS of 7 after the completion of the VFSS. Five individuals (13%) received a diet downgrade or remained on the same diet recommendations from their admission. Total numerical score (TNS) of less than 170 on the MASA predicted presence of aspiration in 27% of patients (6 of 22). Seventy-two percent of the sample (16 of 22) had a TNS less than 170 but did not demonstrate any instances of aspiration. The odds of patients having a PAS of 3 or greater increased by approximately 15% (odds ratio, 1.15; 95% confidence interval, 1.03-1.27; P=.013). Thus, with each additional day of intubation during acute care stay, there was a 15% greater likelihood of having airway invasion. CONCLUSIONS Instrumental swallow evaluations are imperative to diagnose and treat dysphagia in the post-coronavirus disease population. Because of the heterogeneity of this population, high incidence of prolonged intubation, and limitations of the clinical swallowing evaluation, instrumental assessments need to be performed on a more consistent basis as infection prevention protocols evolve.
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Affiliation(s)
| | - Julia Carpenter
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Valerie Hamilton
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois
| | - Miriam Rafferty
- Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leora R Cherney
- Shirley Ryan AbilityLab, Chicago, Illinois; Think and Speak, Shirley Ryan AbilityLab, Chicago, Illinois; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
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Zang J, Kiehn S, Flügel T, Koseki JC, Nießen A, Kim SH, Pflug C, Nienstedt JC. Implementation of Pediatric Flexible-Endoscopic Evaluation of Swallowing: A Systematic Review and Recommendations for Future Research. Dysphagia 2022; 37:1822-1838. [PMID: 35430715 PMCID: PMC9643173 DOI: 10.1007/s00455-022-10446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although pediatric flexible-endoscopic evaluation of swallowing (FEES) has developed into a standard in dysphagia diagnostics, there are no valid protocols and procedures for children available to date. OBJECTIVE This systematic PROSPERO-registered review aimed to identify implementation protocols for pediatric FEES described in research studies, and to analyze them in detail concerning procedural steps, equipment, and reported outcome. METHODS Included were all studies reporting a pediatric FEES protocol for children aged 0-18 years, if they described at least two criteria defined in advance. The databases MEDLINE and CINHAL were searched systematically from January 2000 to February 2021. Risk of bias for included studies was assessed using the National Institutes of Health (NIH) quality assessment tool for observational cohort and cross-sectional studies. A narrative synthesis of the FEES protocols was conducted and the results compared in tabular form. RESULTS In total 22 studies were included, reporting on FEES in 1547 infants, children, and adolescents with a wide range of diagnoses. It was possible to identify protocols related to all age groups in general as well as to particular groups such as breastfed or bottle-fed infants. None of the included studies demonstrated a good methodological quality; all studies had missing data. Uniform implementation for sub-groups could not be determined. The reported outcome of FEES examinations could not be compared. DISCUSSION None of the included studies showed good methodological quality and a significant amount of data were missing; the review still offers a systematic basis for future research to close the serious gap in the area of pediatric FEES. A proposal is made for a minimum requirement for pediatric FEES protocols in scientific studies.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Saskia Kiehn
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susan Hyoungeun Kim
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg‐Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Mir MJ, Hegland KW. A Survey of Speech-Language Pathologists' Experience With Clinical Cough Assessment. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2021; 6:1627-1640. [PMID: 35546793 PMCID: PMC9084607 DOI: 10.1044/2021_persp-21-00144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to determine if students (clinicians-intraining) and clinicians of speech-language pathology assess cough during clinical swallow evaluations. We also sought to determine if participants received background education and training regarding implementation of clinical cough assessment. Finally, we aimed to identify participant interest in a cough assessment training program. METHOD A clinician-researcher panel developed a 20-question survey to address specific aims. The final survey was distributed via social media and a clinical dysphagia website after two phases of revision. RESULTS A percentage (84.6%) of the survey participants reported that they assess cough in clinical swallow evaluations, mainly using subjective measures. The majority of clinicians reported no background education or skilled training to implement cough assessment. Background education and training was higher for participants outside the United States, although the total sample size of that group was small. Almost all participants (97.8%) were interested in a cough training program. CONCLUSIONS Many practicing clinicians in this survey reported that they complete cough assessments, despite limited education and training to do so. However, they also reported high interest in participating in a clinical cough assessment training program, which would support the field of speech-language pathology and patients at risk of airway protective dysfunction.
