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Sugahara T, Nagami S, Sato R, Ishizaki N, Fujishima I, Aikawa F. Long-term rehabilitation with interferential current stimulation for persistent dysphagia in anti-N-methyl-d-aspartate receptor encephalitis: A case report. Clin Case Rep 2024; 12:e9307. [PMID: 39135769 PMCID: PMC11317889 DOI: 10.1002/ccr3.9307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024] Open
Abstract
Anti-N-methyl-d-aspartate receptor encephalitis is an autoimmune disorder characterized by various neurological symptoms with a relatively favorable prognosis. We present a case of prolonged dysphagia successfully managed with outpatient rehabilitation, including interferential current stimulation and resistance exercises. Significant improvement was observed, highlighting the efficacy of combined treatment in overcoming chronic dysphagia.
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Affiliation(s)
- Takahiro Sugahara
- Department of RehabilitationAikawa Clinic, Medical CorporationYamaguchiJapan
| | - Shinsuke Nagami
- Department of Communication Disorders, School of Rehabilitation SciencesHealth Sciences University of HokkaidoTobetsuHokkaidoJapan
| | - Ryota Sato
- Department of Neurology and Clinical NeuroscienceYamaguchi University Graduate School of MedicineYamaguchiJapan
| | - Naohiko Ishizaki
- Department of RehabilitationAikawa Clinic, Medical CorporationYamaguchiJapan
| | - Ichiro Fujishima
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalShizuokaJapan
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Watanabe S, Kanaya T, Iwasaki T, Morita Y, Suzuki S, Iida Y. Association of early oral intake after extubation and independent activities of daily living at discharge among intensive care unit patients: A single centre retrospective cohort study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 26:584-594. [PMID: 37357786 DOI: 10.1080/17549507.2023.2221408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
PURPOSE We investigated the association between the time to first post-extubation oral intake, barriers to oral intake, and the rate of activities of daily living (ADL) independence at discharge (Barthel Index score <70). METHOD Consecutive patients admitted to the intensive care unit, aged ≥18 years, and mechanically ventilated for ≥48 hr were retrospectively enrolled. The time to first oral intake, barriers to oral intake, daily changes, and clinical outcomes were assessed. Multiple logistic regression analysis adjusted for baseline characteristics was used to determine the association between time to first post-extubation oral intake and ADL independence. RESULT Among the 136 patients, 74 were assigned to the ADL independence group and 62 to the dependence group. The time to first post-extubation oral intake was significantly associated with ADL independence (adjusted p = < 0.001) and was a predictor of ADL independence at discharge. Respiratory and dysphagia-related factors (odds ratio [OR] 0.35; 95% confidence interval [CI] 0.15-0.82, p = 0.015 and OR 0.07; CI 0.01-0.68, p = 0.021, respectively) were significantly associated with the ADL independence at discharge. CONCLUSION Respiratory and dysphagia-related factors, as barriers to the initiation of oral intake after extubation, were significantly associated with ADL independence at discharge.
