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Kim SB, Choi YJ, Kim ST, Kim HJ. Comparison between botulinum toxin type A injection on masseter muscle only and additional injection on anterior belly of digastric muscle in sleep bruxism patients: A clinical trial. J Oral Rehabil 2024; 51:2125-2132. [PMID: 39030872 DOI: 10.1111/joor.13800] [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: 02/08/2024] [Revised: 02/24/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE This study aims to evaluate the effects on bite force and muscle thickness of the botulinum toxin (BoNT) injection for patients with sleep bruxism (SB) by comparing injections into the masseter muscle only and both the masseter and the anterior belly of the digastric muscle (ABDM) in a clinical trial. METHODS Twelve SB patients received BoNT-A injections using US-guided techniques into the masseter muscle only (Group A), while the remaining 12 SB patients received injections into both the masseter and ABDM (Group B). Bite force and muscle thickness were measured before injection, as well as 1 and 2 months after injection. RESULTS The bite force and masseter muscle thickness decreased in both Group A and Group B before injection, and at 1 and 2 months after injection. However, there was no significant difference (p > .05, repeated measures analysis of variance) between the two groups, and there was also no significant difference in ABDM thickness (p > .05, repeated measures analysis of variance). CONCLUSION This study is the first to assess the short-term effects of BoNT injected into ABDM for SB control. Results show no influence on SB reduction, suggesting the need for further research on BoNT's effectiveness in controlling intense ABDM contractions during sleep and assessing suprahyoid muscle potential impact on rhythmic masticatory muscle activity occurrence.
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Affiliation(s)
- Soo-Bin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
| | - You-Jin Choi
- Department of Anatomy, School of Medicine, Konkuk University, Chungju, South Korea
| | - Seong Taek Kim
- Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Seoul, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry, Seoul, South Korea
- Department of Electric and Electronical Engineering, College of Engineering, Yonsei University, Seoul, South Korea
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2
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Chen YH, Shieh WY, Huang YF, Cheng HYK, Wang CM. Development of a tool for monitoring the jaw-opening pace and preliminary comparison the pace between young and old ages. J Formos Med Assoc 2024; 123:942-949. [PMID: 38185618 DOI: 10.1016/j.jfma.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/13/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Studies have demonstrated that high-speed jaw-opening exercises are effective in improving swallowing function. However, there has been no objective tool available for monitoring jaw-opening pace. This study aimed to develop an objective tool for monitoring and validating jaw-opening pace and compare it between young and old ages from different age groups. MATERIALS AND METHODS A load cell plug-in jaw pad connected to an automatic recording and analysis system was used to record jaw-opening motions for offline analysis. We recruited 58 healthy volunteers from different age groups (20-39 y/o; 40-59y/o; 60-79y/o). During a 2-min recording session, each participant was instructed to fully open and close their jaw as quickly as possible while wearing a sensor. Bland-Altman plot, paired t-test and Pearson's correlation test were used to compare the number of jaw-opening motions between manual counting and automatic software analysis. The number of jaw-opening motions during the 2-min recording was compared between the three age groups. RESULTS Automated analysis of jaw-opening pace was efficient and equally comparable with the traditional manual counting method across the three age groups. A declining trend in jaw-opening pace among the old age group was found but with no statistically significant difference. CONCLUSION A jaw-opening motion monitoring tool with reliable automatic pace analysis software was validated in young and old ages The jaw-opening pace demonstrated a tendency to decline with age.
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Affiliation(s)
- Yu-Hsin Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan
| | - Wann-Yun Shieh
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan; Department of Computer Science and Information Engineering, Chang Gung University, Tao-Yuan, 33302, Taiwan
| | - Yi-Fang Huang
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan; Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Tao-Yuan, 33302, Taiwan
| | - Hsin-Yi Kathy Cheng
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, TaoYuan, 33302, Taiwan
| | - Chin-Man Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan; College of Medicine, Chang Gung University, Tao-Yuan, 33302, Taiwan.
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3
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Govender R, Gilbody N, Simson G, Haag R, Robertson C, Stuart E. Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists. Curr Treat Options Oncol 2024; 25:703-718. [PMID: 38691257 PMCID: PMC11222272 DOI: 10.1007/s11864-024-01198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 05/03/2024]
Abstract
OPINION STATEMENT Dysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.