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Affiliation(s)
- Michela Jean Mir
- Rehabilitation Science PhD, College of Public Health and Health Professions, University of Florida, Gainesville
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
| | - Karen Wheeler Hegland
- Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville
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O'Brien MK, Botonis OK, Larkin E, Carpenter J, Martin-Harris B, Maronati R, Lee K, Cherney LR, Hutchison B, Xu S, Rogers JA, Jayaraman A. Advanced Machine Learning Tools to Monitor Biomarkers of Dysphagia: A Wearable Sensor Proof-of-Concept Study. Digit Biomark 2021; 5:167-175. [PMID: 34723069 DOI: 10.1159/000517144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Difficulty swallowing (dysphagia) occurs frequently in patients with neurological disorders and can lead to aspiration, choking, and malnutrition. Dysphagia is typically diagnosed using costly, invasive imaging procedures or subjective, qualitative bedside examinations. Wearable sensors are a promising alternative to noninvasively and objectively measure physiological signals relevant to swallowing. An ongoing challenge with this approach is consolidating these complex signals into sensitive, clinically meaningful metrics of swallowing performance. To address this gap, we propose 2 novel, digital monitoring tools to evaluate swallows using wearable sensor data and machine learning. Methods Biometric swallowing and respiration signals from wearable, mechano-acoustic sensors were compared between patients with poststroke dysphagia and nondysphagic controls while swallowing foods and liquids of different consistencies, in accordance with the Mann Assessment of Swallowing Ability (MASA). Two machine learning approaches were developed to (1) classify the severity of impairment for each swallow, with model confidence ratings for transparent clinical decision support, and (2) compute a similarity measure of each swallow to nondysphagic performance. Task-specific models were trained using swallow kinematics and respiratory features from 505 swallows (321 from patients and 184 from controls). Results These models provide sensitive metrics to gauge impairment on a per-swallow basis. Both approaches demonstrate intrasubject swallow variability and patient-specific changes which were not captured by the MASA alone. Sensor measures encoding respiratory-swallow coordination were important features relating to dysphagia presence and severity. Puree swallows exhibited greater differences from controls than saliva swallows or liquid sips (p < 0.037). Discussion Developing interpretable tools is critical to optimize the clinical utility of novel, sensor-based measurement techniques. The proof-of-concept models proposed here provide concrete, communicable evidence to track dysphagia recovery over time. With refined training schemes and real-world validation, these tools can be deployed to automatically measure and monitor swallowing in the clinic and community for patients across the impairment spectrum.
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Affiliation(s)
- Megan K O'Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
| | - Olivia K Botonis
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Elissa Larkin
- Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Julia Carpenter
- Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Bonnie Martin-Harris
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Rachel Maronati
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | | | - Leora R Cherney
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA.,Think and Speak Lab, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA
| | - Brianna Hutchison
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Shuai Xu
- Departments of Materials Science and Engineering, Center for Bio-Integrated Electronics, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
| | - John A Rogers
- Departments of Materials Science and Engineering, Center for Bio-Integrated Electronics, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, USA
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Evaluating the Use of Telepractice for Bottle-Feeding Assessments. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110989. [PMID: 34828701 PMCID: PMC8625576 DOI: 10.3390/children8110989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
There is currently limited evidence supporting the use of telepractice to conduct bottle-feeding assessments. This study aimed to investigate the inter-rater reliability of bottle-feeding assessments conducted via synchronous telepractice (real-time videoconferencing). Secondary aims were to investigate parent and clinician satisfaction. Bottle-feeding skills of 30 children (aged 1 month-2 years) were simultaneously assessed by a telepractice SP (T-SP) at a remote location and an in-person SP (IP-SP) at the family home. A purpose-designed assessment form was used to evaluate: (1) developmental level (screen only), (2) state, color, and respiration, (3) oral motor skills, (4), infant oral reflexes, (5) tongue tie (screen only), (6) non-nutritive suck, (7) bottle-feeding, (8) overall feeding skills and (9) recommendations. Results of the T-SP and IP-SP assessments were compared using agreement statistics. Parents reported perceptions of telepractice pre and post session, and also rated post-session satisfaction. The telepractice SP completed a satisfaction questionnaire post-appointment. The majority of assessment components (45/53, 85%) met the agreement criteria (≥80% exact agreement). Difficulties were noted for the assessment of palate integrity, gagging during non-nutritive suck assessment, and 6 components of the tongue tie screen. Parent and clinician satisfaction was high; SPs reported that they would offer telepractice services to 93% of families again in the future. Overall, the results demonstrated that most components of a bottle-feeding assessment could be reliably completed via synchronous telepractice in family homes. However, further research is required to improve the reliability of some intra-oral assessment components.
