Changes in the dysphagia and nutritional status of patients with brain injury

The effect of behavioral therapy on dysphagia of acute ischemic stroke patients feeding with a nasogastric tube

This prospective observational study aimed to assess the impact of behavioral therapy on dysphagia in patients with acute ischemic stroke undergoing nasogastric tube feeding. The study was conducted between June 2020 and May 2022 at the Neurological Center of Bach Mai Hospital, Vietnam, with a sample size of 230 patients divided into two groups: a normal and a behavioral therapy group. The normal therapy group received routine care and treatment based on standard protocols, while the behavioral therapy group underwent daily swallowing exercises for approximately 60 minutes. The Gugging Swallowing Screen (GUSS) was utilized to screen individuals with dysphagia, and the difference-in-differences (DID) method was adopted to estimate the effect of behavioral therapy on dysphagia patients. The study concluded that behavioral therapy improved dysphagia in patients with acute ischemic stroke undergoing nasogastric tube feeding. This study highlights the potential of behavioral therapy as an effective intervention for dysphagia rehabilitation in stroke patients.

Correlation between dysphagia and serum albumin levels and prognosis: a retrospective study

Introduction

Introduction: dysphagia is a common complication of stroke, and serum albumin is widely recognized as a strong prognostic marker of health and/or disease status. However, the correlation between dysphagia and serum albumin levels has not been established. Objectives: to observe the correlation between dysphagia and serum albumin levels and prognosis in patients with stroke. Methods: we performed a retrospective study of patients hospitalized between June 1, 2018, and June 1, 2022. A total of 1,370 patients were enrolled. The patients were divided into two groups: dysphagia and non-dysphagia. Binary logistic regression and multiple linear regression models were used to analyze the correlation between dysphagia, albumin, modified Rankin Scale (mRS), activities of daily living (ADL), and length of hospital stay (LOS). Results: after adjusting for confounding factors, the risk of pneumonia in the dysphagia group was 2.417 times higher than that in the non-dysphagia group (OR = 2.417, 95 % CI: 1.902-3.072, p = 0.000). The risk of mRS ≥ 3 and modified Barthel index (MBI) < 60 in patients with dysphagia was 3.272-fold (OR = 3.272, 95 % CI: 2.508-4.269, p < 0.001) and 1.670-fold (OR = 1.670, 95 % CI: 1.230-2.268, p < 0.001), respectively; and the risk of hypoproteinemia was 2.533 times higher (OR = 2.533, 95 % CI: 1.879-3.414, p = 0.000). Stepwise linear regression showed that dysphagia was significantly correlated with lower albumin levels and higher mRS, lower ADL, and longer LOS in patients with stroke (β = -0.220, β = 0.265, β = -0.210, and β = 0.147, respectively; p < 0.001). Conclusions: dysphagia in patients with stroke is associated with decreased albumin levels and has an impact on its prognosis.

Dysphagia and daily oral fluids among cerebrovascular stroke patients: an theory-based nursing intervention protocol

Objective

To evaluate the improvement of dysphagia and the daily amounts of oral fluids served among people who had recently experienced a cerebrovascular stroke (CVS) after applying a nursing intervention protocol.

Methods

A quasi-experimental design was used to examine 60 stroke patients who were randomly and alternatively divided equally into a study group and a control group. Gugging Swallowing Screen (GUSS) and fluid balance chart were used. Within the first 24 h of a patient’s admission, expert nurses were trained in nursing intervention protocol to manage dysphagia and daily oral fluids.

Results

Post-nursing intervention, the severity of dysphagia decreased among the study group more than in the control group. Additionally, the study group began taking greater amounts of fluids by the oral route than before the nursing intervention.

Conclusions

A standardized nursing intervention protocol is needed to decrease the severity of dysphagia after CVS and increase the amount of daily oral fluids. The presence of a structured theory-based nursing intervention protocol for dysphagia management will greatly contribute to decreasing the consequences of dysphagia after CVS, and can also be expected to attenuate the effects of aspiration pneumonia, dehydration, and malnutrition; further, it also increases adherence to the protocol by both nurses and patients.

Time Course and Characteristics of the Nutritional Conditions in Acute Traumatic Cervical Spinal Cord Injury

Introduction

This retrospective cohort study aimed to examine the nutritional time course and elucidate the critical period of undernutrition following acute traumatic cervical spinal cord injury (CSCI).