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Affiliation(s)
- Roganie Govender
- Head & Neck Academic Centre& UCL Division of Surgery & Interventional ScienceGround Floor Central, University College London Hospital, 250 Euston Road, London, NW1 2PQ, UK.
| | - Nicky Gilbody
- North Middlesex University Hospital NHS Trust, London, UK
| | | | | | - Ceri Robertson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Stuart
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
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4
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Ye J, Wu C, Chen J, Wang H, Pan Y, Huang X, Wu J, Zhong X, Zhou H, Wang W, Wu S, Zhou T, Wang L, Lu P, Ruan C, Guo J, Ning Y, Xiao A. Effectiveness of nurse-delivered stepwise swallowing training on dysphagia in patients with Alzheimer's disease: A multi-center randomized controlled trial. Int J Nurs Stud 2024; 150:104649. [PMID: 38070229 DOI: 10.1016/j.ijnurstu.2023.104649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Although swallowing exercises are a fundamental treatment for dysphagia, few studies have evaluated the effectiveness of swallowing training in patients with Alzheimer's disease. METHODS We recruited 93 patients with Alzheimer's disease from three hospitals in Guangdong, China. This was a parallel armed randomized controlled trial that randomly assigned patients to intervention (n = 48) and control (n = 45) groups. The intervention group adopted systematic stepwise swallowing training for four weeks based on routine dysphagia care. The control group implemented routine dysphagia care, including diet and posture management and health education about swallowing dysfunction. The swallowing function was the primary outcome, which was assessed using the Water Swallowing Test and Standard Swallowing Assessment. An abnormal eating behavior questionnaire was used to assess the incidence of aberrant eating behavior in patients with Alzheimer's disease. The Mini-Nutritional Assessment Short Form and Barthel index were adopted to evaluate the nutritional status and ability to carry out daily activities between groups. SPSS software was used to perform the chi-square test, t-test, and generalized estimation equation for data analysis. RESULTS We analyzed the effects of the stepwise swallowing training program using the generalized estimating equation method. The intervention group exhibited greater improvements in their swallowing function (Water Swallowing Test: β = -3.133, 95 % CI: -4.113, -2.154, P < 0.001; Standard Swallowing Assessment: β = -5.813, 95 % CI: -7.782, -3.844, P < 0.001), abnormal eating behaviors (abnormal eating behavior questionnaire: β = -13.324, 95 % CI: -21.643, -5.005, P = 0.002), daily function (Barthel index: β = 11.280, 95 % CI: 4.021, 18.540, P = 0.002), and nutritional status (Mini-Nutritional Assessment Short Form: β = 2.402, 95 % CI: 1.313, 3.490, P < 0.001) over time than the routine-care group in the fourth week. CONCLUSIONS Stepwise swallowing training is a safe and effective intervention for managing dysphagia and other related symptoms in patients with Alzheimer's disease.
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Affiliation(s)
- Junrong Ye
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chenxin Wu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Jiao Chen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Haoyun Wang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yuanxin Pan
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Xingxiao Huang
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jialan Wu
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaomei Zhong
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huarong Zhou
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Wang
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Shengwei Wu
- Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tingwei Zhou
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Li Wang
- Department of Nursing, Third People's Hospital of Jiangmen, Guangdong, China
| | - Peilan Lu
- Department of Neurology, Third People's Hospital of Jiangmen, Guangdong, China
| | - Chunrui Ruan
- Department of Geriatrics, Third People's Hospital of Jiangmen, Guangdong, China
| | - Jianxiong Guo
- Department of Chronic Diseases, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuping Ning
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Aixiang Xiao
- Geriatric Neuroscience Center, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Department of Nursing, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, 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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Goldman JG, Volpe D, Ellis TD, Hirsch MA, Johnson J, Wood J, Aragon A, Biundo R, Di Rocco A, Kasman GS, Iansek R, Miyasaki J, McConvey VM, Munneke M, Pinto S, St. Clair KA, Toledo S, York MK, Todaro R, Yarab N, Wallock K. Delivering Multidisciplinary Rehabilitation Care in Parkinson's Disease: An International Consensus Statement. JOURNAL OF PARKINSON'S DISEASE 2024; 14:135-166. [PMID: 38277303 PMCID: PMC10836578 DOI: 10.3233/jpd-230117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. OBJECTIVE The goal of the international Parkinson's Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. METHODS The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. RESULTS The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. CONCLUSIONS Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.