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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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Raatz M, Ward EC, Marshall J, Burns CL. Evaluating the Use of Telepractice to Deliver Pediatric Feeding Assessments. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1686-1699. [PMID: 34061575 DOI: 10.1044/2021_ajslp-20-00323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study aimed to investigate the interrater reliability of pediatric feeding assessments conducted via synchronous (real-time) telepractice. Secondary aims were to investigate parent and clinician satisfaction. Method The eating and/or cup drinking skills of 40 children (aged 4 months to 7 years) were simultaneously assessed by one speech-language pathologist (SLP) leading the appointment via telepractice and a second SLP present in the family home. A purpose-designed assessment form was used to assess (a) positioning, (b) development, (c) oral sensorimotor function, (d) prefeeding respiratory status, (e) observation of eating and drinking, (f) parent-child interaction, (g) overall feeding skills, and (h) feeding recommendations. The telepractice SLP completed a postappointment satisfaction questionnaire, and parents completed five questionnaires specifically investigating perceptions of and satisfaction with the telepractice feeding appointment. Results Agreement for all assessment components except intraoral examination (palate integrity and tonsils) was > 85%. All appointments were able to be conducted via telepractice, and for 90% of these (n = 36), clinicians agreed that telepractice was an effective service delivery method. Parents reported high levels of satisfaction with telepractice, with 76% reporting that the telepractice appointment was similar to a traditional in-person appointment. Conclusion Study results demonstrated that synchronous pediatric feeding assessments conducted in family homes via telepractice were feasible, reliable, and acceptable to both clinicians and parents. Supplemental Material https://doi.org/10.23641/asha.14700228.
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Affiliation(s)
- Madeline Raatz
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Jeanne Marshall
- Speech Pathology Department, Queensland Children's Hospital, South Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Clare L Burns
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology and Audiology Department, Royal Brisbane and Women's Hospital, Queensland, Australia
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Zang J, Nienstedt JC, Koseki JC, Nießen A, Flügel T, Kim SH, Pflug C. Pediatric Flexible Endoscopic Evaluation of Swallowing: Critical Analysis of Implementation and Future Perspectives. Dysphagia 2021; 37:622-628. [PMID: 33909132 PMCID: PMC8080860 DOI: 10.1007/s00455-021-10312-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/20/2021] [Indexed: 01/07/2023]
Abstract
This study aimed to critically review pediatric swallowing assessment data to determine the future need for standardized procedures. A retrospective analysis of 152 swallowing examinations in 128 children aged 21 days to 18 years was performed. The children were presented at a university dysphagia center between January 2015 and June 2020 for flexible-endoscopic evaluation of swallowing (FEES). Descriptive analysis was conducted for the sample, swallowing pathologies, diagnosis, and missing values. Using binary logistic regression, the relationship between dysphagia and underlying diseases was investigated. The largest group with a common diagnosis in the cohort were children with genetic syndromes (n = 43). Sixty-nine children were diagnosed with dysphagia and 59 without dysphagia. The non-dysphagic group included 15 patients with a behavioral feeding disorder. The presence of an underlying disease significantly increased the chance of a swallowing problem (OR 13.08, 95% CI 3.66 to 46.65, p = .00). In particular, the categories genetic syndrome (OR 2.60, 95% CI 1.15 to 5.88) and neurologic disorder (OR 4.23, 95% CI 1.31 to 13.69) were associated with higher odds for dysphagia. All pediatric FEES were performed without complications, with a completion rate of 96.7%, and with a broad variability of implementation. Several charts lacked information concerning swallowing pathologies, though. Generally, a more standardized protocol and documentation for pediatric FEES is needed to enable better comparability of studies on epidemiology, assessment, and treatment outcomes in future.
