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Sekimoto Y, Matsuo K, Sakai A, Shibata S, Minakuchi S. Improvement of oral function and its impact on oral food intake in subacute stroke patients: A prospective study with dental intervention. J Oral Rehabil 2024; 51:1365-1372. [PMID: 38651211 DOI: 10.1111/joor.13711] [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: 11/24/2023] [Revised: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The association between oral food intake and oral function during the subacute stage of stroke is not well known. OBJECTIVE To investigate (1) oral function changes in subacute stroke patients and (2) association between oral function and oral intake status at several time points. METHODS In a prospective study involving 324 stroke patients at a convalescent rehabilitation unit, four oral function parameters (maximum tongue pressure, MTP; lip-tongue motor function, LTMF; maximum occlusal force, MOF and oral health assessment tool, OHAT) were quantitatively measured upon admission (T0), at 1 month (T1) and 2 months (T2). Oral feeding status was assessed using the Functional Oral Intake Scale (FOIS) and divided based on the FOIS score into the dysphagic and regular diet groups. The changes in oral functions at the three time points were tested using generalized estimating equation analysis. The association between FOIS groups and oral functions at T1 and T2 was analysed by means of logistic regression analysis. RESULTS All oral function parameters improved significantly over time during the hospital stay (mean differences: 4.9 for MTP, 0.6 for LTMF, 1.1 for MOF and -1.8 for OHAT). The FOIS groups were significantly associated with MTP (p < .05) and OHAT (p < .05) at both T1 and T2. CONCLUSION Our findings suggest that oral function significantly improves in patients during subacute stroke rehabilitation and better oral health can be associated with better oral intake. Improved oral function through dental intervention and oral rehabilitation may contribute to gains in oral food intake.
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Affiliation(s)
- Yu Sekimoto
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Dentistry, PL General Hospital, Medical Corporation Hosho, Tokyo, Japan
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Koichiro Matsuo
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayu Sakai
- Department of Dentistry and Oral-Maxillofacial Surgery, Fujita Health University Hospital, Toyoake, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Shunsuke Minakuchi
- Department of Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Wang Y, Ye Y, Shi S, Mao K, Zheng H, Chen X, Yan H, Lu Y, Zhou Y, Ye W, Ye J, Han JJ. Prediagnosis recognition of acute ischemic stroke by artificial intelligence from facial images. Aging Cell 2024; 23:e14196. [PMID: 38845183 PMCID: PMC11320352 DOI: 10.1111/acel.14196] [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: 01/01/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 08/15/2024] Open
Abstract
Stroke is a major threat to life and health in modern society, especially in the aging population. Stroke may cause sudden death or severe sequela-like hemiplegia. Although computed tomography (CT) and magnetic resonance imaging (MRI) are standard diagnosis methods, and artificial intelligence models have been built based on these images, shortage in medical resources and the time and cost of CT/MRI imaging hamper fast detection, thus increasing the severity of stroke. Here, we developed a convolutional neural network model by integrating four networks, Xception, ResNet50, VGG19, and EfficientNetb1, to recognize stroke based on 2D facial images with a cross-validation area under curve (AUC) of 0.91 within the training set of 185 acute ischemic stroke patients and 551 age- and sex-matched controls, and AUC of 0.82 in an independent data set regardless of age and sex. The model computed stroke probability was quantitatively associated with facial features, various clinical parameters of blood clotting indicators and leukocyte counts, and, more importantly, stroke incidence in the near future. Our real-time facial image artificial intelligence model can be used to rapidly screen and prediagnose stroke before CT scanning, thus meeting the urgent need in emergency clinics, potentially translatable to routine monitoring.
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Affiliation(s)
- Yiyang Wang
- Peking‐Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB)Peking UniversityBeijingChina
- Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, Chinese Academy of SciencesUniversity of Chinese Academy of SciencesShanghaiChina
| | - Yunyan Ye
- Emergency Department, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shengyi Shi
- Emergency Department, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Kehang Mao
- Peking‐Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB)Peking UniversityBeijingChina
| | - Haonan Zheng
- Peking‐Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB)Peking UniversityBeijingChina
| | - Xuguang Chen
- Emergency Department, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hanting Yan
- Emergency Department, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yiming Lu
- Emergency Department, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Geriatrics, International Laboratory in Hematology and Cancer, Medical Center on Aging of Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of MedicineRuijin Hospital/CNRS/Inserm/Cote d'Azur UniversityShanghaiChina
- The State Key Laboratory of Medical GenomicsPole Sino‐Francais de Recherche en Sciences Du Vivant et GenomiqueShanghaiChina
| | - Yong Zhou
- Clinical Research Institute, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Weimin Ye
- School of Public HealthFujian Medical UniversityFuzhouChina
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Jing Ye
- Emergency Department, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Geriatrics, International Laboratory in Hematology and Cancer, Medical Center on Aging of Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of MedicineRuijin Hospital/CNRS/Inserm/Cote d'Azur UniversityShanghaiChina
- The State Key Laboratory of Medical GenomicsPole Sino‐Francais de Recherche en Sciences Du Vivant et GenomiqueShanghaiChina
| | - Jing‐Dong J. Han
- Peking‐Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Center for Quantitative Biology (CQB)Peking UniversityBeijingChina
- Peking University Chengdu Academy for Advanced Interdisciplinary BiotechnologiesChengduChina
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Oliveira GC, Ngo QC, Passos LA, Oliveira LS, Papa JP, Kumar D. Facial expressions to identify post-stroke: A pilot study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108195. [PMID: 38692251 DOI: 10.1016/j.cmpb.2024.108195] [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: 08/31/2023] [Revised: 01/22/2024] [Accepted: 04/21/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Timely stroke treatment can limit brain damage and improve outcomes, which depends on early recognition of the symptoms. However, stroke cases are often missed by the first respondent paramedics. One of the earliest external symptoms of stroke is based on facial expressions. METHODS We propose a computerized analysis of facial expressions using action units to distinguish between Post-Stroke and healthy people. Action units enable analysis of subtle and specific facial movements and are interpretable to the facial expressions. The RGB videos from the Toronto Neuroface Dataset, which were recorded during standard orofacial examinations of 14 people with post-stroke (PS) and 11 healthy controls (HC) were used in this study. Action units were computed using XGBoost which was trained using HC, and classified using regression analysis for each of the nine facial expressions. The analysis was performed without manual intervention. RESULTS The results were evaluated using leave-one-our validation. The accuracy was 82% for Kiss and Spread, with the best sensitivity of 91% in the differentiation of PS and HC. The features corresponding to mouth muscles were most suitable. CONCLUSIONS This pilot study has shown that our method can detect PS based on two simple facial expressions. However, this needs to be tested in real-world conditions, with people of different ethnicities and smartphone use. The method has the potential for a computerized assessment of the videos for use by the first respondents using a smartphone to perform screening tests, which can facilitate the timely start of the treatment.
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Affiliation(s)
- Guilherme C Oliveira
- School of Sciences, São Paulo State University, São Paulo, Brazil; School of Engineering, Royal Melbourne Institute of Technology, Victoria, Australia.
| | - Quoc C Ngo
- School of Engineering, Royal Melbourne Institute of Technology, Victoria, Australia.
| | - Leandro A Passos
- School of Sciences, São Paulo State University, São Paulo, Brazil
| | | | - João P Papa
- School of Sciences, São Paulo State University, São Paulo, Brazil.
| | - Dinesh Kumar
- School of Engineering, Royal Melbourne Institute of Technology, Victoria, Australia.
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Chen L, Li J, Tian F, Tang H, Chen Z, Xue C, Hao M, Xue J. A simple nomogram for predicting aspiration associated with dysphagia in hospitalized patients after stroke. Neurol Sci 2024; 45:2729-2736. [PMID: 38233596 DOI: 10.1007/s10072-024-07312-2] [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: 11/10/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Aspiration is a common complication of poststroke dysphagia (PSD) and is associated with poor prognosis and mortality. There is no uniform criterion for determining aspiration associated with dysphagia. The aim of this study was to identify early predictors of aspiration, leading to the development of a simple nomogram for identifying aspiration risk associated with dysphagia in hospitalized patients after stroke. METHODS Demographic information and clinical characteristics of 330 patients with PSD in the training cohort were utilized to develop a nomogram. The LASSO regression method was used to screen variables, and logistic regression was used to construct the nomogram. Internal validation was performed with bootstrap in the training cohort, and external validation was performed in the validation cohort of another 82 patients. The area under the curve (AUC), calibration curves, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. RESULTS Seven variables were selected based on LASSO and multivariate logistic regression. The AUC of the nomogram was 0.834 (95% CI, 0.790-0.878) in the training cohort, 0.806 (95% CI, 0.791-0.880) in the internal validation cohort, and 0.882 (95% CI, 0.810-0.954) in the external validation cohort, which indicated that the model had good discrimination. The calibration and DCA curves showed that the nomogram had good accuracy and clinical utility. CONCLUSIONS In this study, we established a nomogram that can be used to identify the risk of aspiration associated with dysphagia after stroke, and patients may benefit from early screening and preventive care.
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Affiliation(s)
- Lihua Chen
- Department of Nursing, Guizhou Provincial People's Hospital, 83 East Zhongshan Road, Guiyang City, Guizhou, China
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Juan Li
- Department of Nursing, Guizhou Provincial People's Hospital, 83 East Zhongshan Road, Guiyang City, Guizhou, China.
| | - Fang Tian
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Huan Tang
- School of Nursing, Zunyi Medical University, Zunyi, Guizhou, China
| | - Zuoxiu Chen
- Department of Nursing, Guizhou Provincial People's Hospital, 83 East Zhongshan Road, Guiyang City, Guizhou, China
| | - Chao Xue
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Mingqing Hao
- Department of Endoscopy, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Juan Xue
- School of Nursing, Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
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Ross CF, Laurence-Chasen JD, Li P, Orsbon C, Hatsopoulos NG. Biomechanical and Cortical Control of Tongue Movements During Chewing and Swallowing. Dysphagia 2024; 39:1-32. [PMID: 37326668 PMCID: PMC10781858 DOI: 10.1007/s00455-023-10596-9] [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: 04/08/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
Tongue function is vital for chewing and swallowing and lingual dysfunction is often associated with dysphagia. Better treatment of dysphagia depends on a better understanding of hyolingual morphology, biomechanics, and neural control in humans and animal models. Recent research has revealed significant variation among animal models in morphology of the hyoid chain and suprahyoid muscles which may be associated with variation in swallowing mechanisms. The recent deployment of XROMM (X-ray Reconstruction of Moving Morphology) to quantify 3D hyolingual kinematics has revealed new details on flexion and roll of the tongue during chewing in animal models, movements similar to those used by humans. XROMM-based studies of swallowing in macaques have falsified traditional hypotheses of mechanisms of tongue base retraction during swallowing, and literature review suggests that other animal models may employ a diversity of mechanisms of tongue base retraction. There is variation among animal models in distribution of hyolingual proprioceptors but how that might be related to lingual mechanics is unknown. In macaque monkeys, tongue kinematics-shape and movement-are strongly encoded in neural activity in orofacial primary motor cortex, giving optimism for development of brain-machine interfaces for assisting recovery of lingual function after stroke. However, more research on hyolingual biomechanics and control is needed for technologies interfacing the nervous system with the hyolingual apparatus to become a reality.