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Affiliation(s)
- Jennifer G. Goldman
- JPG Enterprises LLC, Medical Division, Chicago, IL, USA
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniele Volpe
- Fresco Parkinson Institute, Fiesole, Italy
- Fresco Parkinson Center Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
- NYU Grossman School of Medicine, New York, NY, USA
| | - Terry D. Ellis
- Boston University Sargent College of Health and Rehabilitation Sciences, Boston, MA, USA
| | - Mark A. Hirsch
- Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC, USA
| | - Julia Johnson
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Julia Wood
- Lewy Body Dementia Association, Lilburn, GA, USA
| | - Ana Aragon
- Independent Consultant Occupational Therapist, Bath, UK
| | | | | | | | | | | | | | - Marten Munneke
- Radboudumc Center of Expertise for Movement Disorders, Nijmegen, Netherlands
| | - Serge Pinto
- The French National Centre for Scientific Research, Aix-Marseille University, Aix-en-Provence, France
| | | | - Santiago Toledo
- ^Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Ronnie Todaro
- Voz Advisors, New York, NY, USA
- ^Parkinson’s Foundation, New York, NY, USA
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Dyreborg L, Raunbak SM, Sørensen SS, Melgaard D, Westmark S. The Cost-Effectiveness of Chin Tuck Against Resistance Compared to Usual Care in Citizens with Oropharyngeal Dysphagia - An Economic Evaluation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:787-797. [PMID: 38143783 PMCID: PMC10749109 DOI: 10.2147/ceor.s431380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Purpose This study aims to evaluate the cost-effectiveness of chin tuck against resistance (CTAR) for citizens suffering from dysphagia compared to the standard municipal treatment in Denmark. Patients and Methods A cost-utility analysis, employing a municipal perspective, was conducted using cost data collected alongside clinical data of a randomized controlled trial evaluating the effect of CTAR training for citizens with dysphagia. The composition of the clinical randomized controlled trial, which included citizens with different diagnoses, means that participants had different disease courses. Ninety-two citizens from seven different Danish municipalities were enrolled, of whom 43 received standard care, and 49 received CTAR in addition to standard care. The effect outcome of the economic evaluation was quality-adjusted life years (QALY), estimated using the EQ-5D-5L questionnaire. Individual resource consumption of each citizen was determined based on the use of home care, home nursing care, physio- and occupational therapy, dietitian guidance, and hospital admissions. The incremental costs and QALYs between the intervention group (CTAR in addition to standard care) and standard care group were estimated using regression analysis, and sensitivity analyses were performed to investigate the robustness of the results. Results The base case analysis showed that the intervention group was dominant compared to the standard care group, with a decrease in incremental costs of £542.38 and an increase in incremental QALYs of 0.0118. All sensitivity analyses demonstrated similar findings as the base case analysis, supporting the robustness of the results. Conclusion This study found that the intervention group was the dominant alternative, hence being more effective and cost-saving, compared to the standard care group in a Danish municipality perspective with a three-month time horizon. This study adds to the scarce evidence on the cost-effectiveness of CTAR in a Danish clinical setting, but further studies should focus on estimating long-term cost-effectiveness.
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Affiliation(s)
- Line Dyreborg
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Sabine Michelsen Raunbak
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Sabrina Storgaard Sørensen
- Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Dorte Melgaard
- North Denmark Regional Hospital, Hjørring, Denmark
- Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Mech-sense, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Westmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
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8
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Pereira ASDM, Gatti M, Ribeiro VV, Taveira KVM, Berretin-Felix G. Speech Language Pathology interventions in the areas of breathing, chewing, swallowing and speaking: a scoping review. Codas 2023; 36:e20220339. [PMID: 38126592 PMCID: PMC10750894 DOI: 10.1590/2317-1782/20232022339pt] [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: 01/02/2023] [Accepted: 05/31/2023] [Indexed: 12/23/2023] Open
Abstract
There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.
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Affiliation(s)
- Asenate Soares de Matos Pereira
- Programa de Pós-graduação em Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.
| | - Marina Gatti
- Programa de Pós-graduação em Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.
| | | | | | - Giédre Berretin-Felix
- Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.
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Gao M, Xu L, Wang X, Yang X, Wang Y, Wang H, Song J, Zhou F. Efficacy and safety of oropharyngeal muscle strength training on poststroke oropharyngeal dysphagia: a systematic review and meta-analysis. BMJ Open 2023; 13:e072638. [PMID: 37758672 PMCID: PMC10537832 DOI: 10.1136/bmjopen-2023-072638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES To investigate how oropharyngeal muscle strength training affected the safety and performance of swallowing in patients with poststroke oropharyngeal dysphagia. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central Register of Controlled of Trials, Web of Science, PubMed, Embase databases and ClinicalTrials.gov were systematically searched, for publications in English, from database inception to December 2022. ELIGIBILITY CRITERIA Studies comparing the effect of oropharyngeal muscle strength training with conventional dysphagia therapy in patients with poststroke. Penetration-Aspiration Scale (PAS) and Functional Oral Intake Scale (FOIS) were assessed as the main outcomes. DATA EXTRACTION AND SYNTHESIS Two researchers independently screened the literature, extracted data and evaluated the quality of the included studies, with disagreements resolved by another researcher. The Cochrane risk-of-bias tool was used to assess the risk of bias. Review Manager V.5.3 was employed for the meta-analysis. Random effect models were used for meta-analysis. RESULTS Seven studies with 259 participants were included in this meta-analysis. The results showed that oropharyngeal muscle strength training could reduce PAS score compared with conventional dysphagia therapy (mean difference=-0.98, 95% CI -1.34 to -0.62, p<0.0001, I2=28%). The results also showed that oropharyngeal muscle strength training could increase FOIS score (mean difference=1.04, 95% CI 0.55 to 1.54, p<0.0001, I2=0%) and the vertical displacement of the hyoid bone (mean difference=0.20, 95% CI 0.01 to 0.38, p=0.04, I2=0%) compared with conventional dysphagia therapy. CONCLUSION In patients with poststroke oropharyngeal dysphagia, oropharyngeal muscle strength training can improve swallowing safety and performance. PROSPERO REGISTRATION NUMBER CRD42022302471.