Methods

The study was performed at a single facility that treated spinal cord injuries. We examined individuals with acute traumatic CSCI admitted to our hospital within 3 days of injury. Both prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores, which objectively reflect nutritional and immunological conditions, were assessed at admission and 1, 2, and 3 months after the injury. The American Spinal Injury Association impairment scale (AIS) categorizations and severity of dysphagia were evaluated at these time points.

Results

A total of 106 patients with CSCI were evaluated consecutively for 3 months after injury. Individuals with AIS categorizations of A, B, or C at 3 days after injury were significantly more undernourished than those with an AIS categorization of D at 3 months after injury, indicating that individuals with mild paresis better maintained their nutritional condition after injury. Nutritional conditions, as assessed by both PNI and CONUT scores, improved significantly between 1 and 2 months after injury, whereas no significant differences were found between admission and 1 month after injury. Nutritional status and dysphagia were significantly correlated at each time point (p<0.001), indicating that swallowing dysfunction is an important factor associated with malnutrition.

Conclusions

Nutritional conditions showed significant gradual improvements from 1 month after the injury. We must pay attention to undernutrition, which is associated with dysphagia, especially in individuals with severe paralysis during the acute phase following injury.

Prevalence of signs of dysphagia and associated risk factors in geriatric patients admitted to an acute medical unit

BACKGROUND AND AIMS

Dysphagia is a prevalent disorder among the older persons. Despite this, signs of dysphagia often go unnoticed in hospital settings. This cross-sectional study aimed at investigating the prevalence of signs of dysphagia among patients aged 65 or older in a Danish acute care setting.

METHODS

We studied 334 patients aged 65 years or older admitted to the acute medical unit (AMU) at Aalborg University Hospital, Denmark. Signs of dysphagia were assessed using bedside screening tools including the Eating Assessment Tool (EAT-10), a 30 mL Water Swallowing Test (WST) and the Gugging Swallowing Screen tool (GUSS). Other risk factors were assessed using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS), the Nutritional Risk Screening 2002 (NRS), and the Charlson's Comorbidity Index (CCI).

RESULTS

Signs of dysphagia were identified in 144 of 334 (43.1%) patients. Geriatric patients with signs of dysphagia were significantly older (79.5 years [74; 85] vs. 77 years [72; 84], p = 0.025) and had higher CCI scores (3 points [2; 4] vs. 2 points [1; 4], p = 0.001) than those with normal swallowing capacity. Furthermore, a multivariate logistic regression model found signs of dysphagia to be independently associated with nutritional risk (OR = 2.169, 95% CI 1.313-3.582, p = 0.002), cerebrovascular disease (OR = 2.209, 95% CI 1.235-3.953, p = 0.008), chronic pulmonary disease (OR = 2.276, 95% CI 1.338-3.871, p = 0.002) and rheumatic disease (OR = 2.268, 95% CI 1.099-4.683, p = 0.027). Age was not independently associated with signs of dysphagia among the geriatric patients.

CONCLUSION

Signs of dysphagia were common among patients aged 65 or older in the acute care setting. Signs of dysphagia were associated with nutritional risk, higher CCI scores and specific comorbidities. These findings could indicate a need for systematic screening for dysphagia in acute geriatric patients, yet further investigation is needed to assess clinical outcomes associated with dysphagia within this population.

The Basics of Nutrition: A Primary Rehabilitation Intervention

Nutrition, the process by which a body nourishes itself through the transformation of food into energy and body tissues, is the most important factor in health maintenance, response to injury or illness, short-term and long-term rehabilitation, and longevity. Most rehabilitation providers and the individuals they treat have limited training and knowledge on even the basics of nutrition. An appropriate diet for individuals who are either in a health maintenance or an active program of rehabilitation includes 1500 to 2500 calories per day delivered via a balanced range of foodstuffs, preferably in a whole-food, plant-based manner.

Re-Establishing Solid Food Consumption in a Person With Traumatic Brain Injury and Extended Food Avoidance/Restriction Using a Multicomponent Behavioral Intervention

We describe and report the results of a multicomponent behavioral intervention for re-establishing solid food consumption in a 26-year-old woman with prolonged food avoidance and restriction which developed following a traumatic brain injury. The intervention was evaluated by direct measurement of daily meal consumption over a period of several months, including an extended follow-up, and resulted in successful resumption of oral feeding. A complicating paroxysmal movement disorder resolved during treatment as well and resolution of the presenting problem led to significant quality of life improvements. We discuss the relationship of the presenting symptoms to avoidant/restrictive food intake disorder and to food rejection behavior seen when substantial damage has occurred to the parietal lobe. The case illustrates the value of assessment-based, individualized intervention design and an integrated neurobehavioral case conceptualization.