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Affiliation(s)
- Callum F Ross
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA.
| | - J D Laurence-Chasen
- National Renewable Energy Laboratory, National Renewable Energy Laboratory, Golden, Colorado, USA
| | - Peishu Li
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA
| | - Courtney Orsbon
- Department of Radiology, University of Vermont Medical Center, Burlington, USA
| | - Nicholas G Hatsopoulos
- Department of Organismal Biology & Anatomy, The University of Chicago, 1027 East 57th St, Chicago, IL, 60637, USA
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Hsueh SJ, Hsu B, Chang KC. The role of the tongue in post-stroke dysphagia and obstructive sleep apnea: Correlation with sonography measurement. Clin Neurol Neurosurg 2024; 236:108108. [PMID: 38181678 DOI: 10.1016/j.clineuro.2023.108108] [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: 09/14/2023] [Revised: 11/23/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is a common risk factor for stroke, and dysphagia and pneumonia are both well-known complications of stroke. The development of these conditions is related to the oropharyngeal structures. We investigated whether specific structural features of the tongue may lead to the development of these complications. METHODS Patients with ischemic stroke who required admission and community-dwelling elderly controls were enrolled. The participants underwent tongue measurements by received hand-held ultrasound, and received questionnaires to evaluate sleep quality and daytime sleepiness. The patient group also underwent objective sleep measurement by actigraphy and the 3-Step Swallowing Test (3-SSS). Sleep parameters and outcomes were analyzed. RESULTS Patient with ischemic stroke had significantly thicker tongue than controls (6.53 cm v. 6.05 cm, p = 0.002). Multiple logistic regression analysis revealed that the anatomical parameters of the tongue in patients with stroke were significantly correlated with parameters of OSA, and the thickness of the tongue was positively correlated with the development of OSA (p = 0.024) and pneumonia (p = 0.048). CONCLUSIONS A thicker-than average tongue may be a risk factor for OSA and pneumonia in patient with stroke. Hand-held ultrasound can be used to identify these anatomical features. Further studies are warranted to clarify the role of the tongue in these post-stroke complications.
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Affiliation(s)
- Sung-Ju Hsueh
- Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Brian Hsu
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Kai-Chieh Chang
- Department of Neurology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
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BaHammam F, Durham J, Abdulmohsen B, Wassall R, McCracken GI. Oral health decline in patients after stroke: a qualitative study. Br Dent J 2023; 235:881-885. [PMID: 38066151 DOI: 10.1038/s41415-023-6558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 12/18/2023]
Abstract
Introduction To develop and implement effective oral care interventions for patients after stroke, there is a need to understand the causes behind the decline in their oral health. This qualitative study was, therefore, undertaken to explore experiences and views of health service providers about the causes of oral health decline in this group of patients.Methods A purposively selected sample of healthcare service providers who work in two NHS Trusts in the North of England were interviewed utilising a semi-structured interview technique. Interviews were conducted with the assistance of a topic guide and continued until data saturation (n = 30) was reached. The constant comparative approach was used to analyse the data.Results Two major factors, perceived by the participants, were thought to cause oral health decline in patients after stroke. Post-stroke neurological deficits resulting in oral-related functional disturbances was the first. The second was the barriers leading to difficulties in performing or receiving daily oral care. These barriers were related to the patients, their service providers, or the environment in which care is being delivered.Conclusions This study described the major factors affecting the oral health of patients after stroke, which can offer a starting point for developing effective oral care interventions for them.
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Affiliation(s)
- Fahad BaHammam
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Centre, National Guard Health Affairs, Riyadh, Saudi Arabia.
| | - Justin Durham
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bana Abdulmohsen
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebecca Wassall
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Giles I McCracken
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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Kaylor SA, Singh SA. Clinical outcomes associated with speech, language and swallowing difficulties post-stroke. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2023; 70:e1-e15. [PMID: 37916686 PMCID: PMC10623651 DOI: 10.4102/sajcd.v70i1.957] [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: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND There is a lack of prospective research in South Africa's speech therapy private sector, specifically, in the acute stroke population. There is a need to understand the quality of speech therapy services and outcomes post-stroke in the private sector. OBJECTIVES This prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), and outcomes post-stroke (i.e. length of hospital stay [LOS], degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). METHOD A prospective design was used to determine the incidence of speech, language, and swallowing conditions post-stroke. Convenience sampling was used to select participants (N = 68). Various statistical tests were used and the alpha level was set at Bonferroni correction p 0.01. RESULTS Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to speech therapy later than 24 h post-admission (52.94%) stayed in hospital for a median of 3 days longer than those who were referred within 24 h (p = 0.042). Dysphagia was significantly associated with moderate to severe physical disability (p 0.01). Dysphagia with aspiration was significantly associated with poor functional level of oral intake, at admission and at discharge (p 0.01). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p 0.01, r = 0.70). CONCLUSION In South Africa's private sector, co-occurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed speech therapy referrals.Contribution: This article contributes data on speech therapy services, communication and swallowing disorders post-stroke, and outcomes in South Africa's private sector.
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Affiliation(s)
- Stephanie A Kaylor
- Department of Communication Sciences and Disorders, Faculty of Health and Rehabilitation Sciences, University of Cape Town, Cape Town.
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Skott P, Åkesson E, Johansson K, Dalum J, Persson E, Karlsson Å, Seiger Å, McAllister A, Sandborgh-Englund G. Orofacial dysfunction after stroke-A multidisciplinary approach. Gerodontology 2023. [PMID: 37694276 DOI: 10.1111/ger.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This paper describes the study protocol in an ongoing clinical trial evaluating oral screen training as part of a post-stroke rehabilitation programme. Baseline data were related to four domains: dysphagia, lip function, masticatory performance and patient-related outcome measures (PROM). BACKGROUND Stroke is one of the most common causes of disability-adjusted life years, and dysphagia is a common remaining problem after stroke. Rehabilitation using oral screen training has been suggested to improve swallowing, but evidence is still insufficient. MATERIALS AND METHODS Patients diagnosed with stroke with persisting objective and/or subjective swallowing dysfunction after primary rehabilitation were assessed for eligibility. In total, 25 patients were included. Objective function was assessed by swallowing capacity test (SCT), lip force and masticatory performance, subjective function by EAT-10 and NOT-S and PROM by LiSat-11 and ESAS. RESULTS Baseline data presented a heterogeneous pattern with no significant association between objective and subjective dysfunction. Most of the participants (20/25) showed impaired swallowing capacity in SCT, and 23/24 revealed orofacial dysfunction according to NOT-S. The most common subjective item reported was chewing and swallowing problems (19/24). CONCLUSION The heterogenous findings in the included tests and the lack of correlations emphasise the importance of multidisciplinary approaches to identify objective and subjective orofacial post-stroke dysfunction in clinical practice to be able to offer evidence-based individualised care. The included participants were representative of stroke patients with dysphagia, which supports proceeding with the planned intervention.
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Affiliation(s)
- Pia Skott
- Folktandvården Stockholm AB, Public Dental Services, Stockholm, Sweden
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Åkesson
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholms Sjukhem, Stockholm, Sweden
| | - Kerstin Johansson
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Dalum
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Åke Seiger
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Aleris Rehab Station, Stockholm, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anita McAllister
- Division of Speech Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Sandborgh-Englund
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Li Y, Huang Q, Ge S, Wu B, Tang X. Investigating oral health-related quality of life in patients with ischaemic stroke in China. Gerodontology 2023; 40:348-354. [PMID: 36214162 DOI: 10.1111/ger.12660] [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: 02/18/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen's oral health outcome model. BACKGROUND Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke. MATERIALS AND METHODS Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen's oral health outcome model. RESULTS Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL. CONCLUSION The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.
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Affiliation(s)
- Ying Li
- School of Nursing, Xuzhou Medical University, Xuzhou, China
- Department of Emergency, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qiyuan Huang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, Texas, USA
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Xianping Tang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
- Aging Studies Institute of Xuzhou Medical University, Xuzhou, China
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Lopes RFT, Palinkas M, Pádua da Silva G, Verri ED, Regalo IH, Gonçalves CR, Hallak JEC, Costa Gomes GG, Regalo SCH, Siéssere S. Stroke: An electromyographic approach to the masseter and temporal muscles, orofacial soft tissue pressure, and occlusal force. PLoS One 2023; 18:e0282362. [PMID: 36857404 PMCID: PMC9976995 DOI: 10.1371/journal.pone.0282362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
Stroke is a cerebrovascular disease that triggers changes in the central and peripheral nervous systems, and can compromise human body function. This cross-sectional observational study aimed to analyze the electromyographic (EMG) activity of the masseter and temporal muscles, orofacial soft tissue pressure, and strength of occlusal contacts in patients who had suffered a stroke. Twenty-four patients were divided into two groups: stroke (n = 12) and control (n = 12). The EMG of the masseter and temporal muscles was evaluated during mandibular rest, protrusion, right laterality, left laterality, and maximal voluntary contraction. The Iowa Oral Pressure Instrument (IOPI) was used to measure pressure from the tongue, lips, and buccinator muscles. A computerized system for occlusal analysis (T-Scan III) was used to measure the occlusal contact points of the right and left hemiarches (upper and lower) and the upper and lower first molars. Data were subjected to Student's t-test (p < 0.05). The stroke group had lower normalized electromyographic activity, with a significant difference in the left temporal muscle during rest (p = 0.03) when compared to the control group. There was a significant difference between the groups in tongue pressure (p = 0.004) with a lower mean value in the stroke group. There was a significant difference between the groups in the evaluation of the occlusal contact points of the first permanent molars, with a lower mean percentage in the stroke group. The results indicate that stroke negatively affects functional performance of the stomatognathic system.
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Affiliation(s)
- Robson Felipe Tosta Lopes
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marcelo Palinkas
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
- Faculty of Medicine of Ribeirão Preto, Department of Neuroscience and Behavioral Sciences, University of São Paulo and National Institute and Technology—Translational Medicine (INCT.TM), São Paulo, Brazil
- * E-mail:
| | - Gabriel Pádua da Silva
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Edson Donizetti Verri
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Isabela Hallak Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Camila Rosa Gonçalves
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Jaime Eduardo Cecilio Hallak
- Faculty of Medicine of Ribeirão Preto, Department of Neuroscience and Behavioral Sciences, University of São Paulo and National Institute and Technology—Translational Medicine (INCT.TM), São Paulo, Brazil
| | - Guilherme Gallo Costa Gomes
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Simone Cecílio Hallak Regalo
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
- Faculty of Medicine of Ribeirão Preto, Department of Neuroscience and Behavioral Sciences, University of São Paulo and National Institute and Technology—Translational Medicine (INCT.TM), São Paulo, Brazil
| | - Selma Siéssere
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, São Paulo, Brazil
- Faculty of Medicine of Ribeirão Preto, Department of Neuroscience and Behavioral Sciences, University of São Paulo and National Institute and Technology—Translational Medicine (INCT.TM), São Paulo, Brazil
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12
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Minoura A, Ihara Y, Kato H, Murakami K, Watanabe Y, Hirano K, Ito Y, Kokaze A. Lip Seal Strength and Tongue Pressure among Japanese Male Workers: Comparison of Different Age Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2862. [PMID: 36833558 PMCID: PMC9957075 DOI: 10.3390/ijerph20042862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/01/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
Lip seal strength and tongue pressure are related to sarcopenia in older adults and are directly linked to the quality of life of workers after retirement. This study examined lip seal strength and tongue pressure among Japanese male workers by age. A self-administered questionnaire survey including alcohol consumption and smoking was conducted on 454 male workers. Height, weight, lip seal strength, and tongue pressure were also measured and then stratified by age (20s, 30s, 40s, 50s, and 60s and over). The mean (25th, 75th percentiles) lip seal strength and tongue pressure for all workers were 13.7 N (11.6, 16.4) and 41.7 kPa (35.2, 48.2), respectively. Both lip seal strength and tongue pressure were lowest in the 20s, at 12.1 N (9.6, 14.0) and 40.6 kPa (33.4, 47.6), respectively. The multiple regression analysis adjusted for smoking showed a significant positive association between lip seal strength and BMI for the 20s, 50s, and 60s and over, and a significant positive association between tongue pressure and BMI for the 30s, 40s, 50s, and 60s and over. To maintain oral health in older adults, it may be useful to measure workers' lip seal strength and tongue pressure and intervene at an earlier stage.