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Affiliation(s)
- Minxing Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Physical Medicine and Rehabilitation, Second Clinical College China Medical University, Shenyang, Liaoning, China
| | - Lingyuan Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoqiu Yang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Ying Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Heying Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jinan Song
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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10
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Cho YS, Yoon TH, Park JS. Effects of suprahyoid muscle strengthening exercise using kinesiology taping on muscle activation and thickness in community-dwelling elderly: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e35166. [PMID: 37713858 PMCID: PMC10508572 DOI: 10.1097/md.0000000000035166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Recently, swallowing resistive exercise using kinesiology taping (KT) has been reported as a novel method for dysphagia rehabilitation However, clinical evidence is still unclear, and effects in the elderly have not been confirmed. OBJECTIVE This study aimed to investigate the effects of suprahyoid muscle strengthening exercise using KT on muscle activation and thickness in community-dwelling elderly. METHODS A total of 24 healthy older people were enrolled in this study and randomly assigned to an experimental group and a placebo group. In the experimental group, KT was attached to the front of the neck with a tension of about 70% to 80%, and a resistive swallowing exercise was performed. In the placebo group, the tape was applied similarly but without tension. Both groups performed resistive swallowing exercises 10 times a day (50 swallows per day) for 6 weeks. The activation and thickness of the suprahyoid muscles were measured using portable ultrasound equipment and an surface electromyelograph device. RESULTS The experimental group showed a significant increase in suprahyoid muscle activation (mean and peak) and muscle thickness (digastric and mylohyoid) than the placebo group (all, P < .05). CONCLUSION This study confirmed that suprahyoid muscle strengthening exercise using KT had a positive effect on the suprahyoid muscles in healthy older adults, thus suggesting the possibility of a therapeutic exercise method for dysphagia rehabilitation.
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Affiliation(s)
- Young-Seok Cho
- Department of Occupational Therapy, Hyejeon College, Hongseong-gun, Republic of Korea
| | - Tae-Hyung Yoon
- Department of Occupational Therapy, Dongseo University, Busan, Korea
| | - Ji-Su Park
- Research Institute for Korean Medicine, Pusan National University, Yangsan-si, Republic of Korea
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11
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Vitale K, Powell WR, Krekeler BN, Yee J, Rogus-Pulia N. Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2111-2127. [PMID: 37566883 PMCID: PMC10569446 DOI: 10.1044/2023_ajslp-22-00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/14/2023] [Accepted: 04/27/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Exercise-based treatments may improve swallowing safety and efficiency; yet, it is not clearly understood which factors predict nonadherence to recommended treatment protocols. The aim of this study was to construct an algorithm for stratifying risk of nonadherence to a lingual strengthening dysphagia treatment program. METHOD Using recursive partitioning, we created a classification tree built from a pool of sociodemographic, clinical, and functional status indicators to identify risk groups for nonadherence to an intensive lingual strengthening treatment program. Nonadherence, or noncompletion, was defined as not completing two or more follow-up sessions or a final session within 84 days. RESULTS The study cohort consisted of 243 Veterans enrolled in the Intensive Dysphagia Treatment program across six sites from January 2012 to August 2019. The overall rate of nonadherence in this cohort was 38%. The classification tree demonstrated good discriminate validity (C-statistic = 0.74) and contained eight groups from five variables: primary diagnosis, marital status, Penetration-Aspiration Scale (PAS) severity score, race/ethnicity, and age. Nonadherence risk was categorized as high (range: 69%-77%), intermediate (27%-33%), and low risk (≤ 13%-22%). CONCLUSIONS This study identified distinct risk groups for nonadherence to lingual strengthening dysphagia rehabilitation. Additional research is necessary to understand how these factors may drive nonadherence. With external validation and refinement through prospective studies, a clinically relevant risk stratification tool can be developed to identify patients who may be at high risk for nonadherence and provide targeted patient support to mitigate risk and provide for unmet needs.