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Affiliation(s)
- Jana Zang
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Julie Cläre Nienstedt
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana-Christiane Koseki
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Almut Nießen
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Flügel
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susan Hyoungeun Kim
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Pflug
- Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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25
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Curtis JA, Laus J, Schneider SL, Troche MS. Examining the Relationships Between Lingual Strength, Perihyoid Strength, and Swallowing Kinematics in Dysphagic Adults: A Retrospective Cross-Sectional Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:405-416. [PMID: 33439740 DOI: 10.1044/2020_jslhr-20-00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to examine the relationships of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics and swallowing safety in a heterogenous group of dysphagic adults. Method A retrospective analysis was completed of videofluoroscopic swallow studies of consecutive dysphagic outpatient adults presenting to a tertiary swallowing center from January 1, 2015, to December 31, 2017. Videofluoroscopic swallow study records were included if containing displacement swallowing kinematics of a 20-ml single liquid swallow and clinical measures of anterior (L-MIPA) or posterior (L-MIPP) lingual maximal isometric press, saliva mean swallowing pressures (S-MSP), and/or open mouth-maximal isometric press (OM-MIP). Regression analyses were used to examine the relationships between clinical measures of lingual (L-MIPA, L-MIPP, S-MSP) and perihyoid (OM-MIP) strength and displacement swallowing kinematics, and binomial logistic regressions were used to examine the relationships between clinical measures of lingual and perihyoid strength and swallowing safety (Penetration-Aspiration Scale [PAS]). Results Multivariate regressions revealed significant relationships of L-MIPA, L-MIPP, S-MSP, and OM-MIP with group-level changes to the displacement swallowing kinematics. Univariate analyses revealed significant relationships of L-MIPA and L-MIPP with pharyngeal constriction ratio, maximal extent of upper esophageal segment opening, and PAS. Conclusions Weak relationships were identified of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics. These findings suggest that clinical measures of lingual and perihyoid strength do not fully explain impairments in swallowing kinematics across a heterogenous group of dysphagic patients. Weak-to-moderate relationships were identified between clinical measures of lingual strength and PAS, suggesting that they may have value in predicting functional measures of swallowing safety. Further research is needed to examine how findings may differ between specific patient populations.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Joey Laus
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Sarah L Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Jones CA, Colletti CM, Ding MC. Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep 2020; 20:61. [PMID: 33136216 PMCID: PMC7604228 DOI: 10.1007/s11910-020-01081-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW We explored themes in recent post-stroke dysphagia literature, focusing on the following questions: (1) What does post-stroke dysphagia look like?; (2) Who gets post-stroke dysphagia?; (3) What are the consequences of post-stroke dysphagia?; and (4) How can we improve treatment of post-stroke dysphagia? RECENT FINDINGS There have been several improvements in quantitative descriptions of swallowing physiology using standard and new evaluation techniques. These descriptions have been correlated with lesion locations, and several factors can predict development of post-stroke dysphagia and its sequelae. Novel treatment paradigms have leveraged post-stroke neuroplastic improvements using neurostimulation and biofeedback techniques. Despite recent findings, the field is limited by lack of standardization and unanswered questions on rehabilitation variables. Our improved understanding of post-stroke dysphagia will enhance our ability to prevent, identify, and treat it. Future work should be grounded in swallowing physiology and continue refining treatments, particularly in the acute stage.
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Affiliation(s)
- Corinne A Jones
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA. .,Speech, Language, & Hearing Sciences; Moody College of Communication, The University of Texas, Austin, TX, USA.
| | - Christina M Colletti
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
| | - Ming-Chieh Ding
- Neurology; Dell Medical School, The University of Texas, 1601 Trinity St. Bldg. B, Stop Z0700, Austin, TX, 78712, USA
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