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Affiliation(s)
- Akira Minoura
- Department of Hygiene, Public Health and Preventive Medicine, School of Medicine, Showa University, Tokyo 142-8555, Japan
| | - Yoshiaki Ihara
- Division of Oral Functional Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo 145-8515, Japan
| | - Hirotaka Kato
- Division of Oral Functional Rehabilitation Medicine, Department of Special Needs Dentistry, School of Dentistry, Showa University, Tokyo 145-8515, Japan
| | - Kouzou Murakami
- Department of Radiology, Division of Radiation Oncology, School of Medicine, Showa University, Tokyo 142-8555, Japan
| | - Yoshio Watanabe
- Division of Respiratory Medicine and Allergology, Department of Medicine, School of Medicine, Showa University, Tokyo 142-8555, Japan
| | - Kojiro Hirano
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Showa University, Tokyo 142-8555, Japan
| | - Yoshinori Ito
- Department of Radiology, Division of Radiation Oncology, School of Medicine, Showa University, Tokyo 142-8555, Japan
| | - Akatsuki Kokaze
- Department of Hygiene, Public Health and Preventive Medicine, School of Medicine, Showa University, Tokyo 142-8555, Japan
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13
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Hu X, Pu M, Wang Z, Yu J, Wu X, Cheng J, Chen C, Yin H, Yang T, Zhang Z, Zhao L, Xie P, Li Q. Clinical and imaging predictors of dysphagia and swallowing ability recovery in acute ischemic stroke. Neurol Sci 2023; 44:621-629. [PMID: 36301361 DOI: 10.1007/s10072-022-06470-5] [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: 08/28/2022] [Accepted: 10/20/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Dysphagia is one of the most common complications of acute ischemic stroke, and prediction of dysphagia is crucial for post-stroke treatment. We aimed to identify predictors of dysphagia and swallowing function recovery following ischemic stroke and to investigate dysphagia-associated lesion location. METHODS We prospectively enrolled patients with acute ischemic stroke confirmed on diffusion-weighted imaging. All patients received swallowing evaluation within 48 h after admission. Follow-up oral intake ability was measured on 7 and 30 days after stroke onset. Voxel-based lesion-symptom mapping was performed to determine locations associated with dysphagia. RESULTS Of 126 patients included in the final analysis, 23 patients (18.3%) were classified as initial dysphagia. The presence of facial palsy (P = 0.008) and larger white matter hyperintensity (WMH) volume (P = 0.003) was associated with initial dysphagia. Initial risk of aspiration assessed by Any2 score (P = 0.001) at baseline was identified as independent predictor for dysphagia at day 7. Patients with higher Any2 score (P < 0.001), aphasia (P = 0.013), and larger WMH volume (P = 0.010) were less likely to have a full swallowing function recovery at 1 month. Acute infarcts in right corona radiata and right superior longitudinal fasciculus were correlated with impaired recovery of swallowing ability at 1 month. CONCLUSIONS Initial risk of aspiration was identified as risk factor for short-term and long-term dysphagia. Aphasia and larger WMH volume were revealed to be significant predictors for swallowing function recovery at 1 month. Right corona radiata was identified as an essential brain area for dysphagia.
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Affiliation(s)
- Xiao Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Mingjun Pu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zijie Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jialun Yu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaofang Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jing Cheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chu Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hao Yin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Tiannan Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhehao Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Libo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- NHC Key Laboratory of Diagnosis and Treatment On Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- NHC Key Laboratory of Diagnosis and Treatment On Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230000, China.
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14
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Zapata-Soria M, Cabrera-Martos I, López-López L, Ortiz-Rubio A, Granados-Santiago M, Ríos-Asín I, Valenza MC. Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010657. [PMID: 36613028 PMCID: PMC9819907 DOI: 10.3390/ijerph20010657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/01/2023]
Abstract
Background: Understanding the stomatognathic system disturbances is key to diagnosing them early and implementing rehabilitation approaches to promote functional recovery. The objective of this study was to systematically review all published data that examined the assessment and rehabilitation strategies for the stomatognathic system disturbances in patients with stroke. Methods: Five databases (i.e., PubMed/MEDLINE, Scopus, Science Direct, Web of Science, and PEDro), were screened for manuscripts that included the assessment and rehabilitation strategies for stomatognathic system disturbances. The methodological quality was evaluated using the Mixed Methods Appraisal Tool. Results: Sixteen articles were included in this systematic review. The most frequently reported symptoms in patients with stroke included stiffness and thickness of the masseter muscle on the affected side and suprahyoid muscles; facial muscles' asymmetry and weakness; temporomandibular disorders; and a reduced maximum lip force, tongue pressure, and saliva flow rate. The rehabilitation strategies more frequently reported included exercises directed to the jaw, temporomandibular joint, tongue, and neck. The mean score for methodological quality was 85%. Conclusion: The stomatognathic system disturbances are frequently reported among patients with stroke, leading to dysfunction in masticatory performance or swallowing. More studies on interventions for stomatognathic system disturbances are required before conclusions may be drawn. Key Practitioner Message: This systematic review has clinical implications for rehabilitation practices, given that the results may help to develop early assessment and rehabilitation strategies for stomatognathic disturbances in patients with stroke.
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Affiliation(s)
| | | | - Laura López-López
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain
| | | | | | - Izarbe Ríos-Asín
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain
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15
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Kang MG, Jung HW. Association Between Oral Health and Frailty in Older Korean Population: A Cross-Sectional Study. Clin Interv Aging 2022; 17:1863-1872. [PMID: 36575660 PMCID: PMC9790170 DOI: 10.2147/cia.s384417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose Frailty is closely associated with biological age, concurrent medical conditions, morbidity, and decreased survival. Poor oral health is common in older individuals and is associated with frailty. Considering its potential importance, a study on the association between oral health and frailty is meaningful. Therefore, we aimed to analyze the association between major oral health factors and frailty using nationally representative samples of older adults. Patients and Methods This cross-sectional study included 3018 older adults (age ≥ 65 years) from the seventh Korea National Health and Nutrition Examination Survey. Oral examination results, laboratory data, handgrip strength, life style factors derived from questionnaires, and food intake survey results were analyzed. This study used the deficit accumulation model among the main operational definitions of frailty. We constructed a frailty index based on 36 items and classified participants as non-frail, pre-frail, or frail. Oral health factors included chewing difficulty, number of teeth, periodontal disease, and number of carious teeth. Logistic regression analysis was performed to determine significant factors. Results A total of 1222 (40.5%), 1014 (33.6%), and 782 (25.9%) individuals were classified as non-frail, pre-frail, and frail, respectively. Chewing difficulty was associated with increased risk of frailty after adjusting for age, sex, socioeconomic factors, and comorbidities (odds ratio 2.68, 95% confidence interval 2.08-3.44). Periodontal disease was positively associated with chewing difficulty (odds ratio 1.29, 95% confidence interval 1.07-1.56), and chewing difficulty decreased as the number of teeth increased (odds ratio 0.97, 95% confidence interval 0.96-0.99). Conclusion Chewing difficulty was significantly associated with frailty in the older population. Considering the negative effect of chewing difficulty on frailty, more attention should be focused on oral health.
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Affiliation(s)
- Min-gu Kang
- Department of Internal Medicine, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence: Hee-Won Jung, Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan, College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea, Tel +82 10 2318 3490, Email
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16
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Vaughan A, Copley A, Miles A. Physical rehabilitation of central facial palsy: A survey of current multidisciplinary practice. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:616-625. [PMID: 34928754 DOI: 10.1080/17549507.2021.2013533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Purpose: The role of allied health practitioners providing physical rehabilitation of central facial palsy (CFP) is minimally reported in the literature. This study explores current practice and the roles, attitudes and perceptions of allied health professionals (AHPs) working with people with CFP.Method: An electronic survey was distributed to speech-language pathologists (SLPs), occupational therapists and physiotherapists. Responses (n = 78) were analysed using qualitative and quantitative methods.Result: SLPs often lead management of CFP; however, their role is not clearly defined nor well recognised. Several barriers were identified which prevent AHPs from providing consistent specialist rehabilitation to people with CFP. These included a lack of training, no clear delegation of role, limited evidence and lack of resources.Conclusion: Survey respondents viewed CFP to be within SLP scope of practice; although, ownership of management varies between countries and professions. Most SLPs recognise the negative impact of CFP and feel a sense of responsibility to provide assessment and treatment of this impairment, but many barriers to doing so have been identified. Suggestions to improve access to rehabilitation for people with CFP included increased access to training for SLPs, more evidence, clinical practice guidelines and more clinical resources. Further research is required to ensure people suffering from CFP can access services that provide skilled management of their impairment.
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Affiliation(s)
- Annabelle Vaughan
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Anna Miles
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Speech Science, The University of Auckland, Auckland, New Zealand
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17
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da Silva GP, Verri ED, Palinkas M, Gonçalves CR, Gonçalves PN, Lopes RFT, Gomes GGC, Regalo IH, Siéssere S, Regalo SCH. Impact of Hemorrhagic Stroke on Molar Bite Force: A Prospective Study. Prague Med Rep 2022; 123:181-187. [PMID: 36107446 DOI: 10.14712/23362936.2022.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Stroke is a neurological deficit of cerebrovascular origin that promotes physical impairments of adult individuals. The present study is aimed to demonstrate whether hemorrhagic stroke affects the maximum molar bite force. The prospective study carried in Centro Universitario Claretiano de Batatais, Brazil, determined the distribution of the sample into two groups: hemorrhagic stroke group (n=18, median age, 62.5 years) and disease-free group (n=18, median age, 62.0 years), with 10 men and 8 women in each group. Subjects were paired one-to-one (age and body mass index). The dynamometer was used to measure the maximum molar bite force (right and left). All analyses were performed with a significance level of 5% (Student's t-test). Differences were found on the right (p=0.048) and left (p=0.042) molar bite force, with lower bite force (both sides) in hemorrhagic stroke group. The study suggests that hemorrhagic stroke negatively affects the maximum molar bite force and necessitates changes in food intake to nutritious and softer consistency foods.
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Affiliation(s)
- Gabriel Pádua da Silva
- School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,UNIFAFIBE, Bebedouro, Brazil
| | - Edson Donizetti Verri
- Claretiano, University Center of Batatais, Batatais, Brazil.,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Marcelo Palinkas
- Faculty Anhanguera, Ribeirão Preto, São Paulo, Brazil. .,National Institute for Translational Medicine (INCT-TM), Ribeirão Preto, Brazil. .,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
| | - Camila Roza Gonçalves
- Hospital do Amor, Barretos, Brazil.,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | | | - Robson Felipe Tosta Lopes
- School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.,UNIFAFIBE, Bebedouro, Brazil
| | | | | | - Selma Siéssere
- National Institute for Translational Medicine (INCT-TM), Ribeirão Preto, Brazil.,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Simone Cecilio Hallak Regalo
- National Institute for Translational Medicine (INCT-TM), Ribeirão Preto, Brazil.,School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
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18
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Shu X, Fan Y, Leung KCM, Lo ECM. Masticatory function of stroke patients: A systematic review with meta-analysis. Gerodontology 2022; 40:172-182. [PMID: 36004768 DOI: 10.1111/ger.12653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The present systematic review and meta-analysis aimed to summarise the current information on the masticatory function of stroke patients. METHODS Four electronic databases (Medline, Embase, CINAHL and Web of Science) were searched for relevant observational studies and clinical trials (up to Jun 2021) on the masticatory function of stroke patients. Two reviewers independently performed study selection and quality assessments (using JBI Critical Appraisal Checklist). Meta-analysis was conducted for the comparison of bite force and masticatory performance using standardised mean difference (SMD). Of the 3837 records identified, nine studies, corresponding to 11 papers and 302 participants, were included in the analysis. RESULTS The maximum bite force of stroke patients was significantly lower than that of the healthy individuals (SMD -0.52, 95% CI: -0.95 to -0.08, P = .02). There was no significant difference between the ipsi-lesional and the contra-lesional sides of the same stroke patient (SMD 0.13, 95% CI: -0.14 to 0.39, P = .34). Stroke patients had lower masticatory performance than healthy people (SMD -0.97, 95% CI: 0.57 to 1.37, P < .00001), and the contra-lesional side was worse than the ipsi-lesional side. Electromyographic analysis indicated that muscle activation of stroke patients was poorer than the healthy individuals, and stroke patients seem to exhibit dysfunction in the recruiting and firing of motor units. CONCLUSIONS Stroke patients have lower maximum bite force and masticatory performance than healthy people, with masticatory performance being the most affected.