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Affiliation(s)
- Kailey Vitale
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Otolaryngology, Boston Medical Center, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, MA
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brittany N. Krekeler
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, OH
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, OH
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Nicole Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
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12
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Mpouzika M, Iordanou S, Kyranou M, Iliopoulou K, Parissopoulos S, Kalafati M, Karanikola M, Papathanassoglou E. Strategies of Screening and Treating Post-Extubation Dysphagia: An Overview of the Situation in Greek-Cypriot ICUs. Healthcare (Basel) 2023; 11:2283. [PMID: 37628481 PMCID: PMC10454777 DOI: 10.3390/healthcare11162283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Post-extubation dysphagia (PED) can lead to serious health problems in critically ill patients. Contrasting its high incidence rate of 12.4% reported in a recent observational study, many ICUs lack routine bedside screening, likely due to limited awareness. This study aimed to establish baseline data on the current approaches and the status of perceived best practices in PED screening and treatment, as well as to assess awareness of PED. A nationwide cross-sectional, online survey was conducted in all fourteen adult ICUs in the Republic of Cyprus in June 2018, with a 100% response rate. Over 85% of ICUs lacked a standard screening protocol for PED. The most commonly reported assessment methods were cough reflex testing and the water swallow test. Treatment approaches included muscle strengthening exercises without swallowing and swallowing exercises. Only 28.6% of ICUs acknowledged PED as a common issue. The study identified significant gaps in awareness and knowledge regarding PED screening and treatment in Greek-Cypriot ICUs. Urgent implementation of comprehensive dysphagia education programs within the units is necessary, and interdisciplinary collaboration among nurses, intensivists, and speech and language therapists is crucial to improve the quality of care provided.
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Affiliation(s)
- Meropi Mpouzika
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | - Stelios Iordanou
- Limassol General Hospital, State Health Services Organization, 4131 Limassol, Cyprus;
| | - Maria Kyranou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
| | | | | | - Maria Kalafati
- Department of Nursing, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Maria Karanikola
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, 3041 Limassol, Cyprus; (M.K.); (M.K.)
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13
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Choy J, Pourkazemi F, Anderson C, Bogaardt H. Dosages of Swallowing Exercises Prescribed in Stroke Rehabilitation: A Medical Record Audit. Dysphagia 2023; 38:686-699. [PMID: 35951119 PMCID: PMC10006267 DOI: 10.1007/s00455-022-10500-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/13/2022] [Indexed: 01/19/2023]
Abstract
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015, p = .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
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Affiliation(s)
- Jacinda Choy
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia.
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia.
| | - Fereshteh Pourkazemi
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Caitlin Anderson
- HammondCare Braeside Hospital, 340 Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Hans Bogaardt
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, 2006, Australia
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, 5005, Australia
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14
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Liu J, Wang Q, Tian J, Zhou W, Gao Y, Chen X, Zhang W, Gao Y, Zhou L. Effects of chin tuck against resistance exercise on post-stroke dysphagia rehabilitation: A systematic review and meta-analysis. Front Neurol 2023; 13:1109140. [PMID: 36698882 PMCID: PMC9868925 DOI: 10.3389/fneur.2022.1109140] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background Chin tuck against resistance (CTAR) exercise was introduced to substitute for the commonly used Shaker exercise for dysphagia rehabilitation. The effects of CTAR exercise in stroke survivors needs to be validated. Objective To investigate the effects of Chin tuck against resistance (CTAR) exercise on the swallowing function and psychological condition in stroke survivors compared to no exercise intervention and the Shaker exercise. Materials and methods The Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL and four Chinese databases were searched for randomized controlled trails (RCTs) and quasi-RCTs from inception to February 2022. Results After screened and assessed the methodological quality of the studies, nine studies with 548 stroke survivors were included in the systematic review. 8 studies were included in the meta-analysis using RevMan 5.4 software. The mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated. The results revealed that CTAR exercise is effective in improving swallowing safety (MD, -1.43; 95% CI, -1.81 to -1.06; P < 0.0001) and oral intake ability (SMD, -1.82; 95% CI, -3.28 to -0.35; P = 0.01) compared with no exercise intervention, CTAR exercise is superior to Shaker exercise in improving swallowing safety (MD, -0.49; 95% CI, -0.83 to -0.16; P = 0.004). The psychological condition in CTAR group is significant better than the control group (MD, -5.72; 95% CI, -7.39 to -4.05; P < 0.00001) and Shaker group (MD, -2.20; 95% CI, -3.77 to -0.64; P = 0.006). Conclusions Our findings support CTAR exercise as a superior therapeutic exercise for post-stroke dysphagia rehabilitation than Shaker exercise. More high-qualities RCTs from larger multicenter are needed to analysis the effects of CTAR exercise in patients with different type and phase of stroke and explore the optimal training dose.