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Affiliation(s)
- Shinichi Watanabe
- Department of Rehabilitation Medicine, Nagoya Medical Centre, Aichi, Japan
- Department of Physical Therapy, Gifu University of Health Science, Gifu, Japan
| | - Takahiro Kanaya
- Department of Rehabilitation Medicine, Hokkaido Medical Centre, Hokkaido, Japan
| | - Takumi Iwasaki
- Department of Rehabilitation Medicine, Nagoya Medical Centre, Aichi, Japan
| | - Yasunari Morita
- Department of Critical Care Medicine, Nagoya Medical Centre, Aichi, Japan
| | - Shuichi Suzuki
- Department of Critical Care Medicine, Nagoya Medical Centre, Aichi, Japan
| | - Yuki Iida
- Department of Physical Therapy, Toyohashi Sozo University, Aichi, Japan
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Hattori T, Mitani N, Numasawa Y, Azuma R, Orimo S. Simultaneous Four Supratentorial Lesions Predict Tube Dependency Due to an Impaired Anticipatory Phase of Ingestion. Transl Stroke Res 2024; 15:761-772. [PMID: 37249762 DOI: 10.1007/s12975-023-01162-4] [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: 08/06/2022] [Revised: 04/23/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
This study aimed to identify the neuroanatomical predictors of oropharyngeal dysphagia and tube dependency in patients with supratentorial or infratentorial ischemic strokes. Patients with acute ischemic stroke were enrolled and were classified into 3 groups: right supratentorial (n = 61), left supratentorial (n = 89), and infratentorial stroke (n = 50). Dysphagia was evaluated by a modified water swallowing test and the Food Intake LEVEL Scale to evaluate oropharyngeal dysphagia and tube dependency, respectively. As two dysphagia parameters, we evaluated the durations from onset of stroke to (1) success in the modified water swallowing test and to (2) rating 7 points or above on the Food Intake LEVEL Scale: patients regained sufficient oral intake and were not tube-dependent. Voxel-based lesion-symptom mapping analysis was performed for a spatially normalized lesion map of magnetic resonance imaging to explore the anatomies that are associated with the two dysphagia parameters for each stroke group. The right precentral gyrus and parts of the internal capsule are associated with oropharyngeal dysphagia. The four supratentorial areas are associated with tube dependency. The dorsal upper medulla is associated with both oropharyngeal dysphagia and tube dependency. These results suggest that supratentorial stroke patients can be tube-dependent due to an impaired anticipatory phase of ingestion. The simultaneous damage in the four supratentorial areas: the inferior part of the precentral gyrus, lenticular nucleus, caudate head, and anterior insular cortex, predicts tube dependency. In contrast, infratentorial stroke patients can be tube-dependent due to oropharyngeal dysphagia caused by lesions in the dorsal upper medulla, damaging the swallowing-related nucleus.
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Affiliation(s)
- Takaaki Hattori
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan.
| | - Naoko Mitani
- Division of Rehabilitation, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshiyuki Numasawa
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan
| | - Reo Azuma
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
| | - Satoshi Orimo
- Department of Neurology, Kanto Central Hospital, Tokyo, Japan
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Yoshizawa K, Yagi T, Uchida T, Moriguchi T, Moroi A, Ueki K. Concomitant pyogenic spondylodiscitis and empyema following tongue cancer resection and wisdom tooth extraction: A case report and literature review. Medicine (Baltimore) 2024; 103:e39087. [PMID: 39058851 PMCID: PMC11272347 DOI: 10.1097/md.0000000000039087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Pyogenic spondylodiscitis is an infectious spinal disease that causes significant motor dysfunctions. Its diagnosis can be challenging owing to its rapid onset and nonspecific symptoms. PATIENT CONCERNS A 79-year-old Japanese man with a history of type 2 diabetes mellitus and polymyalgia rheumatica presented to our department with tongue pain. Following partial glossectomy and wisdom tooth extraction under general anesthesia, on 10 postoperative day (POD) the patient developed right-sided abdominal pain and difficulty in walking. On 12 POD, the patient was admitted to a municipal hospital due to respiratory distress and paraplegia. DIAGNOSES The patient was diagnosed with pyogenic spondylodiscitis and empyema. Blood tests revealed elevated C-reactive protein levels (36.5), white blood cell count (19,570), and neutrophil count (17,867). INTERVENTIONS The patient received meropenem hydrate 3 g/2 days as empiric antibiotic treatment for acute infection. Upon admission to the emergency department on 16 POD, the lung abscess was drained, hemilaminectomy was performed. OUTCOMES Blood cultures, sputum tests, and cultures from the thoracic and spinal abscesses drained during surgery revealed methicillin-sensitive Staphylococcus aureus. The infection was successfully managed, and the respiratory disturbance and inflammatory response improved. However, the lower half of the patient body remained paralyzed. Subsequently, the patient was transferred to a rehabilitation facility on 45 POD. The patient continued to undergo functional restoration training, gradually regained function, and eventually achieved the ability to walk with grasping gait. LESSONS This is the first case report of S aureus causing pyogenic spondylodiscitis and empyema due to blood stream infection from a post-oral surgical wound. Pyogenic spondylodiscitis arising from a secondary hematogenous infection is difficult to diagnose and can lead to severe functional impairment. Prompt and appropriate diagnosis and treatment based on detailed patient interviews, additional blood tests, and computed tomography are essential.