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Affiliation(s)
- Xin Shu
- Faculty of Dentistry, The University of Hong Kong. Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Yanpin Fan
- Faculty of Dentistry, The University of Hong Kong. Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Katherine Chiu Man Leung
- Faculty of Dentistry, The University of Hong Kong. Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - Edward Chin Man Lo
- Faculty of Dentistry, The University of Hong Kong. Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
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19
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Abstract
Symmetry of the face is one of the most important features for the perception of attractiveness. Asymmetry of the face means that the right and left sides of the face are not identical. Subclinical facial asymmetry is very common in the general population. Most people have some slight facial asymmetry, and this is the normal biological situation in humans. Abnormalities from soft tissue, dental, and skeletal elements lead to facial asymmetry. Asymmetry has many causal factors, and its aetiology includes both congenital and acquired conditions. Neurological facial asymmetry is scarcely addressed in the dental literature. In this narrative review, we focus on the most common neurological causes of facial asymmetry. From a neurological point of view, facial asymmetry can result from disturbances of the cranial nerves, developmental disorders, or myopathies. In the broad range of differential diagnostics of facial asymmetry, neurological abnormalities should be taken into consideration. The treatment must be related to the underlying cause. Complete knowledge of the aetiological factors and the character of the asymmetry plays a crucial role in formulating a treatment plan.
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20
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Bousiou A, Konstantopoulou K, Martimianaki G, Peppa E, Trichopoulou A, Polychronopoulou A, Halazonetis DJ, Schimmel M, Kossioni AE. Oral factors and adherence to Mediterranean diet in an older Greek population. Aging Clin Exp Res 2021; 33:3237-3244. [PMID: 33893988 DOI: 10.1007/s40520-021-01861-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to investigate the effect of oral factors on adherence to the Mediterranean diet in an older population METHODS: 130 persons over 60 years visiting Open Care Community Centers for Older People participated in this study. Oral interviews recorded demographic and sociomedical information, subjective oral complaints, and dental habits. Adherence to Mediterranean diet was assessed using the MDI_BNC4H index (range: 0-14). An oral examination was performed, and evaluation of the masticatory performance was carried out using a two-color chewing gum that was digitally analysed. RESULTS The mean age of the study participants was 73.9 ± 8.5 years. The score of adherence to the Mediterranean diet ranged from 3 to 9 (5.6 ± 1.4). 58 participants used removable prostheses, while 20 used a pair of complete dentures. Univariate analyses revealed that the parameters that negatively significantly, or marginally significantly, affected the level of adherence to the Mediterranean diet were lower masticatory performance (p = 0.050), larger number of drugs per day (p = 0.056), higher BMI (p = 0.043) and smoking (p = 0.053). The multivariable analysis revealed that lower adherence to the Mediterranean diet was significantly associated with higher BMI (p = 0.047) and lower masticatory performance (p = 0.050). CONCLUSIONS Increased masticatory performance was an independent predictor of better adherence to the Mediterranean diet in an older population.
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Affiliation(s)
- Andrianna Bousiou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, 11527, Athens, Greece
| | - Kalliopi Konstantopoulou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, 11527, Athens, Greece
| | - Georgia Martimianaki
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | | | - Argy Polychronopoulou
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Demetrios J Halazonetis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Anastassia E Kossioni
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, 11527, Athens, Greece.
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21
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Bousiou A, Konstantopoulou K, Polychronopoulou A, Halazonetis DJ, Schimmel M, Kossioni AE. Sociomedical and oral factors affecting masticatory performance in an older population. Clin Oral Investig 2021; 26:3477-3486. [PMID: 34850264 DOI: 10.1007/s00784-021-04316-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/22/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the sociomedical and oral factors affecting masticatory performance in a community-dwelling older population. MATERIALS AND METHODS Community-dwelling persons over 60 years were investigated using medical and dental oral interviews, oral and denture examination (natural teeth, tooth mobility, number of occluding tooth pairs, and removable dentures' prevalence and quality), and evaluation of masticatory performance using a mixing ability test. RESULTS A total of 130 participants with a mean age of 73.9±8.5 years were recorded. Fifty-eight (44.6%) used various types of removable prostheses. Twenty were edentulous and used a pair of complete dentures. Univariate analyses revealed statistically significant associations (p≤0.05) between masticatory performance and aging, marital status, subjective chewing ability, use of removable dentures, use of various combinations of complete dentures, pain caused by maxillary denture, number of teeth, tooth mobility, posterior chewing pairs, all chewing contacts natural or prosthetic, retention of mandibular partial dentures, and dentures' occlusion. The multivariable quantile regression analysis revealed that fewer natural teeth (95% CI: -0.02-0.01, p<0.001), being edentulous and using a pair of complete dentures (95% CI: 0.09-0.35, p=0.001), and larger percentage of severely mobile teeth (95% CI: 0.07-0.82, p=0.020) were associated with lower masticatory performance. CONCLUSIONS Poor masticatory performance in older adults was associated with fewer teeth, being edentulous and using a pair of complete dentures, and increased prevalence of severe tooth mobility. CLINICAL RELEVANCE Retaining the natural dentition and preventing and treating periodontal disease are important measures to maintain masticatory performance in older adults.
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Affiliation(s)
- Andrianna Bousiou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, 11527, Athens, Greece
| | - Kalliopi Konstantopoulou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, 11527, Athens, Greece
| | - Argy Polychronopoulou
- Department of Preventive and Community Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Demetrios J Halazonetis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Anastassia E Kossioni
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Thivon 2, 11527, Athens, Greece.
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22
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Shu X, He S, Lo ECM, Leung KCM. A Systematic Review and Meta-analysis of the Effect of Oral Exercises on Masticatory Function. J Dent Res 2021; 101:515-525. [PMID: 34836460 DOI: 10.1177/00220345211050326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the current systematic review was to summarize and to evaluate the available information on the effectiveness of oral exercise in improving the masticatory function of people ≥18 y. Electronic databases (Medline, Embase, CENTRAL) and gray literatures were searched (up to December 2020) for relevant randomized and nonrandomized controlled clinical trials. Two reviewers independently conducted the study selection, data extraction, and quality assessments. Meta-analysis was conducted for the comparison of bite force and masticatory performance using mean difference (MD) and standardized mean difference (SMD), respectively. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was adopted for collective grading of the overall body of evidence. Of the 1,576 records identified, 18 studies (21 articles) were included in the analysis. Results of meta-analysis indicated that oral exercise could significantly improve the mean bite force of the participants (parallel comparison: MD, 41.2; 95% CI, 11.6-70.7, P = 0.006; longitudinal comparison: MD, 126.5; 95% CI, 105.2-144.9, P < 0.001). However, the improvement in masticatory performance was not significant (parallel comparison: SMD, 0.11; 95% CI, -0.20 to 0.42, P = 0.48; longitudinal comparison: SMD, 0.4; 95% CI, -0.11 to 0.91, P = 0.13). Results of meta-regression showed that greater improvements in bite force can be achieved among younger adults and with more intensive exercise. Chewing exercise is the most effective oral exercise, followed by clenching exercise, while simple oral exercise may not have a significant effect. Based on the results of the meta-analysis and GRADE assessment, a weak recommendation for people with declined masticatory function to practice oral exercise is made.
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Affiliation(s)
- X Shu
- Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - S He
- Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - E C M Lo
- Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
| | - K C M Leung
- Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong, China
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23
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Domínguez-Mayoral A, Sánchez-Gómez J, Guerrero P, Ferrer M, Gutiérrez C, Aguilar M, Fouz-Rosón N, Benítez JM, Pérez-Sánchez S, Gamero-García MÁ, De Torres-Chacón R, Barragán-Prieto A, Algaba P, Ruiz-Bayo L, Montaner J. High prevalence of obstructive sleep apnea syndrome in Spain's Stroke Belt. J Int Med Res 2021; 49:3000605211053090. [PMID: 34719990 PMCID: PMC8562644 DOI: 10.1177/03000605211053090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain. Methods We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests. Results Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients. Conclusions The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.
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Affiliation(s)
- Ana Domínguez-Mayoral
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Jesús Sánchez-Gómez
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Patricia Guerrero
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Marta Ferrer
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Carmen Gutiérrez
- Neurophysiology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - María Aguilar
- Neurophysiology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Natalia Fouz-Rosón
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - José María Benítez
- Pneumology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Soledad Pérez-Sánchez
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Miguel Ángel Gamero-García
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Reyes De Torres-Chacón
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Ana Barragán-Prieto
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Pilar Algaba
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Lidia Ruiz-Bayo
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain
| | - Joan Montaner
- Stroke Unit, Neurology Department, 16582Virgen Macarena University Hospital, 16582Virgen Macarena University Hospital, Seville, Spain.,Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
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24
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Schimmel M, Aarab G, Baad-Hansen L, Lobbezoo F, Svensson P. A conceptual model of oro-facial health with an emphasis on function. J Oral Rehabil 2021; 48:1283-1294. [PMID: 34462948 PMCID: PMC9292770 DOI: 10.1111/joor.13250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/14/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
The individual inclination to lead an autonomous life until death is associated with requirements that may be of physiological, psychosocial and environmental nature. We aim to describe a conceptual oro‐facial health model with an emphasis on oro‐facial function, taking the domains of quality of life and patient‐centred values into account. In the context of oro‐facial function, the requirements of life are met when the oro‐facial system is in a fit state. ‘Fitness of the oro‐facial system, that is oro‐facial health, is a state that is characterised by an absence of, or positive coping with physical disease, mental disease, pain and negative environmental and social factors. It will allow natural oro‐facial functions such as sensing, tasting, touching, biting, chewing, swallowing, speaking, yawning, kissing and facial expression’. In the presented conceptual model of oro‐facial health, it is postulated that each individual has present and future potentials related to biological prerequisites and resources that are developed by an individual through the course of life. These potentials form the oro‐facial functional capacity. When the individual potentials together do not meet the requirements of life anymore, dysfunction and disease result. The oro‐facial system is subject to physiological ageing processes, which will inevitably lead to a decrease in the oro‐facial functional capacity. Furthermore, comorbid medical conditions might hamper oro‐facial function and, alongside with the ageing process, may lead to a state of oral hypofunction. Currently, there is a lack of widespread, validated, easy‐to‐use instruments that help to distinguish between states of oro‐facial fitness as opposed to oral hypofunction. Clearly, research is needed to establish adequate, validated instruments alongside with functional rehabilitation procedures.
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Affiliation(s)
- Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lene Baad-Hansen
- Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter Svensson
- Department of Dentistry and Oral Health, Section for Orofacial Pain and Jaw Function, Aarhus University, Aarhus, Denmark.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark.,Faculty of Odontology, Malmø University, Sweden
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25
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Matsuo K, Sekimoto Y, Okamoto M, Shibata S, Otaka Y. Association between oral health status and oral food intake level in subacute stroke patients admitted to a convalescent rehabilitation unit. Gerodontology 2021; 39:67-73. [PMID: 34448242 DOI: 10.1111/ger.12586] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Stroke patients often suffer from dysphagia during their recovery. We hypothesised that subacute stroke patients with dysphagia had more deteriorated oral health status including muscle strength and motor function. OBJECTIVE Quantitatively investigate oral health status and identify associations with oral feeding status in stroke patients admitted to a convalescent rehabilitation unit. METHODS We prospectively recruited 187 stroke patients admitted to a convalescent rehabilitation unit. Oral feeding status was examined using the Functional Oral Intake Scale (FOIS), and the cohort was divided into three groups based on FOIS score as non-oral feeding (FOIS-123; 22 patients), dysphagic diet (FOIS-45; 74 patients), and regular diet (FOIS-67; 91 patients) groups. Activities of daily living (ADL) were assessed with the Functional Independence Measure (FIM). Oral health status was measured quantitatively in six oral function parameters and Oral Health Assessment Tool (OHAT), and differences according to the FOIS, age and FIM were statistically tested. RESULTS In bivariate analysis, two parameters, tongue pressure and tongue-lip motor functions were significantly higher in the regular diet group than in the other groups (P < .01). Gross OHAT score was also significantly better in the regular diet group than in the other groups (P < .01). These significant associations mostly remained in the multiple model after adjusting for age and FIM. CONCLUSION This study suggests that, amongst oral health status, tongue strength and motor function, as well as OHAT score, may have strong associations with oral feeding status in subacute stroke patients at convalescent rehabilitation units regardless of ADL levels.