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Affiliation(s)
- Jing Liu
- School of Nursing, Naval Medical University, Shanghai, China
| | - Qiuyi Wang
- School of Nursing, Naval Medical University, Shanghai, China
| | - Jing Tian
- School of Nursing, Naval Medical University, Shanghai, China
| | - Wanqiong Zhou
- School of Nursing, Naval Medical University, Shanghai, China
| | - Yitian Gao
- School of Nursing, Naval Medical University, Shanghai, China
| | - Xuemei Chen
- School of Nursing, Naval Medical University, Shanghai, China
| | - Wei Zhang
- School of Nursing, Naval Medical University, Shanghai, China
| | - Yajing Gao
- Nursing School, Peking University, Beijing, China
| | - Lanshu Zhou
- School of Nursing, Naval Medical University, Shanghai, China
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15
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Borges TGV, Muniz CR, Ferreira FR, Brendim MP, Muxfeldt ES. Swallowing outcome to speech therapy intervention in resistant hypertensive patients with obstructive sleep apnea. Eur Arch Otorhinolaryngol 2023; 280:443-453. [PMID: 36098863 PMCID: PMC9469056 DOI: 10.1007/s00405-022-07612-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/11/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate (i) the outcome of swallowing therapy program on the rehabilitation of oropharyngeal dysphagia in resistant hypertensive patients with obstructive sleep apnea (OSA) and (ii) the association between the clinical and anthropometric characteristics of these individuals and this outcome. METHODS This was a prospective interventional study in which resistant hypertensives diagnosed with OSA by polysomnography and dysphagia by fiberoptic endoscopic evaluation of swallowing (FESS) participated. All participants underwent a FEES and assessment of the risk of dysphagia (Eating Assessment Tool, EAT-10) and swallowing-related quality of life (Swal-QoL) before and after the intervention. The therapeutic program was performed daily by the participants, with weekly speech-therapist supervision for eight weeks, including the following strategies: Masako, chin tuck against resistance, and expiratory muscle training. RESULTS A total of 26 (78.8%) of the participants exhibited improvement in the degree of dysphagia in the intervention outcome. After the intervention, there was a statistically significant improvement in the level of penetration-aspiration (p = 0.007), the degree of pharyngeal residue (p = 0.001), the site of onset of the pharyngeal phase (p = 0.001), and the severity of dysphagia (p = 0.001) compared to before intervention. The EAT-10 score was 2 (0-6) before and 0 (0-3) after intervention (p = 0.023). Swal-QoL had a score on the symptom frequency domain of 92.8 (75-100) before and 98.2 (87.5-100) after intervention (p = 0.002). CONCLUSIONS Resistant hypertensive patients with OSA showed improved swallowing performance after swallowing therapy program.
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Affiliation(s)
- Thalyta Georgia Vieira Borges
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Carla Rocha Muniz
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Flavia Rodrigues Ferreira
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
| | - Mariana Pinheiro Brendim
- Speech-Language Pathology Department, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 4º andar - Speech-Language Pathology Clinic, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha do Fundão, Rio de Janeiro, 21941-590 Brazil
| | - Elizabeth Silaid Muxfeldt
- Program in Internal Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro - UFRJ, 3º andar - Hypertension Program - ProHArt, Rua Professor Rodolpho Paulo Rocco, 255 - Ilha Do Fundão, Rio de Janeiro, Rio de Janeiro 21941-590 Brazil
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16
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Cosentino G, Todisco M, Giudice C, Tassorelli C, Alfonsi E. Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease. Curr Opin Neurol 2022; 35:741-752. [PMID: 36226719 DOI: 10.1097/wco.0000000000001117] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW Neurogenic dysphagia worsens quality of life and prognosis of patients with different neurological disorders. Management of neurogenic dysphagia can be challenging. This review provides a comprehensive overview of current evidence on screening, diagnosis, and treatment of neurogenic dysphagia in stroke and Parkinson's disease, suggesting clues for clinical practice. RECENT FINDINGS The pros and cons of diagnostic techniques are discussed in the light of updated evidence. Findings from recent meta-analyses of different treatment approaches, including traditional dysphagia therapy, peripheral and central neurostimulation techniques, and treatment with botulinum toxin, are critically discussed, emphasizing inconsistencies and controversial issues. SUMMARY Screening tests and clinical swallow examination should be routinely performed in neurological patients at risk for dysphagia. In patients testing positive for dysphagia, first-line instrumental investigations, represented by fiberoptic endoscopic evaluation of swallowing or videofluoroscopic swallow study, should be performed to confirm the presence of dysphagia, to assess its severity, and to inform the treatment. Second-line and third-line instrumental methods can be used in selected patients to clarify specific pathophysiological aspects of oropharyngeal dysphagia. Treatment strategies should be personalized, and combination of traditional dysphagia therapy with innovative treatment approaches may increase the chance of restoring effective and safe swallowing.