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Affiliation(s)
- Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Takashi Yagi
- Departments of Neurosurgery, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Tsuyoshi Uchida
- Department of General Thoracic Surgery, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Takeshi Moriguchi
- Department of Emergency and Critical Care Medicine, School of Medicine, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo City, Yamanashi, Japan
| | - Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo City, Yamanashi, Japan
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Kiyomiya Y, Fujiu-Kurachi M, Hirata A, Nakasone W, Azuma M, Kishida S, Tsuda G. Morphological and functional changes of the geniohyoid muscle in elderly patients after hip fracture surgery: Comparison of ultrasound images with a focus on swallowing function. J Oral Rehabil 2024; 51:870-878. [PMID: 38214198 DOI: 10.1111/joor.13650] [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: 04/26/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The purpose of this study was to clarify, using ultrasound imaging, (1) whether the area and contraction of GH change in elderly patients after hip fracture surgery and (2) whether the changes in the area and contraction of GH are related to decline in swallowing function. METHODS The participants were 21 female patients over 65 years of age who underwent hip fracture surgery. The patients were divided into two groups based on the results of swallowing assessment by water drinking: One with normal swallowing function (NSF) and the other with suspected decline in swallowing function (DSF). Sagittal cross-sectional area (SA) of GH at rest and the shortening rate (SR) of GH upon contraction during swallowing were compared at two time points: immediately and 2 weeks after surgery. Wilcoxon signed-rank test was used for intra-group comparisons, and Mann-Whitney U-test was used for between-group comparisons. RESULT SA of GH decreased significantly at 2 weeks after surgery in both groups, regardless of their swallowing function. In the intra-group comparison, SR significantly decreased (worsened) only in DSF group. SR at 2 weeks after surgery was significantly higher in NSF than in the DSF. In the inter-group comparison, DSF showed a significantly smaller (worse) change of SR than NSF in 2 weeks after surgery. CONCLUSION Decrease in muscle mass, or atrophy, of GH observed in both NSF and DSF, did not coincide with the post-operative change in GH contraction of the two groups. The results suggest the importance of continuous swallowing assessment in the elderly individuals during their perioperative period.
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Affiliation(s)
- Yuto Kiyomiya
- Department of Rehabilitation, Seirei akura Citizen Hospital, Chiba, Japan
- Department of Speech, Language and Hearing Sciences, International University of Health and Welfare Graduate School, Chiba, Japan
| | - Masako Fujiu-Kurachi
- Department of Speech and Hearing Sciences, International University of Health and Welfare, Chiba, Japan
| | - Aya Hirata
- Department of Speech and Hearing Sciences, International University of Health and Welfare, Tochigi, Japan
| | - Waku Nakasone
- Department of Otolaryngology, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Masaki Azuma
- Department of Surgery, Takane Hospital, Chiba, Japan
| | - Shunji Kishida
- Department of Orthopaedic Surgery, Seirei Sakura Citizen Hospital, Chiba, Japan
| | - Gota Tsuda
- Department of Otolaryngology, Seirei Sakura Citizen Hospital, Chiba, Japan
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Nakamori M, Toko M, Yamada H, Hayashi Y, Haruta A, Hiraoka A, Yoshikawa M, Nagasaki T, Ushio K, Yoshikawa K, Shimizu Y, Mikami Y, Maruyama H. Detailed findings of videofluoroscopic examination among patients with Parkinson's disease on the effect of cervical percutaneous interferential current stimulation. Front Neurol 2023; 14:1279161. [PMID: 38020611 PMCID: PMC10664245 DOI: 10.3389/fneur.2023.1279161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Parkinson's disease (PD) leads to various types of swallowing disorders. We investigated the effect of cervical percutaneous interferential current stimulation on dysphagia. By conducting detailed qualitative and quantitative analysis of videofluoroscopic examination, we aimed to understand dysphagia in patients with PD and investigate its effects on swallowing function. Methods Patients received cervical percutaneous interferential current stimulation for 20 min twice a week for 8 weeks. In this exploratory study, we evaluated aspiration/laryngeal penetration, oral cavity residue, vallecular residue, and pharyngeal residue. In addition, we performed temporal analysis. Results Twenty-five patients were completely evaluated. At baseline, the proportions of laryngeal penetration/aspiration, oral cavity residue, epiglottic vallecula residue, and pharyngeal residue were 40.0, 88.0, 72.0, 60.0, and 16.0%, respectively. Conversely, pharyngeal transit time, laryngeal elevation delay time, pharyngeal delay time, and swallowing reflex delay were nearly within the normal ranges. Cervical percutaneous interferential current sensory stimulation improved only oral cavity residue at the end of the intervention, from 88.0 to 56.0%. Discussion Patients with PD demonstrated remarkably high frequencies of residues in the oral and pharyngeal regions. The usefulness of cervical interferential current stimulation was partially demonstrated for oral cavity residue. Considering that PD exhibits diverse symptoms, further accumulation of cases and knowledge is warranted. Trial registration jRCTs062220013.