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Affiliation(s)
- Koichiro Matsuo
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Aichi, Japan.,Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yu Sekimoto
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Mieko Okamoto
- Department of Dentistry and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Aichi, Japan
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan
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26
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Zhang Z, Prilutsky BI, Butler AJ, Shinohara M, Ghovanloo M. Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8708. [PMID: 34444456 PMCID: PMC8393282 DOI: 10.3390/ijerph18168708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/10/2021] [Accepted: 08/12/2021] [Indexed: 01/17/2023]
Abstract
Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23-60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.
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Affiliation(s)
- Zhenxuan Zhang
- School of Electrical & Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA;
| | - Boris I. Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
| | - Andrew J. Butler
- School of Health Professions, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Minoru Shinohara
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
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27
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Lin SC, Lin KH, Tsai YC, Chiu EC. Effects of a food preparation program on dietary well-being for stroke patients with dysphagia: A pilot study. Medicine (Baltimore) 2021; 100:e26479. [PMID: 34160459 PMCID: PMC8238296 DOI: 10.1097/md.0000000000026479] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Dysphagia is one of the common issues observed in patients with stroke. Stroke patients with dysphagia have to eat blended food or similar types of food for each meal, resulting in dietary dissatisfaction. The purpose of this study was to investigate the effects of a food preparation program on dietary well-being for stroke patients with dysphagia. METHODS This study was a pilot randomized clinical trial. Twenty-two patients were assigned randomly into the food preparation group (n = 11) and control group (n = 11). The food preparation group received oral motor exercises, recognition of food texture and thickener, and hands-on food preparation for 6 weeks. Outcome measures included the Dietary Well-Being Scale, brief version of the World Health Organization Quality of life, Swallowing Quality of Life Questionnaire, and Mini Nutritional Assessment. RESULTS Patients in the food preparation group showed significant improvements in the Dietary Well-Being Scale, psychological and environmental domains of the brief version of the World Health Organization Quality of life (P = .001-.024) with small to large effect sizes (success rate difference = 0.23-0.46). The Swallowing Quality of Life Questionnaire and Mini Nutritional Assessment displayed non-significant differences (P = .053-.092) and revealed small to moderate effect sizes (success rate difference = 0.23-0.32). CONCLUSIONS The food preparation program showed a positive impact on dietary well-being and a potential improvement in the health-related quality of life, quality of life related to the process of swallowing, and nutritional status for stroke patients with dysphagia. We recommend that stroke patients with dysphagia receive adequate knowledge and hands-on food preparation training to increase their dietary intake and well-being.
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Affiliation(s)
| | | | - Yi-Chi Tsai
- Taipei Private YoHsiang Long Term Care Institution
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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28
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Tramontano M, Morone G, LA Greca FM, Marchegiani V, Palomba A, Iosa M, Musto G, Simonelli M. Sunnybrook Facial Grading System reliability in subacute stroke patients. Eur J Phys Rehabil Med 2021; 57:685-690. [PMID: 34105919 DOI: 10.23736/s1973-9087.21.06629-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A lack of evidence on the reliability limits the utility of the Sunnybrook Facial Grading System (SFGS) in individuals affected by stroke both in clinical and research settings. AIM To examine the test-retest reliability and the inter-rater reliability of the SFGS in patients affected by subacute stroke. DESIGN A repeated-assessments design (fifteen days apart) was used to examine the test-retest reliability of the SFGS. SETTING Inpatient rehabilitation unit. POPULATION Thirty-two inpatients with subacute stroke. METHODS Thirty-two inpatients with subacute stroke participated in the test-retest reliability study. All patients were video-recorded in sitting position and uncovered face for about two minutes, in static position to evaluate symmetry at rest, then assessing symmetry of voluntary movement and synkinesis. For the inter-rater reliability, fifteen experts in neurorehabilitation were selected as raters. The facial function was assessed using the Italian version of the SFGS was used as grading system on a recorded video of each patient. The inter-rater reliability was carried out through the ICC, Intraclass Correlation Coefficient, while the intra-rater reliability was assessed comparing for each rater the scores evaluated at T0 and T1 using Wilcoxon signed-rank test. RESULTS Evaluations at T0 and T1 showed a significant correlation with a total ICC (T0 + T1) of 0.901 (95% CI 0.852-0.942; p-value <0.001). The ICC of T0 scores is 0.914 (95% CI 0.869-0.950; p-value <0.001), while the ICC of T1 scores is 0.886 (95% CI 0.829-0.995; p-value <0.001). The scores of the "voluntary movement symmetry" area are correlated with ICC of 0.916 (95% CI 0.835-0.958; p-value <0.001). The scores of the "resting symmetry" area show correlation with ICC of 0.567 (95% CI 0.277-0.762; p-value <0.001). The area of "synkinesis" shows a lower correlation with ICC of 0.175 (95% CI -0.180-0.489; p-value <0.001). The scores attributed to the patients in the two different moments of observation resulted not significantly different from 12 out of 15 raters. CONCLUSIONS The SFGS resulted reliable in its overall score to assess the facial palsy also in patients affected by stroke. CLINICAL REHABILITATION IMPACT The findings of this study provide empirical evidence of reliable properties of the SFGS for assessing central facial palsy in patients with stroke.
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Affiliation(s)
| | | | | | | | - Angela Palomba
- Multidisciplinary Department of Medicine for Surgery and Orthodontics, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
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Kugimiya Y, Oki T, Ohta M, Ryu M, Kobayashi K, Sakurai K, Ueda T. Distribution of lip-seal strength and its relation to oral motor functions. Clin Exp Dent Res 2021; 7:1122-1130. [PMID: 33963687 PMCID: PMC8638310 DOI: 10.1002/cre2.440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Lip‐seal strength, which represents the muscle strength of the lips, appears to chiefly contribute to mastication and pronunciation. However, the functional characteristics of lip‐seal strength in adults are still undefined. The present study aimed to understand not only the distribution of lip‐seal strength in adult men and women but also the effect of age on this strength and identify oral motor functions correlated with lip‐seal strength. Materials and methods The subjects included 339 participants (men: 170, age 39.2 ± 18.2 years; women: 169, age 43.1 ± 19.7 years). Oral motor function was evaluated for lip‐seal strength, oral diadochokinesis (ODK), tongue pressure, occlusal force, and masticatory performance. Statistical analyses included the Shapiro–Wilk, Mann–Whitney U, and Jonckheere–Terpstra tests, in addition to the Spearman's correlation analysis and curvilinear regression analysis. Results Lip‐seal strength did not have a normal distribution (p < 0.001). The mean ± standard deviation and median (first quartile, third quartile) of lip‐seal strength were 11.2 ± 3.4 and 10.9 (8.7, 13.2)N for the whole sample, 12.3 ± 3.4 and 11.9 (9.4, 14.4)N for men, and 10.2 ± 3.0 and 9.9 (8.0, 12.0)N for women. A significant difference was observed in lip‐seal strength between men and women (p < 0.001). Oral motor functions showed a marked correlation with lip‐seal strength, including tongue pressure, occlusal force, and masticatory performance and ODK (/pa/ and /ta/), tongue pressure, and masticatory ability in men and women, respectively. In women, lip‐seal strength declined with increase in age. Conclusions Lip‐seal strength was non‐normally distributed in both men and women, and lip‐seal strength was affected by age only in women. Lip‐seal strength and multiple oral motor functions were significantly correlated. Because the indicators of perioral muscle strength and performance were correlated with lip‐seal strength, lip‐seal strength may also partially reflect the condition of the perioral muscles.
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Affiliation(s)
- Yoshihiro Kugimiya
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Takeshi Oki
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Midori Ohta
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Masahiro Ryu
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Kenichiro Kobayashi
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Kaoru Sakurai
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Takayuki Ueda
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
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30
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Herreras Huamán VJ, Yauyo López SL. Alteraciones de la voz y deglución en pacientes neurológicos post ruptura de aneurisma cerebral. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2021. [DOI: 10.5209/rlog.69343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
El objetivo del estudio fue determinar las alteraciones de la voz y de la deglución en pacientes con deficiencias neurológicas secundarias a hemorragia subaracnoidea por ruptura de aneurisma cerebral. El estudio es descriptivo de corte transversal; realizado en 30 pacientes del Hospital Nacional Guillermo Almenara Irigoyen de Perú, quienes cumplieron los criterios de elegibilidad. Las cualidades de la voz y deglución fueron evaluadas mediante la Evaluación Clínica de la Voz y de la Deglución en pacientes con Accidente Cerebrovascular hemorrágico que emplea el sonómetro, auscultación laríngea y pulsioxímetro. Los resultados obtenidos fueron: según las cualidades de la voz: timbre un 63,3% opaco, tono el 86,7% tono grave, intensidad una intensidad disminuida con un 90%; la duración un 86,7% corta. En Características de la deglución de la fase oral en texturas alimenticias el 83,3% deficiente, número de masticaciones un 76,7% deficiente, en tiempo/duración de la masticación 86,7% deficiente y restos alimenticios el 90% presente. Características de la deglución en la fase faríngea según número de degluciones un 46,7% inadecuado, según tos y carraspeo 36,7 % lo presentan y el 73,3% presencia de apnea. Grado de disfonía un 70% de Grado II. Grado de disfagia un 60% de presenta grado grave. Por lo que se concluye que existen alteraciones de la voz con predominancia del timbre opaco, tono grave, intensidad disminuida y duración de tipo corta, alteraciones de la deglución en la fase oral y presencia de un alto porcentaje de disfagia de grado severa y disfonía de grado II.
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Gerreth P, Gerreth K, Maciejczyk M, Zalewska A, Hojan K. Is an Oral Health Status a Predictor of Functional Improvement in Ischemic Stroke Patients Undergoing Comprehensive Rehabilitation Treatment? Brain Sci 2021; 11:brainsci11030338. [PMID: 33799980 PMCID: PMC8002018 DOI: 10.3390/brainsci11030338] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 01/07/2023] Open
Abstract
The study's aim was a clinical observation concerning the influence of oral health on functional status in stroke patients undergoing neurorehabilitation. This pilot cross-sectional clinical study was performed in 60 subacute phase stroke patients during 12 weeks of treatment. The program was patient-specific and consisted of neurodevelopmental treatment by a comprehensive rehabilitation team. The functional assessment was performed using the Barthel index (BI), Berg balance scale (BBS), functional independence measure (FIM), and Addenbrooke's cognitive examination III (ACE III) scales. Oral health was assessed according to World Health Organization (WHO) criteria, and it was presented using DMFT, DMFS, gingival index (GI), and plaque index (PlI). Significant improvement in many functional scales was noticed. However, important differences in most dental parameters without relevant changes in GI and PlI after the study were not observed. Reverse interdependence (p < 0.05) was shown between physical functioning (BI, FIM, or BBS) with GI and PlI results, and most dental parameters correlated with ACE III. Using multivariate regression analysis, we showed that ACE III and BI are predictive variables for DMFT, just as FIM is for DS (p < 0.05). The present research revealed that poor oral health status in patients after stroke might be associated with inpatient rehabilitation results.