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Affiliation(s)
- Giuseppe Cosentino
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation
- Department of Brain and Behavioral Sciences, University of Pavia
| | - Massimiliano Todisco
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation
- Department of Brain and Behavioral Sciences, University of Pavia
| | - Carla Giudice
- Department of Brain and Behavioral Sciences, University of Pavia
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia
- Headache Science and Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Enrico Alfonsi
- Translational Neurophysiology Research Unit, IRCCS Mondino Foundation
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17
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Effect of Chin Tuck against Resistance Exercise in Citizens with Oropharyngeal Dysphagia-A Randomised Controlled Study. Geriatrics (Basel) 2022; 7:geriatrics7060129. [PMID: 36412618 PMCID: PMC9680398 DOI: 10.3390/geriatrics7060129] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022] Open
Abstract
Oropharyngeal dysphagia (OD) impacts the safety and efficacy of the swallowing function. The aim was to uncover the effect of chin tuck against resistance (CTAR) exercises compared to standard care in relation to the swallowing function in citizens with OD. Ninety-two citizens (46% male, median age 78 years (IQR 71, 84)) with OD confirmed by the Volume-Viscosity Swallow Test and/or Minimal Eating Observation Form version II were randomised to standard care with the addition of CTAR daily for six weeks or standard care only. The participants were included from seven Danish municipalities from March 2019 to October 2020. A nonsignificant effect on dysphagia of CTAR training combined with standard care versus standard care alone was documented. Both CTAR training combined with standard care and standard care alone had a significant effect on the swallowing function in citizens with OD, with the best effect in the group receiving CTAR training combined with standard care. A significant effect compared to baseline was observed in all participants (p = 0.03) after 12 weeks. Participants in both groups had a significant reduction in problems with manipulating food in the mouth (p = 0.005), swallowing (p = 0.005), and chewing (p = 0.03) but an increased appetite (p = 0.01). The reported quality of life scored with DHI-DK was significantly improved in both groups.
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18
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Cheng I, Hamad A, Sasegbon A, Hamdy S. Advances in the Treatment of Dysphagia in Neurological Disorders: A Review of Current Evidence and Future Considerations. Neuropsychiatr Dis Treat 2022; 18:2251-2263. [PMID: 36268265 PMCID: PMC9578488 DOI: 10.2147/ndt.s371624] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/08/2022] [Indexed: 11/19/2022] Open
Abstract
Dysphagia, which refers to difficult and/or disordered swallowing, is a common problem associated with various neurological diseases such as stroke, motor neuron diseases and neurodegenerative diseases. Traditionally, dysphagia treatments are either compensatory, which includes modifications of bolus texture or feeding posture, or rehabilitative, which includes behavioral exercises and sensory stimulation. Despite being widely adopted in clinical practice, recent views have challenged the clinical efficacy of these treatments due to the low level of evidence supported by mainly non-controlled studies. As such, with advancements in technology and scientific research methods, recent times have seen a surge in the development of novel dysphagia treatments and an increasing number of robust randomized controlled clinical trials. In this review, we will review the clinical evidence of several newly introduced treatments for dysphagia in the last two decades, including rehabilitative exercises, biofeedback, pharmacological treatments, neuromodulation treatments and soft robotics. Despite the recent improvements in the quality of evidence for the efficacy of dysphagia treatments, several critical issues, including heterogeneity in treatment regimens, long-term treatment effects, underlying mechanisms of some neuromodulation treatments, and the effects of these techniques in non-stroke dysphagia, remain to be addressed in future clinical trials.
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Affiliation(s)
- Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Adeel Hamad
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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19
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Gao M, Wang Y, Xu L, Wang X, Wang H, Song J, Yang X, Zhou F. Safety and performance of oropharyngeal muscle strength training in the treatment of post-stroke dysphagia during oral feeding: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e061893. [PMID: 35705350 PMCID: PMC9204412 DOI: 10.1136/bmjopen-2022-061893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Dysphagia is a common functional disorder after stroke. Most patients post-stroke are incapable of oral feeding, which often leads to complications such as malnutrition, aspiration pneumonia and dehydration that seriously affect the quality of life of patients. Oropharyngeal muscle strength training is a major method of swallowing training, and recent studies have focused on healthy adults, elderly persons, and patients with head and neck cancer or neurodegenerative diseases; but there have been few studies on such training in patients with post-stroke dysphagia. Our study aims to systematically review the safety and performance of oropharyngeal muscle strength training in the treatment of post-stroke dysphagia during oral feeding. METHODS AND ANALYSIS The Cochrane Library, Web of Science, PubMed, Embase and ClinicalTrials.gov databases will be systematically searched, and all relevant articles in English from the establishment of the databases to January 2022 will be reviewed. The study will be conducted in accordance with the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. The primary outcome measures include the Penetration-Aspiration Scale and the Functional Oral Intake Scale. Two authors will independently screen the articles, extract the data and assess the study quality. Any disagreements during this process will be resolved by discussion or by consultation with a third author. Next, quantitative or qualitative, subgroup and sensitivity analyses of the included literature data will be performed as appropriate. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review as no primary data collection will be required. The results of the present study will be published in a peer-reviewed journal in the field of deglutition disorders. PROSPERO REGISTRATION NUMBER CRD42022302471.