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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
| | - Megumi Toko
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hidetada Yamada
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Azusa Haruta
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Aya Hiraoka
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kai Ushio
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Kohei Yoshikawa
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshitaka Shimizu
- Department of Dental Anesthesiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukio Mikami
- Department of Rehabilitation Medicine, Hiroshima University Hospital, 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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Chojin Y, Okamoto N, Noguchi S, Fube Y, Aritake Y, Shiraki M, Izumitani K, Suzuki M, Omori M, Kato T, Mukae H, Yatera K. Clinical efficacy of assessment of swallowing ability for pneumonia and other assessment tools for occurrence and mortality from pneumonia among older inpatients in a long-term care hospital. Respir Investig 2023; 61:651-659. [PMID: 37531712 DOI: 10.1016/j.resinv.2023.06.008] [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: 10/08/2022] [Revised: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Aspiration pneumonia is an important condition in elderly patients and detecting dysphagia early can help clinicians identify patients with a high risk of aspiration pneumonia. We previously reported the usefulness of the Assessment of Swallowing Ability for Pneumonia (ASAP) in predicting the occurrence of and mortality from pneumonia in patients in acute care hospitals; however, there are very few reports on the utility of this screening test for patients in stable condition. METHODS Elderly patients in stable condition (n = 133) without pneumonia were prospectively enrolled. Associations between ASAP, Functional Independence Measure (FIM), Controlling Nutrition Status (CONUT), and Charlson Co-morbidity Index (CCI) scores and occurrence of/mortality from pneumonia during hospitalization were evaluated. RESULTS The occurrence of pneumonia was observed in 27 (20.3%) patients, and 18 (13.5%) died during hospitalization. Multivariate analysis showed that low ASAP score and low FIM motor were independent predictors for the occurrence of pneumonia, and low ASAP score was an independent predictor for mortality from pneumonia. Areas under the curve for ASAP, FIM motor, FIM cognition, and CONUT scores were 0.895 (95% confidence interval [CI], 0.829-0.960), 0.913 (95% CI, 0.860-0.968), 0.841 (95% CI, 0.761-0.921), and 0.753 (95% CI, 0.649-0.858), respectively, for occurrence, and 0.881 (95% CI, 0.807-0.955), 0.904 (95% CI, 0.860-0.949), 0.829 (95% CI, 0.727-0.931), 0.746 (95% CI, 0.617-0.874), respectively, for mortality. CONCLUSION The ASAP and FIM motor are useful for predicting the occurrence of and mortality from pneumonia in elderly inpatients in long-term care hospitals.