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Affiliation(s)
- Piotr Gerreth
- Private Dental Practice, 57 Kasztelanska Street, 60-316 Poznan, Poland;
- Postgraduate Studies in Scientific Research Methodology, Poznan University of Medical Sciences, 10 Fredry Street, 60-701 Poznan, Poland
| | - Karolina Gerreth
- Department of Risk Group Dentistry, Chair of Pediatric Dentistry, Poznan University of Medical Sciences, 70 Bukowska Street, 60-812 Poznan, Poland;
| | - Mateusz Maciejczyk
- Department of Hygiene, Epidemiology and Ergonomics, Medical University of Bialystok, 2C Adama Mic kiewicza Street, 15-022 Bialystok, Poland;
| | - Anna Zalewska
- Experimental Dentistry Laboratory, Medical University of Bialystok, 24A Marii Sklodowskiej-Curie Street, 15-276 Bialystok, Poland;
| | - Katarzyna Hojan
- Department of Occupational Therapy, Poznan University of Medical Sciences, 6 Swiecickiego Street, 60-781 Poznan, Poland
- Department of Rehabilitation, Greater Poland Cancer Centre, 15 Garbary Street, 61-866 Poznan, Poland
- Correspondence:
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Kothari SF, Nascimento GG, De Caxias FP, Jakobsen MB, Nielsen JF, Kothari M. Changes in oral health related quality of life and its associated factors in individuals with brain injury. Brain Inj 2021; 35:718-724. [PMID: 33645361 DOI: 10.1080/02699052.2021.1891289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: To evaluate changes in oral health-related quality of life (OHRQoL) and associated factors in individuals with acquired brain injury (ABI) during hospitalization.Methods: Forty-six individuals with ABI were examined at week 1 and 5 of hospitalization. OHRQoL was recorded through Oral Health Impact Profile-14 (OHIP-14), clinical oral examinations were conducted, while orofacial health-related 'motor' and 'cognitive' scores were retrieved from patients' e-journal. Association between variables were investigated using factor analysis and multilevel regression modeling.Results: There were no significant differences in the OHIP-14 scores between week 1 and 5. Factors analysis revealed two OHIP-14 domains, 'psychosocial' and 'physica'. Individuals who improved their cognitive skills over study period and those with 'severe' periodontitis at baseline had increased scores of OHIP-14 'psychosocial' domain. Individuals who improved orofacial health-related 'motor' skills over study period had decreased 'physical' domain scores. Increased cognition over study period, current smoking and dental calculus were associated with increased 'physical' domain.Conclusions: The OHRQoL was poor both at week 1 and 5. Individual's cognitive and motor skills as well as their oral health status influenced their OHRQoL. Thus, individual's awareness and involvement in addition to oral care seem to be imperative in improving the OHRQoL in neurorehabilitation setting.
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Affiliation(s)
- Simple F Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark.,Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Fernanda P De Caxias
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), School of Dentistry, Araçatuba, SP, Brazil
| | - Mille B Jakobsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Jørgen F Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark
| | - Mohit Kothari
- Hammel Neurorehabilitation Centre and University Research Clinic, Department of Clinical Medicine, Aarhus University, Hammel, Denmark.,JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
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Kothari SF, Nascimento GG, Jakobsen MB, Nielsen JF, Kothari M. Periodontitis and orofacial health-related systemic impairment in patients with brain injury: a factor analysis approach. Brain Inj 2020; 35:96-102. [PMID: 33315510 DOI: 10.1080/02699052.2020.1858497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aim: To investigate the association of periodontitis to orofacial health-related systemic impairment in patients with acquired brain injury (ABI).Methods: Ninety individuals with ABI were included. Full mouth periodontal examination was performed. Orofacial health-related 'motor' and 'cognitive' scores, dysphagia and feeding status, onset of pneumonia were retrieved from e-journal. Factor analysis dubbed periodontal data as 'moderate' and 'severe' periodontitis while orofacial health-related brain injury scores were dubbed into 'motor' and 'cognitive' domains. Association between periodontal findings and systemic impairments were analyzed using multivariable linear regression models.Results: Higher scores of 'moderate' periodontitis were significantly associated with lower scores of motor impairment (β = -0.2), feeding tube dependency (β = 0.2) and dysphagia (β = 1.21), whereas higher scores of 'severe' periodontitis were associated with lower scores of cognition (β = -0.2) and reduced dental visits (β = -0.2). Both periodontal domains were significantly associated with aging (β = 0.02) and onset of pneumonia (β = 0.5-0.7).Conclusions: Robust association between 'moderate' periodontitis and motor impairment, feeding problems and dysphagia, reflects an acute clinical condition, demanding cross-disciplinary intervention. Periodontal examination can be an early indicator tool for systemic chronic conditions, as ABI and periodontitis share a common environmental, social and biological background. Periodontitis majorly affects ageing population and are prone to pneumonia, compromising rehabilitation plan.
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Affiliation(s)
- Simple F Kothari
- Hammel Neurorehabilitation Centre, University Research Clinic, Hammel, Denmark.,Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Gustavo G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Mille B Jakobsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Hammel, Denmark
| | - Jørgen F Nielsen
- Hammel Neurorehabilitation Centre, University Research Clinic, Hammel, Denmark.,JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
| | - Mohit Kothari
- Hammel Neurorehabilitation Centre, University Research Clinic, Hammel, Denmark.,JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
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Gurgel-Juarez N, Egan M, Wiseman M, Finestone H, Flowers HL. Technology for maintaining oral care after stroke: considerations for patient-centered practice. Disabil Rehabil Assist Technol 2020; 17:916-926. [PMID: 32988252 DOI: 10.1080/17483107.2020.1822450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Activities of daily living including oral care may be challenging after stroke. Some stroke survivors are not able to complete oral care independently and need assistance from healthcare professionals and care partners. Poor oral hygiene may impact stroke recovery and rehabilitation possibly incurring issues such as aspiration pneumonia, malnutrition, and social isolation. The objective of this paper is to outline practical ways to apply oral care technology in daily use for stroke survivors. MATERIALS AND METHODS We reviewed the literature on i) stroke-related impairments impacting oral care, ii) oral hygiene dental devices, and iii) technology for oral care education. RESULTS Oral care activities involve integrated skills in the areas of motivation, energy, planning, body movement and sensation, and mental acuity and health. Post-stroke impairments such as fatigue, hemiparesis, and mental impairments may impact oral care activities. Technology may help survivors and caregivers overcome some barriers. Three types of technologies are available for facilitating post-stroke oral care: i) non-powered tools and adaptations; ii) powered oral care tools, and; iii) electronic aids to guide oral care activities. Particular choices should maximise patient safety and autonomy while ensuring accessibility and comfort during oral care tasks. CONCLUSION The available device and technologies may help substantially with the accommodations needed for post-stroke oral care, improving the oral health of stroke survivors. Good oral health confers benefit to overall health and well-being and could enhance recovery and rehabilitation outcomes. Nonetheless, more research is necessary to demonstrate the feasibility and effectiveness of technology in stroke contexts.IMPLICATIONS FOR REHABILITATIONOral care may be challenging after stroke due to patient fatigue, hemiparesis, cognitive impairments, and other impaired body functions.Poor oral hygiene may impact stroke recovery and rehabilitation due to risk of aspiration pneumonia, malnutrition, and social isolation.Powered oral care tools, non-powered tools, and adaptations to non-powered tools are some of the technology available to help overcome post-stroke barriers for oral care.Computer programs and online resources for education and guidance for oral care activities may help improve recommendation uptake and compliance.
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Affiliation(s)
| | - Mary Egan
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada.,Research Institute Safest, Bruyère Research Institute, Ottawa, Canada
| | | | - Hillel Finestone
- Department of Physical Medicine and Rehabilitation, Élisabeth Bruyère Hospital, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Heather L Flowers
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada.,Research Institute Safest, Bruyère Research Institute, Ottawa, Canada.,Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada.,Canadian Partnership for Stroke Recovery, Heart and Stroke Foundation, Ottawa, Canada
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Tran EK, Juarez KO, Long JL. Stem cell treatments for oropharyngeal dysphagia: Rationale, benefits, and challenges. World J Stem Cells 2020; 12:1001-1012. [PMID: 33033560 PMCID: PMC7524699 DOI: 10.4252/wjsc.v12.i9.1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/28/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
Dysphagia, defined as difficulty swallowing, is a common symptom negatively impacting millions of adults annually. Estimated prevalence ranges from 14 to 33 percent in those over age 65 to over 70 percent in a nursing home setting. The elderly, those with neurodegenerative diseases, head and neck cancer patients, and those with autoimmune conditions such as Sjögren's syndrome are disproportionately affected. Oropharyngeal dysphagia refers specifically to difficulty in initiating a swallow due to dysfunction at or above the upper esophageal sphincter, and represents a large proportion of dysphagia cases. Current treatments are limited and are often ineffective. Stem cell therapy is a new and novel advancement that may fill a much-needed role in our treatment regimen. Here, we review the current literature regarding stem cell treatments for oropharyngeal dysphagia. Topics discussed include tissue regeneration advancements as a whole and translation of these principles into research surrounding tongue dysfunction, xerostomia, cricopharyngeal dysfunction, and finally an overview of the challenges and future directions for investigation. Although this field of study remains in its early stages, initial promising results show potential for the use of stem cell-based therapies to treat oropharyngeal dysphagia and warrant further research.
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Affiliation(s)
- Eric K Tran
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, United States
| | - Kevin O Juarez
- Department of Otolaryngology, Yale School of Medicine, New Haven, CT 06511, United States
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA 90095, United States
- Greater Los Angeles VA Healthcare System, Los Angeles, CA 90073, United States
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36
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Garcia-Casado J, Prats-Boluda G, Ye-Lin Y, Restrepo-Agudelo S, Perez-Giraldo E, Orozco-Duque A. Evaluation of Swallowing Related Muscle Activity by Means of Concentric Ring Electrodes. SENSORS (BASEL, SWITZERLAND) 2020; 20:s20185267. [PMID: 32942616 PMCID: PMC7570555 DOI: 10.3390/s20185267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Surface electromyography (sEMG) can be helpful for evaluating swallowing related muscle activity. Conventional recordings with disc electrodes suffer from significant crosstalk from adjacent muscles and electrode-to-muscle fiber orientation problems, while concentric ring electrodes (CREs) offer enhanced spatial selectivity and axial isotropy. The aim of this work was to evaluate CRE performance in sEMG recordings of the swallowing muscles. Bipolar recordings were taken from 21 healthy young volunteers when swallowing saliva, water and yogurt, first with a conventional disc and then with a CRE. The signals were characterized by the root-mean-square amplitude, signal-to-noise ratio, myopulse, zero-crossings, median frequency, bandwidth and bilateral muscle cross-correlations. The results showed that CREs have advantages in the sEMG analysis of swallowing muscles, including enhanced spatial selectivity and the associated reduction in crosstalk, the ability to pick up a wider range of EMG frequency components and easier electrode placement thanks to its radial symmetry. However, technical changes are recommended in the future to ensure that the lower CRE signal amplitude does not significantly affect its quality. CREs show great potential for improving the clinical monitoring and evaluation of swallowing muscle activity. Future work on pathological subjects will assess the possible advantages of CREs in dysphagia monitoring and diagnosis.
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Affiliation(s)
- Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (G.P.-B.); (Y.Y.-L.)
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (G.P.-B.); (Y.Y.-L.)
| | - Yiyao Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (G.P.-B.); (Y.Y.-L.)
| | - Sebastián Restrepo-Agudelo
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050012, Colombia; (S.R.-A.); (E.P.-G.); (A.O.-D.)
| | - Estefanía Perez-Giraldo
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050012, Colombia; (S.R.-A.); (E.P.-G.); (A.O.-D.)
| | - Andrés Orozco-Duque
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellín 050012, Colombia; (S.R.-A.); (E.P.-G.); (A.O.-D.)