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Affiliation(s)
- Minxing Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, Liaoning, China
| | - Ying Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lingyuan Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Heying Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jinan Song
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaoqiu Yang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Fenghua Zhou
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
- Department of Physical Medicine and Rehabilitation, The Second Clinical College, China Medical University, Shenyang, Liaoning, China
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20
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Wu C, Zhang K, Ye J, Huang X, Yang H, Yuan L, Wang H, Wang T, Zhong X, Guo J, Yu L, Xiao A. Evaluating the effectiveness of stepwise swallowing training on dysphagia in patients with Alzheimer's disease: study protocol for a randomized controlled trial. Trials 2022; 23:490. [PMID: 35698162 PMCID: PMC9195482 DOI: 10.1186/s13063-022-06446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high prevalence of dysphagia among Alzheimer's disease (AD) patients has become a public health and economic concern. Therefore, effective and accessible dysphagia treatments are needed. As a fundamental rehabilitation of dysphagia, swallowing muscle exercises have received increased attention. Stepwise swallowing training (SST), integrated with all swallowing organs movement, is expected to improve swallowing dysfunction among AD patients. By using a randomized controlled trial design, we propose a multi-center research to evaluate the effectiveness of SST program among AD patients. METHODS A multi-center exploratory randomized controlled trial, with a 4-week follow-up period, will be conducted in three major public psychiatric hospitals in Guangdong, China. Participants in the control group will be assigned to routine dysphagia care, while participants in the intervention group will undergo the same nursing care and additionally receive the SST program. The SST program includes five sections of swallowing organs training: lip movement, facial movement, tongue movement, mandibular movement, and neck movement. Primary outcomes evaluate the swallowing function, namely, Water Swallowing Test (WTS) and Standard Swallowing Assessment (SSA). Secondary outcomes aim at measuring the improvement of negative impacts of dysphagia, namely eating behavior, ability of daily activity, and nutritional status. Data will be collected at baseline (T1), at 2 weeks (T2, intervention), and 4 weeks after intervention (T3, follow-up). DISCUSSION This study will offer trial-based evidence of the effectiveness of SST in relieving dysphagia among AD patients. SST program is expected to improve both the swallowing function and reduce the negative impacts of dysphagia, with an exploration of acceptability in the SST program. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200056481 . Prospectively registered on 6 February 2022.
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Affiliation(s)
- Chenxin Wu
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.,Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China
| | - Kun Zhang
- School of Public Health and Management, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, China
| | - Junrong Ye
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Xingxiao Huang
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Hang Yang
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Lexin Yuan
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.,Nursing Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Haoyun Wang
- Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China
| | - Ting Wang
- Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China
| | - Xiaomei Zhong
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China
| | - Jianxiong Guo
- Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.
| | - Lin Yu
- TCM Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China.
| | - Aixiang Xiao
- Geriatric Psychiatry Department, Affiliated Brain Hospital of Guangzhou Medical University, 36 MingXin Road, Liwan Distrist, Guangzhou, China. .,Nursing School, Guangzhou Medical University, 195 Dongfeng West Road, Yuexiu District, Guangzhou, China. .,School of Public Health and Management, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, China.
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21
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Clunie GM, Bolton L, Lovell L, Bradley E, Bond C, Bennington S, Roe J. Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic. Methods A retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic. Results A total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake. Conclusions This study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
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Affiliation(s)
- Gemma M Clunie
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Bolton
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Bradley
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Cara Bond
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Bennington
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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22
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Eskildsen SJ, Poulsen I, Jakobsen D, Riberholt CG, Curtis DJ. Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury. BMJ Open 2021; 11:e053244. [PMID: 34857571 PMCID: PMC8640633 DOI: 10.1136/bmjopen-2021-053244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 11/03/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Dysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI. OBJECTIVE To systematically map the accessible research literature to answer the research question: Which non-surgical, non-pharmacological interventions are used in the treatment of dysphagia in patients with moderate and severe ABI in the acute and subacute phase? DESIGN: Scoping review based on the methodology of Arksey and O'Malley and methodological advancement by Levac et al. DATA SOURCES: MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021. ELIGIBILITY CRITERIA All studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included. DATA EXTRACTION AND SYNTHESIS Data was extracted by two independent reviewers and studies were categorised based on treatment modality. RESULTS A total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into cortical or non-cortical stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training. CONCLUSION This scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.
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Affiliation(s)
- Signe Janum Eskildsen
- Department of Occupational Therapy and Physiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Research Unit of Nursing and Health Care, Health, Aarhus University, Aarhus, Denmark
| | - Ingrid Poulsen
- Research Unit of Nursing and Health Care, Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Copenhagen University Hospital, Rigshospitalet, Amager and Hvidovre, Denmark
| | - Daniela Jakobsen
- Department of Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Derek John Curtis
- Department of Brain Injury, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Child Centre Copenhagen, The Child and Youth Administration, Copenhagen, Denmark
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