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Affiliation(s)
- Yasuo Chojin
- Department of Respiratory Medicine, Kitakyushu Central Hospital, Japan.
| | - Naoki Okamoto
- Department of Respiratory Medicine, Kitakyushu Central Hospital, Japan
| | - Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Yukiko Fube
- Department of Rehabilitation, Kitakyushu Central Hospital, Japan
| | - Yohei Aritake
- Department of Rehabilitation, Kitakyushu Central Hospital, Japan
| | | | - Kayo Izumitani
- Department of Pharmacy, Kitakyushu Central Hospital, Japan
| | - Mayumi Suzuki
- Department of Clinical Laboratory, Kitakyushu Central Hospital, Japan
| | - Masami Omori
- Department of Rehabilitation, Tobata Kyoritsu Hospital, Japan
| | - Tatsuji Kato
- Department of Respiratory Medicine, Tobata Kyoritsu Hospital, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
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Hongo T, Yumoto T, Naito H, Fujiwara T, Kondo J, Nozaki S, Nakao A. Frequency, associated factors, and associated outcomes of dysphagia following sepsis. Aust Crit Care 2022:S1036-7314(22)00089-3. [PMID: 35851194 DOI: 10.1016/j.aucc.2022.06.003] [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: 11/19/2020] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Identifying dysphagia as a potential complication of sepsis may improve swallowing function and survival while decreasing hospital length of stay. OBJECTIVES Our goal was to determine the frequency of dysphagia in sepsis survivors on the 7th day after admission, as well as their associated factors and outcomes. METHODS This single-centre, retrospective, observational study analysed data from sepsis survivors admitted to Okayama Saiseikai General Hospital from 2018 to 2019. Participants with sepsis were assigned to one of two study groups based on the presence or absence of dysphagia using the criterion of Functional Oral Intake Scale score <5 on the 7th day after admission. We used multivariate logistic regression to determine factors independently associated with dysphagia on the 7th day after admission. Multivariate logistic regression was also used to determine associations between groups and outcomes, including dysphagia on hospital discharge, direct discharge home (discharge of patients directly to their home), and total dependency (Barthel Index score ≤20) on hospital discharge. RESULTS One hundred one patients met the study inclusion criteria, 55 with dysphagia and 46 without dysphagia. Fasting period (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) and enteral tube feeding (AOR: 8.56, 95% CI: 1.95-37.5) were independently associated with the presence of dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was associated with dysphagia on hospital discharge (AOR: 46.0, 95%, CI: 7.90-268.3), a lower chance of direct discharge home (AOR: 0.03, 95% CI: 0.01-0.15), and a higher incidence of total dependency (AOR: 9.30, 95% CI: 2.68-32.2). CONCLUSIONS We found that dysphagia was commonly encountered post sepsis. Fasting period and enteral tube feeding were independently associated with dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was also associated with dysphagia on hospital discharge, nondirect discharge home, and dependency in activities of daily living at the time of hospital discharge.
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Affiliation(s)
- Takashi Hongo
- Okayama Saiseikai General Hospital, Emergency Department, Japan; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan
| | - Tetsuya Yumoto
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan
| | - Hiromichi Naito
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan.
| | | | - Jun Kondo
- Okayama Saiseikai General Hospital, Department of Internal Medicine, Japan
| | - Satoshi Nozaki
- Okayama Saiseikai General Hospital, Emergency Department, Japan
| | - Atsunori Nakao
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan
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Hongo T, Yamamoto R, Liu K, Yaguchi T, Dote H, Saito R, Masuyama T, Nakatsuka K, Watanabe S, Kanaya T, Yamaguchi T, Yumoto T, Naito H, Nakao A. Association between timing of speech and language therapy initiation and outcomes among post-extubation dysphagia patients: a multicenter retrospective cohort study. Crit Care 2022; 26:98. [PMID: 35395802 PMCID: PMC8991938 DOI: 10.1186/s13054-022-03974-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/31/2022] [Indexed: 02/07/2023] Open
Abstract
Background Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. Methods We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score < 5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. Results A total of 272 patients were included. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation were 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02–1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05–1.55), 14th day (AOR, 1.34; 95% CI, 1.13–1.58), or 28th day (AOR, 1.21; 95% CI, 1.07–1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02–1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97–1.12). Conclusions Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation. A randomized controlled study is needed to validate these results. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03974-6.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutaityo, Okayama Kita-ku, Okayama, 700-8511, Japan.,Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-honmachi, Kyoto Sakyo-ku, Kyoto, 606-8501, Japan
| | - Keibun Liu
- Critical Care Research Group, Faculty of Medicine, University of Queensland, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD, 4032, Australia
| | - Takahiko Yaguchi
- Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-0041, Japan
| | - Hisashi Dote
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka, 430-8558, Japan
| | - Ryusuke Saito
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka, 430-8558, Japan
| | - Tomoyuki Masuyama
- Department of Emergency, Misato Kenwa Hospital, 4-494-1 Takano, Misato, Saitama, 341-0035, Japan
| | - Kosuke Nakatsuka
- Department of Anesthesiology, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama Minami-ku, Okayama, 702-8055, Japan
| | - Shinichi Watanabe
- Department of Rehabilitation, Nagoya Medical Center, NHO, 4-1-1 Sannomaru, , Nagoya Naka-ku, Aichi, 461-0001, Japan
| | - Takahiro Kanaya
- Department of Rehabilitation, Hokkaido Medical Center, NHO, 7-1-1 Yamanote5jo, Sapporo Nishi-ku, Hokkaido, 063-0005, Japan
| | - Tomoya Yamaguchi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, 2-897-5 Shichijonishimachi, Nara, Nara, 630-8581, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan.