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Mortensen J, Pedersen AR, Nielsen JF, Kothari M. Construct and content validity of the Functional Oral Intake Scale; Analyses from a cohort of patients with acquired brain injury. Brain Inj 2020; 34:1257-1263. [DOI: 10.1080/02699052.2020.1800094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Jesper Mortensen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Asger Roer Pedersen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Mohit Kothari
- Research Unit, Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
- JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
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Paris-Alemany A, Proy-Acosta A, Adraos-Juárez D, Suso-Martí L, La Touche R, Chamorro-Sánchez J. Influence of the Craniocervical Posture on Tongue Strength and Endurance. Dysphagia 2020; 36:293-302. [PMID: 32445059 DOI: 10.1007/s00455-020-10136-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/15/2020] [Indexed: 12/30/2022]
Abstract
Tongue strength has an important role in the swallowing process, and previous research has suggested that tongue position, concerning the craniomandibular region, could affect the oral function. This study aimed to evaluate the strength and endurance of three areas of the tongue in three experimentally induced craniocervical postures. A cross-sectional study with a nonprobabilistic sample of 37 participants (mean age: 3.85 ± 3.64 years; 20 men, 17 women) was performed. Tongue strength and endurance were assessed using a pressure device entitled Iowa Oral Performance Instrument (IOPI), in three different craniocervical positions: neutral head position (NHP), anterior head translation-or forward head position (FHP), and posterior head translation-or retracted head position (RHP). Measurements taken using the IOPI system showed significant differences in tongue strength for the anterior (p = 0.015) and middle areas of the tongue (p = 0.01). Significant differences were observed in analysis of variance (ANOVA) in the FHP (p = 0.02) and NHP (p = 0.009). The results of tongue endurance measurements showed statistically significant differences for FHP (p = 0.001), NHP (p = 0.00), and RHP (p = 0.007). The craniocervical position influences tongue strength, especially in the anterior and middle tongue areas, concerning the posterior, and, in the anterior and neutral head posture, regarding the retracted position. No differences were found in tongue resistance between the various craniocervical positions, but differences were found in resistance between the different tongue areas.
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Affiliation(s)
- Alba Paris-Alemany
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain
| | - Alejandro Proy-Acosta
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Adraos-Juárez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Suso-Martí
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Departament of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain. .,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain. .,Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Spain.
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Vaughan A, Gardner D, Miles A, Copley A, Wenke R, Coulson S. A Systematic Review of Physical Rehabilitation of Facial Palsy. Front Neurol 2020; 11:222. [PMID: 32296385 PMCID: PMC7136559 DOI: 10.3389/fneur.2020.00222] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Facial palsy is a frequent and debilitating sequela of stroke and brain injury, causing functional and aesthetic deficits as well as significant adverse effects on quality of life and well-being. Current literature reports many cases of acquired facial palsy that do not recover spontaneously, and more information is needed regarding the efficacy of physical therapies used in this population. Methods: A systematic search of eight electronic databases was performed from database inception to December 2018. Gray literature searches were then performed to identify additional articles. Studies were included if they addressed physical rehabilitation interventions for adults with acquired facial palsy. Reasons for exclusion were documented. Independent data extraction, quality assessment, and risk of bias assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Following abstract screening, a total of 13 full-text articles were identified for independent screening by two reviewers. This included four randomized control trials, two non-randomized control trials, one cohort study, and six prospective case series studies. Twelve out of the 13 included studies reported on facial palsy as a sequela of stroke. A total of 539 participants received intervention for facial palsy across the 13 included studies. Therapy design, length and frequency of intervention varied across the studies, and a wide range of outcome measures were used. Improvement on various outcome measures was reported across all 13 studies. The quality of the evidence was low overall, and most studies were found to have high risk of bias. Conclusions: All the studies in this review report improvement of facial movement or function following application of various methods of physical rehabilitation for facial palsy. Methodological limitations and heterogeneity of design affect the strength of the evidence and prevent reliable comparison between intervention methods. Strong evidence supporting physical rehabilitation was not found; well-designed rigorous research is required.
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Affiliation(s)
- Annabelle Vaughan
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Danielle Gardner
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Anna Miles
- Speech Science, The University of Auckland, Auckland, New Zealand
| | - Anna Copley
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Rachel Wenke
- Speech Pathology Service, Gold Coast University Hospital, Gold Coast, QLD, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Susan Coulson
- School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
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Temporomandibular Joint Dysfunction and Impaired Stomatognathic Alignment: A Problem Beyond Swallowing in Patients With Stroke. Indian J Otolaryngol Head Neck Surg 2020; 72:329-334. [PMID: 32728543 DOI: 10.1007/s12070-020-01830-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022] Open
Abstract
The aim of this study is to evaluate the efficacy of supervised structured exercise programme in post stroke patients with temporomandibular joint dysfunction (TMJD). 30 post stroke patients diagnosed as TMJD according to "diagnostic criteria for temporomandibular disorders" (DC/TMD) were included for the study. A structured exercise programme including active and active-assisted range of motion (ROM) exercises for neck and temporomandibular joint (TMJ), chins tuck exercises, breathing and relaxing exercises and posture exercises were performed. Cervical ROMs including flexion, extansion, lateral flexion and rotation, Mann assessment of swallowing ability (MASA) and mini mental state exam (MMSE) scores, maximal mouth opening (MMO) and craniomandibular index (CMI) of the patients compared at baseline, 1st and 6th month after supervised rehabilitation procedure. All parameters were significantly improved both in 1st and 6th month evaluation. At 6th month evaluation, the cervical ROMs of the patients improved from severe to mild restriction (p = 0.001), the mean MASA score of the patients improved from moderate to mild swallowing disorder (p = 0.001), mean MMSE score of 30 patients was accepted as normal (p = 0.001), mean MMO of the patients was 56.00 ± 4.84 mm and mean CMI was 0.16 ± 0.05 indicating that the patients had a "mild" limitation in mouth opening and "mild" dysfunction in TMJ (p = 0.001 respectively). Our structured supervised exercise programme improves swallowing quality by establishing proper stomatognathic alignment and TMJ function.
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Barlow S, Custead R, Lee J, Hozan M, Greenwood J. Wireless Sensing of Lower Lip and Thumb-Index Finger 'Ramp-and-Hold' Isometric Force Dynamics in a Small Cohort of Unilateral MCA Stroke: Discussion of Preliminary Findings. SENSORS 2020; 20:s20041221. [PMID: 32102239 PMCID: PMC7070866 DOI: 10.3390/s20041221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 01/22/2023]
Abstract
Automated wireless sensing of force dynamics during a visuomotor control task was used to rapidly assess residual motor function during finger pinch (right and left hand) and lower lip compression in a cohort of seven adult males with chronic, unilateral middle cerebral artery (MCA) stroke with infarct confirmed by anatomic magnetic resonance imaging (MRI). A matched cohort of 25 neurotypical adult males served as controls. Dependent variables were extracted from digitized records of ‘ramp-and-hold’ isometric contractions to target levels (0.25, 0.5, 1, and 2 Newtons) presented in a randomized block design; and included force reaction time, peak force, and dF/dtmax associated with force recruitment, and end-point accuracy and variability metrics during the contraction hold-phase (mean, SD, criterion percentage ‘on-target’). Maximum voluntary contraction force (MVCF) was also assessed to establish the force operating range. Results based on linear mixed modeling (LMM, adjusted for age and handedness) revealed significant patterns of dissolution in fine force regulation among MCA stroke participants, especially for the contralesional thumb-index finger followed by the ipsilesional digits, and the lower lip. For example, the contralesional thumb-index finger manifest increased reaction time, and greater overshoot in peak force during recruitment compared to controls. Impaired force regulation among MCA stroke participants during the contraction hold-phase was associated with significant increases in force SD, and dramatic reduction in the ability to regulate force output within prescribed target force window (±5% of target). Impaired force regulation during contraction hold-phase was greatest in the contralesional hand muscle group, followed by significant dissolution in ipsilateral digits, with smaller effects found for lower lip. These changes in fine force dynamics were accompanied by large reductions in the MVCF with the LMM marginal means for contralesional and ipsilesional pinch forces at just 34.77% (15.93 N vs. 45.82 N) and 66.45% (27.23 N vs. 40.98 N) of control performance, respectively. Biomechanical measures of fine force and MVCF performance in adult stroke survivors provide valuable information on the profile of residual motor function which can help inform clinical treatment strategies and quantitatively monitor the efficacy of rehabilitation or neuroprotection strategies.
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Affiliation(s)
- Steven Barlow
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; (R.C.); (M.H.); (J.G.)
- Department of Biological Systems Engineering, University of Nebraska, 230 L.W. Chase Hall, Lincoln, NE 68583-0726, USA
- Center for Brain-Biology-Behavior, University of Nebraska, C89 East Stadium, Lincoln, NE 68588-0156, USA
- Correspondence: ; Tel.: +1-402-472-6395; Fax: +1-402-472-7697
| | - Rebecca Custead
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; (R.C.); (M.H.); (J.G.)
| | - Jaehoon Lee
- Department of Educational Psychology & Leadership, Texas Tech University, PO Box 41071, Lubbock, TX 79409, USA;
| | - Mohsen Hozan
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; (R.C.); (M.H.); (J.G.)
- Department of Biological Systems Engineering, University of Nebraska, 230 L.W. Chase Hall, Lincoln, NE 68583-0726, USA
- Center for Brain-Biology-Behavior, University of Nebraska, C89 East Stadium, Lincoln, NE 68588-0156, USA
| | - Jacob Greenwood
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; (R.C.); (M.H.); (J.G.)
- Department of Biological Systems Engineering, University of Nebraska, 230 L.W. Chase Hall, Lincoln, NE 68583-0726, USA
- Center for Brain-Biology-Behavior, University of Nebraska, C89 East Stadium, Lincoln, NE 68588-0156, USA
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42
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Lin C, Yeung AWK. What do we learn from brain imaging?—A primer for the dentists who want to know more about the association between the brain and human stomatognathic functions. J Oral Rehabil 2020; 47:659-671. [DOI: 10.1111/joor.12935] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/10/2019] [Accepted: 01/05/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Chia‐shu Lin
- Department of Dentistry School of Dentistry National Yang‐Ming University Taipei Taiwan
- Institute of Brain Science School of Medicine National Yang‐Ming University Taipei Taiwan
- Brain Research Center National Yang‐Ming University Taipei Taiwan
| | - Andy Wai Kan Yeung
- Oral and Maxillofacial Radiology Applied Oral Sciences and Community Dental Care Faculty of Dentistry The University of Hong Kong Hong Kong China
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43
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Lin CS. Functional Adaptation of Oromotor Functions and Aging: A Focused Review of the Evidence From Brain Neuroimaging Research. Front Aging Neurosci 2020; 11:354. [PMID: 31998112 PMCID: PMC6962247 DOI: 10.3389/fnagi.2019.00354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/05/2019] [Indexed: 12/11/2022] Open
Abstract
“Practice makes perfect” is a principle widely applied when one is acquiring a new sensorimotor skill to cope with challenges from a new environment. In terms of oral healthcare, the traditional view holds that restoring decayed structures is one of the primary aims of treatment. This assumes that the patient’s oromotor functions would be recovered back to normal levels after the restoration. However, in older patients, such a structural–functional coupling after dental treatment shows a great degree of individual variations. For example, after prosthodontic treatment, some patients would adapt themselves quickly to the new dentures, while others would not. In this Focused Review, I argue that the functional aspects of adaptation—which would be predominantly associated with the brain mechanisms of cognitive processing and motor learning—play a critical role in the individual differences in the adaptive behaviors of oromotor functions. This thesis is critical to geriatric oral healthcare since the variation in the capacity of cognitive processing and motor learning is critically associated with aging. In this review, (a) the association between aging and the brain-stomatognathic axis will be introduced; (b) the brain mechanisms underlying the association between aging, compensatory behavior, and motor learning will be briefly summarized; (c) the neuroimaging evidence that suggests the role of cognitive processing and motor learning in oromotor functions will be summarized, and critically, the brain mechanisms underlying mastication and swallowing in older people will be discussed; and (d) based on the current knowledge, an experimental framework for investigating the association between aging and the functional adaptation of oromotor functions will be proposed. Finally, I will comment on the practical implications of this framework and postulate questions open for future research.
