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Gazzini L, Caselli A, Dallari V, Fazio E, Abousiam M, Nebiaj A, Albi C, Accorona R, De Virgilio A, Greco A, Calabrese L. Subtotal glossectomy with conservation of the hyo-styloglossus unit (HSU): a new pivotal concept for preserving tongue function in extended glossectomy. Front Surg 2024; 11:1395936. [PMID: 39045088 PMCID: PMC11264312 DOI: 10.3389/fsurg.2024.1395936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/20/2024] [Indexed: 07/25/2024] Open
Abstract
Objective The local spread of oral tongue squamous cell carcinoma (OTSCC) follows pathways of dissemination along areas of lesser resistance. In more advanced scenarios, the tumor can extend beyond the hemi-tongue of origin, by passing through the lingual septum and following the fibers of the transverse muscle. This can lead to the invasion of the contralateral extrinsic muscles, the first being the genioglossus and more laterally the hyoglossus. An anatomically guided surgical resection of the tumor can be planned to ensure both oncological safety and an acceptable functional outcome. This approach aims to preserve the hyo-styloglossus unit (HSU) whenever feasible. Methods Between January 2019 and November 2022, six patients received extended glossectomy Type B (EG Type B), with preservation of the HSU. Preliminary oncological results and functional results in terms of swallowing (FOIS score) and quality of life (MDADI) are presented. Results Five out of the six patients are alive and disease-free, while one patient died due to other causes. All patients who were candidates for an EG Type B underwent a swallowing assessment prior to surgery and followed daily postoperative swallowing training. At discharge, the patients continued swallowing training in an outpatient clinic. Five out of the six patients reached a full oral diet within 1 year of follow-up. Conclusion The oncological results confirm the safety of this technique. The importance of preserving the HSU, the minimal functional unit, shows very encouraging results in terms of swallowing rehabilitation.
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Affiliation(s)
- Luca Gazzini
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Arianna Caselli
- Speech and Language Therapy Division, Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Virginia Dallari
- Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Verona, Italy
| | - Enrico Fazio
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Monir Abousiam
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Aurel Nebiaj
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Cecilia Albi
- Division of Otorhinolaryngology-Head and Neck Surgery, University of Ferrara, Ferrara, Italy
| | - Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Antonio Greco
- Department of “Organi di Senso”, University “Sapienza”, Rome, Italy
| | - Luca Calabrese
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
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Battista P, Aresta S, Tagliente S, Merlo F, Mongelli D, Lagravinese G, Falcone R, Palmirotta C, Turi G, Castellari M, Zonno A, Gelao C, Picciola E, Fiore P, Battel I, Minafra B. Exploring the Neuropsychological Correlates of Swallowing Disorders in People with Parkinson's Disease: a Cross-Sectional Study. Dysphagia 2024:10.1007/s00455-024-10728-9. [PMID: 38951235 DOI: 10.1007/s00455-024-10728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/10/2024] [Indexed: 07/03/2024]
Abstract
Around 80% of persons with Parkinson's disease (PD) present symptoms of dysphagia. Although cognitive impairment may contribute to dysphagia, few studies have investigated the association between the PD neuropsychological profile and objective measures of swallowing dysfunction. Since the swallowing function comprises involuntary but also voluntary actions, we hypothesize that specific measures of attention and executive functions can be underlined in PD-related dysphagia. Therefore, the aim of this study was to extensively investigate the correlation and the relationship between attentive and executive functions and safety/efficiency of pharyngeal phase of swallowing in people with PD. All participants received a fiberoptic endoscopic evaluation of swallowing and were evaluated using the Penetration Aspiration Scale (PAS); the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and the Functional Oral Intake Scale (FOIS-IT). Participants also underwent a neuropsychological assessment covering global cognitive status, attention, and frontal executive functions. Correlations and associations between neuropsychological measures and swallowing components were calculated. Twenty-one participants with PD (mean age 69.38 ± 6.58 years, mean disease duration 8.38 ± 5.31 years; mean MDS-UPDRS III 43.95 ± 24.18) completed all evaluations. The most significant correlations were found between attentive functions (i.e., Stroop Time), and executive functions (i.e., Raven's Progressive Matrices, Digit Backward and Semantic Fluency), and FOIS-IT, PAS, and IT-YPRSRS sinuses and valleculae. These associations were not influenced by disease duration. These results suggest that a dysfunction to attentional processes and/or to executive functions can contribute to penetration and the presence of pharyngeal residue in participants with middle-stage PD.