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan
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10
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Are Oropharyngeal Dysphagia Screening Tests Effective in Preventing Pneumonia? J Clin Med 2022; 11:jcm11020370. [PMID: 35054063 PMCID: PMC8780873 DOI: 10.3390/jcm11020370] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
Oropharyngeal dysphagia, a clinical condition that indicates difficulty in moving food and liquid from the oral cavity to the esophagus, has a markedly high prevalence in the elderly. The number of elderly people with oropharyngeal dysphagia is expected to increase due to the aging of the world's population. Understanding the current situation of dysphagia screening is crucial when considering future countermeasures. We report findings from a literature review including citations on current objective dysphagia screening tests: the Water Swallowing Test, Mann Assessment of Swallowing Ability, and the Gugging Swallowing Screen. Pneumonia can be predicted using the results of the screening tests discussed in this review, and the response after the screening tests is important for prevention. In addition, although interdisciplinary team approaches prevent and reduce aspiration, optimal treatment is a challenging. Intervention studies with multiple factors focusing on the elderly are needed.
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11
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Li B, Zhang T, Zhao J, Li P, Wu Z, Zhao S. Can non-swallowing function assessment predict nasogastric tube removal in patients with poststroke dysphagia? A clinical study. Front Neurol 2022; 13:984707. [PMID: 36938369 PMCID: PMC10014454 DOI: 10.3389/fneur.2022.984707] [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: 07/02/2022] [Accepted: 10/03/2022] [Indexed: 03/04/2023] Open
Abstract
Objective This study aimed to predict nasogastric tube (NGT) removal in patients with poststroke dysphagia (PSD) by non-swallowing function assessment. Methods We enrolled 232 eligible patients and performed rehabilitation. The Fugl-Meyer assessment motor (FMM) and National Institute of Health Stroke Scale (NIHSS) scores were used to measure the motor and overall nervous system functions. Predictors for NGT removal in patients with PSD after rehabilitation were analyzed. Results Of the 232 included patients, the NGTs were removed from 78% of them, while 22% were dependent on a feeding tube after 4 weeks of rehabilitation. Compared to the preserved NGT group, older age, a higher rate of intubation or tracheostomy, and more severe baseline functions were found in the NGT removal group. Age [odds ratio (OR) = 0.907; 95% confidence interval (CI): 0.859-0.957; p = 0.000], difference in the FMM score after 4 weeks of rehabilitation (OR = 1.219; 95% CI: 1.145-1.299; p = 0.00), and item 9 of NIHSS (OR = 0.488; 95% CI: 0.252-0.946; p = 0.034) were predictors of NGT removal after rehabilitation. Conclusion We established a predictive model in patients with PSD using a non-swallowing assessment, which enabled us to predict swallowing recovery based on the non-swallowing function.