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan.,Institute of Brain Science, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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44
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Zeng LN, Rao WW, Luo SH, Zhang QE, Hall BJ, Ungvari GS, Chen LG, Xiang YT. Oral health in patients with stroke: a meta-analysis of comparative studies. Top Stroke Rehabil 2019; 27:75-80. [PMID: 31566117 DOI: 10.1080/10749357.2019.1656413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: This meta-analysis systematically analyzed and compared oral health between stroke patients and controls.Data source: The electronic databases of PubMed, EMBASE, PsycINFO, Medline and Web of Science were independently searched by two authors from their inception to 14 June 2018.Study selection: Eleven studies comparing oral health between stroke patients (n = 1,742) and controls (n = 1,193) were analyzed.Data extraction: The full texts of the 11 studies were independently reviewed. Data on oral health were independently extracted by two authors.Data synthesis: Mean differences (MD) and 95% confidence intervals (CI) were calculated and synthesized using fixed or random-effects models, as appropriate. Compared to controls, stroke patients had poorer oral health: they had more Dental Caries (5 studies; MD = 2.89, 95% CI: 0.91-4.88, p= .04), but less Remaining Teeth scores (6 studies; MD = -2.93, 95% CI: -3.91, -1.95; p < .00001). Both the Plaque Index (3 studies; MD = 0.21, 95% CI: 0.14, 0.28; p < .00001) and Gingival Index scores (4 studies; MD = 0.22, 95% CI: 0.14, 0.30; p < .00001) were significantly higher in stroke patients, indicating worse periodontal status.Conclusions: Stroke patients had poorer overall oral health status compared to controls. Given the importance of oral health to overall health, further research on screening for oral health problems after stroke should be conducted and effective management strategies should be devised and implemented.
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Affiliation(s)
- Liang-Nan Zeng
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, China.,Center for Cognition and Brain Sciences, University of Macau, Taipa, China.,Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University; Neurosurgery Clinical Medical Research Center of Sichuan Province, Academician (Expert) Workstation of Sichuan Province; Sichuan, China
| | - Wen-Wang Rao
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, China.,Center for Cognition and Brain Sciences, University of Macau, Taipa, China
| | - Shi-Hong Luo
- Department of Oral implant, The Affiliated Stomatology Hospital of Southwest Medical University, Sichuan, China
| | - Qing-E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing, China
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Taipa, China.,Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia.,University of Notre Dame Australia, Fremantle, Australia
| | - Li-Gang Chen
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University; Neurosurgery Clinical Medical Research Center of Sichuan Province, Academician (Expert) Workstation of Sichuan Province; Sichuan, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, China.,Center for Cognition and Brain Sciences, University of Macau, Taipa, China
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45
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Blanař V, Hödl M, Lohrmann C, Amir Y, Eglseer D. Dysphagia and factors associated with malnutrition risk: A 5‐year multicentre study. J Adv Nurs 2019; 75:3566-3576. [DOI: 10.1111/jan.14188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Vít Blanař
- Department of Nursing Faculty of Health Studies University of Pardubice Pardubice Czech Republic
| | - Manuela Hödl
- Institute of Nursing Science Medical University of Graz Graz Austria
| | - Christa Lohrmann
- Institute of Nursing Science Medical University of Graz Graz Austria
| | | | - Doris Eglseer
- Institute of Nursing Science Medical University of Graz Graz Austria
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46
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Sessle BJ. Can you be too old for oral implants? An update on ageing and plasticity in the oro‐facial sensorimotor system. J Oral Rehabil 2019; 46:936-951. [DOI: 10.1111/joor.12830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/06/2019] [Accepted: 05/26/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Barry J. Sessle
- Faculty of Dentistry University of Toronto Toronto Ontario Canada
- Department of Physiology, Faculty of Medicine University of Toronto Toronto Ontario Canada
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47
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Leszczak J, Czenczek-Lewandowska E, Przysada G, Wyszyńska J, Weres A, Baran J, Kwolek A, Mazur A. Diet after Stroke and Its Impact on the Components of Body Mass and Functional Fitness-A 4-Month Observation. Nutrients 2019; 11:nu11061227. [PMID: 31146478 PMCID: PMC6627133 DOI: 10.3390/nu11061227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022] Open
Abstract
The aim of the study was to assess the effect of various diets on BMI and selected components of body mass, i.e., fat mass (FAT%), visceral fat (VFAT level), muscle mass (PMM %), body water (TBW %), and functional fitness during a 4-month observation period. Examinations were conducted three times in a group of 100 people after a stroke. The study group was divided into four subgroups according to the type of diet applied. The components of body mass were assessed using the electrical bioimpedance method, and functional fitness using the Barthel scale, the Brunnström scale, and the modified Ashworth scale. Despite the fact that there were no significant differences among the diets applied, it was observed that each of them had a positive effect on the reduction of the mean BMI, FAT%, VFAT level, and the increase in TBW% and PMM%. At the same time, there was a significant improvement in the functional fitness of the hand and upper limb. Weight control and a change in eating habits after a stroke incident is extremely important as it promotes faster recovery and improved functional fitness.
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Affiliation(s)
- Justyna Leszczak
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | | | - Grzegorz Przysada
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
- Clinical Regional Hospital No. 2 in Rzeszów, Lwowska Street 60, 35-301 Rzeszów, Poland.
| | | | - Aneta Weres
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Joanna Baran
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Andrzej Kwolek
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
| | - Artur Mazur
- Faculty of Medicine, University of Rzeszów, 35-959 Rzeszów, Poland.
- Clinical Regional Hospital No. 2 in Rzeszów, Lwowska Street 60, 35-301 Rzeszów, Poland.
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48
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Chávez EM, Wong LM, Subar P, Young DA, Wong A. Dental Care for Geriatric and Special Needs Populations. Dent Clin North Am 2019; 62:245-267. [PMID: 29478456 DOI: 10.1016/j.cden.2017.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article reviews considerations for oral health care associated with the most common causes of mortality and morbidity in older adults. Many of these diseases result in functional or cognitive impairments that must be considered in treatment planning to ensure appropriate, safe, and effective care for patients. Many of these considerations parallel those of adults who have lived with developmental disabilities over a lifetime and similar principles can be applied. Systemic diseases, conditions, and their treatments can pose significant risks to oral health, which requires prevention, treatment, and advocacy for oral health care as integral to chronic disease management.
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Affiliation(s)
- Elisa M Chávez
- Department of Diagnostic Sciences, University of the Pacific, Arthur A. Dugoni School of Dentistry, 155 5th Street, San Francisco, CA 94103, USA.
| | - Lynne M Wong
- Department of Diagnostic Sciences, University of the Pacific, Arthur A. Dugoni School of Dentistry, 155 5th Street, San Francisco, CA 94103, USA
| | - Paul Subar
- Special Care Clinic, Hospital Dentistry Program, Arthur A. Dugoni School of Dentistry, 155 5th Street, San Francisco, CA 94103, USA; Department of Family and Community Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Douglas A Young
- Department of Diagnostic Sciences, University of the Pacific, Arthur A. Dugoni School of Dentistry, 155 5th Street, San Francisco, CA 94103, USA
| | - Allen Wong
- AEGD Program, Hospital Dentistry Program, University of the Pacific, Arthur A. Dugoni School of Dentistry, 155 5th Street, San Francisco, CA 94103, USA
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Barlow SM, Hozan M, Lee J, Greenwood J, Custead R, Wardyn B, Tippin K. Orofacial and thumb-index finger ramp-and-hold isometric force dynamics in young neurotypical adults. J Biomech 2018. [PMID: 29526460 DOI: 10.1016/j.jbiomech.2018.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relation among several parameters of the ramp-and-hold isometric force contraction (peak force and dF/dtmax during the initial phase of force recruitment, and the proportion of hold-phase at target) was quantified for the right and left thumb-index finger pinch, and lower lip midline compression in 40 neurotypical right-handed young adults (20 female/20 males) using wireless force sensors and data acquisition technology developed in our laboratory. In this visuomotor control task, participants produced ramp-and-hold isometric forces as 'rapidly and accurately' as possible to end-point target levels at 0.25, 0.5, 1 and 2 Newtons presented to a computer monitor in a randomized block design. Significant relations were found between the parameters of the ramp-and-hold lip force task and target force level, including the peak rate of force change (dF/dtmax), peak force, and the criterion percentage of force within ±5% of target during the contraction hold phase. A significant performance advantage was found among these force variables for the thumb-index finger over the lower lip. The maximum voluntary compression force (MVCF) task revealed highly significant differences in force output between the thumb-index fingers and lower lip (∼4.47-4.70 times greater for the digits versus lower lip), a significant advantage of the right thumb-index finger over the non-dominant left thumb-index finger (12% and 25% right hand advantage for males and females, respectively), and a significant sex difference (∼1.65-1.73 times greater among males).
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Affiliation(s)
- Steven M Barlow
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; Department of Biological Systems Engineering, University of Nebraska, 230 L.W. Chase Hall, Lincoln, NE 68583-0726, USA; Center for Brain, Biology, and Behavior, University of Nebraska, C89 East Stadium, Lincoln, NE 68588-0156, USA.
| | - Mohsen Hozan
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; Department of Biological Systems Engineering, University of Nebraska, 230 L.W. Chase Hall, Lincoln, NE 68583-0726, USA; Center for Brain, Biology, and Behavior, University of Nebraska, C89 East Stadium, Lincoln, NE 68588-0156, USA.
| | - Jaehoon Lee
- Department of Educational Psychology & Leadership, Texas Tech University, PO Box 41071, Lubbock, TX 79409, USA.
| | - Jake Greenwood
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; Department of Biological Systems Engineering, University of Nebraska, 230 L.W. Chase Hall, Lincoln, NE 68583-0726, USA; Center for Brain, Biology, and Behavior, University of Nebraska, C89 East Stadium, Lincoln, NE 68588-0156, USA.
| | - Rebecca Custead
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA; Center for Brain, Biology, and Behavior, University of Nebraska, C89 East Stadium, Lincoln, NE 68588-0156, USA.
| | - Brianna Wardyn
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA.
| | - Kaytlin Tippin
- Department of Special Education and Communication Disorders, University of Nebraska, 141 Barkley Memorial Center, Lincoln, NE 68583-0738, USA.
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Dursun Ö, Çankaya T. Assessment of Temporomandibular Joint Dysfunction in Patients with Stroke. J Stroke Cerebrovasc Dis 2018; 27:2141-2146. [PMID: 29650380 DOI: 10.1016/j.jstrokecerebrovasdis.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 11/26/2022] Open
Abstract
GOAL The aim of this study was to assess temporomandibular joint dysfunction in patients with stroke. MATERIALS AND METHODS Total of 100 participants, 50 healthy and 50 who had stroke, were recruited into this study. Digital caliper and algometer were used to assess temporomandibular joint range of motion and masticatory muscle pressure pain threshold. Labial commissure angle measurement was used for the assessment of facial paralysis severity. Fonseca questionnaire was used for temporomandibular joint dysfunction assessment and categorization. In addition, dominant mastication shift was measured by the question that asks the pre and poststroke dominant mastication side. FINDINGS In intergroup comparison, significant decrease was found in all temporomandibular range of motion parameters in favor of stroke group (P < .05). Despite the fact that no significant difference was found between groups for the pain threshold in masticatory muscles except for middle part of the left temporalis muscle, values were higher in healthy group (P > .05). As a result of intergroup examination of labial commissure angle degree, Fonseca questionnaire score, it was found that labial commissure angle and Fonseca questionnaire scores were higher in stroke group (P < .05). Intragroup examination of patients with stroke showed that dominant mastication side shift was seen in patients with stroke (P < .05). CONCLUSION It was concluded that, temporomandibular joint dysfunction prevalence was higher in stroke group compared with healthy group and use of modalities specific to temporomandibular joint dysfunction treatment would be beneficial.
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Affiliation(s)
- Ömer Dursun
- School of Physical Therapy and Rehabilitation, Abant Izzet Baysal University, Bolu, Turkey
| | - Tamer Çankaya
- School of Physical Therapy and Rehabilitation, Abant Izzet Baysal University, Bolu, Turkey.
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