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12
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Bordoni B, Escher AR. A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models. Cureus 2021; 13:e18658. [PMID: 34659928 PMCID: PMC8503936 DOI: 10.7759/cureus.18658] [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] [Accepted: 10/11/2021] [Indexed: 12/19/2022] Open
Abstract
The five osteopathic models recognized by the American Association of Colleges of Osteopathic Medicine guide clinicians in the evaluation and therapeutic choice which must be the most appropriate concerning the patient's needs. Skeletal muscles represent an important interpretation, such as screening and treatment, on which these models are based. A muscle district that is not considered by the usual osteopathic practice is the tongue. The lingual complex has numerous functions, both local and systemic; it can adapt negatively in the presence of pathology, just as it can influence the body system in a non-physiological manner if it is a source of dysfunctions. This paper, the first of its kind in the panorama of scientific literature, briefly reviews the anatomy and neurophysiology of the tongue, trying to highlight the logic and the need to insert this muscle in the context of the five osteopathic models. The clinician's goal is to restore the patient's homeostasis, and we believe that this task is more concrete if the patient is approached after understanding all the contractile districts, including the tongue.
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Affiliation(s)
- Bruno Bordoni
- Physical Medicine and Rehabilitation, Don Carlo Gnocchi Foundation, Milan, ITA
| | - Allan R Escher
- Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
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13
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The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168443. [PMID: 34444198 PMCID: PMC8394130 DOI: 10.3390/ijerph18168443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 01/31/2023]
Abstract
Severe dysphagia leads to mortality in older patients and hinders their discharge from hospitals. The temporal flat lateral position (TFLP) enables them to continuously eat, thus resolving the aforementioned issues. We aimed to explore the effect of TFLP on the mortality and discharge rates of older patients with severe dysphagia. This interventional study comprised a historical control of patients admitted to a rural community hospital from January 2019 to December 2020 and diagnosed with severe dysphagia. The primary outcomes included the mortality and the rate of discharge from the hospital. While the intervention group was treated with TFLP, the control group underwent no treatment. We selected 79 participants (intervention group = 26, control group = 53), with an average age of 87.9 years. The discharge rate was significantly higher in the intervention group than in the control group (57.7% vs. 26.4%, p = 0.012). The mortality rate was also significantly lower in the intervention group compared to the control group (34.6% vs. 71.7%, p = 0.003). TFLP can improve the discharge and mortality rates in community hospitals, thereby improving patient outcomes. Clinicians should focus on practical education and the implementation of TFLP in communities in order to promote it.
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14
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Yoshizawa K, Moroi A, Iguchi R, Yokomichi H, Ogihara S, Watanabe K, Nakajima K, Kirito K, Ueki K. Association between the point-rating system used for oral health and the prevalence of Gram-negative bacilli in hematological inpatients: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e26111. [PMID: 34087858 PMCID: PMC8183721 DOI: 10.1097/md.0000000000026111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
Gram-negative bacteremia is a major cause of death among hematology inpatients who require heavy-dose chemotherapy and hematopoietic stem cell transplantation. Gram-negative bacillus (GNB) is more likely to be detected when the oral health is poor. However, there is a dearth of studies on the relationship between oral assessment and prevalence of GNB in hematology inpatients.This retrospective study aimed to evaluate the relationship between the original point-rating system for oral health examinations (point-oral exam) and the prevalence of GNB in hematology inpatients at the hematology ward of the Yamanashi University Hospital. GNB was detected by cultivating samples from the sputum and blood of each patient.A total of 129 subjects underwent a medical checkup and point-oral exam. The sputum and blood culture results of 55 patients were included in this study. The total points of patients positive for GNB (n = 25, 45.5%) were significantly higher than those who were negative for GNB (total score: median, 25th, 75th, percentile; 6 [4, 7] vs 2 [1, 4]; P = .00016). Based on the receiver operating characteristic analysis, a cutoff score of 5 proved to be most useful to detect GNB.An oral evaluation with a cutoff value of 5 or higher in the point-oral exam might indicate the need for a more thorough oral management to prevent the development of systemic infections from GNB.
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Affiliation(s)
- Kunio Yoshizawa
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi
| | - Akinori Moroi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi
| | - Ran Iguchi
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi
| | | | | | | | - Kei Nakajima
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Keita Kirito
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Koichiro Ueki
- Department of Oral and Maxillofacial Surgery, Division of Medicine, Interdisciplinary Graduate School, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi
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