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Affiliation(s)
- Petronilla Battista
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy.
| | - Simona Aresta
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Serena Tagliente
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | | | - Davide Mongelli
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Gianvito Lagravinese
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Rosanna Falcone
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Cinzia Palmirotta
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Gilda Turi
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Micol Castellari
- Department of Physical and Rehabilitation Medicine, University of Foggia, Foggia, Italy
| | - Alessandra Zonno
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Christian Gelao
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Emilia Picciola
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Pietro Fiore
- Department of Physical and Rehabilitation Medicine, University of Foggia, Foggia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit, Institute of Milan, Milan, Italy
| | - Irene Battel
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
| | - Brigida Minafra
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
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Mozzanica F, Pizzorni N, Eplite A, Ginocchio D, Colombo A, Mora G, Ambrogi F, Warnecke T, Schindler A. Swallowing Characteristics in Patients with Multiple System Atrophy Analyzed Using FEES Examination. Dysphagia 2024; 39:387-397. [PMID: 37733099 PMCID: PMC11127813 DOI: 10.1007/s00455-023-10619-5] [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: 03/07/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023]
Abstract
Patients with multiple system atrophy (MSA) frequently experience dysphagia but only few studies analyzed its characteristics. The aim of this study was to describe the swallowing characteristics in these patients using fiberoptic endoscopic evaluation of swallowing (FEES). In addition, the swallowing abilities in patients with predominantly cerebellar MSA (MSA-C) and predominantly parkinsonian MSA (MSA-P) were compared. Twenty-five patients with MSA (16 MSA-P and 9 MSA-C) were enrolled. Clinical data including age, sex, functional oral intake scale (FOIS) score, body mass index (BMI) and the results of the global disability-unified MSA rating scale (GD-UMSARS) were collected. Three different textures of food (liquid, semisolid, solid) were provided during FEES examination. The characteristics of dysphagia (safety, efficiency, phenotype) and laryngeal movement alterations were analyzed. Delayed pharyngeal phase (92%) and posterior oral incontinence (52%) were the phenotypes more frequently seen. Penetration was more frequent with Liquid (68%), while aspiration occurred only with Liquid (20%). Residues of ingested food were demonstrated both in the pyriform sinus and in the vallecula with all the consistencies. Vocal fold motion impairment was the laryngeal movement alteration most frequently encountered (56%). No significant differences between patients with MSA-P and MSA-C in the dysphagia characteristics and laryngeal movement alterations were found. Patients with MSA frequently experience swallowing impairment and altered laryngeal mobility. Dysphagia characteristics and laryngeal movements alterations seems to be similar in MSA-C and MSA-P.
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Affiliation(s)
- Francesco Mozzanica
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- IRCCS Multimedica, Ospedale San Giuseppe, Milan, Italy.
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Angelo Eplite
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Daniela Ginocchio
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Anna Colombo
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gabriele Mora
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation at the Klinikum Osnabrück, Academic Teaching Hospital of the Westfälische Wilhelms-University of Münster, Osnabrück, Germany
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Battel I, Walshe M. An intensive neurorehabilitation programme with sEMG biofeedback to improve swallowing in idiopathic Parkinson's disease (IPD): A feasibility study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:813-825. [PMID: 36478035 DOI: 10.1111/1460-6984.12824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/25/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Studies suggest swallow intervention programmes that incorporate visual biofeedback and motor programming principles can improve swallowing and quality of life for people with idiopathic Parkinson's disease (IPD) and dysphagia. Few studies have examined outcomes using instrumentation. AIMS Using fibreoptic endoscopic examination of swallowing (FEES), this study examines the effectiveness of a neurorehabilitation intervention involving biofeedback via surface electromyography (sEMG) to improve swallowing in people with IPD, and to explore the feasibility of the intervention approach. METHODS & PROCEDURES We recruited 12 participants with IPD and dysphagia. A total of 10 completed the study. Intervention was delivered for 1 h per day, 5 days per week, for 4 weeks (20 h). Swallowing tasks using sEMG biofeedback incorporated principles of motor learning and neuroplasticity. Instrumental and non-instrumental assessment, including quality-of-life measures carried out at four different time points (two pre-treatment and two post-treatment). The final assessment was at 3 months post-intervention. OUTCOME & RESULTS Statistically significant improvement (p < 0.05) in oral intake methods (95% confidence interval (CI) = 4.70-5.50) and in pharyngeal residue from saliva (95% CI = 2.14-3.15) and solids (95% CI = 2.4-3.5) post-intervention were confirmed using FEES with improvements at 3 months. The intervention protocol was well tolerated. Participants reported positive change in saliva control and duration of mealtimes as well as unanticipated improvements in voice and cognitive attention. CONCLUSIONS & IMPLICATIONS An intensive neurorehabilitation with biofeedback shows positive effects in improving swallow function in IPD. This protocol is feasible with amendments to inform a larger clinical trial. WHAT THIS PAPER ADDS What is already known on the subject Biofeedback has positive effects on increasing swallowing function and quality of life in people with IPD and dysphagia. sEMG is the most common method used to deliver swallowing biofeedback in this population. The quality of the evidence on the intervention, based on findings from a recent systematic review, is low. Included studies in this review were heterogeneous in terms of type and frequency of biofeedback, study design and outcome measures. The majority of outcome measures were subjective and higher quality studies to examine the efficacy of biofeedback using sEMG are needed. What this study adds Recognizing the limitations of earlier studies, this within-subject feasibility study examined the efficacy and effectiveness of an intensive biofeedback intervention using sEMG in a sample of people with dysphagia and IPD. Valid and reliable outcome measures were used and repeated after a 3-month period. The feasibility of the methodological approach was also tested and a qualitative component was included in the study. Positive findings were evident. Qualitative information added new perspectives and provided direction for new outcomes to be included in future studies. This study helps to inform further research trials as well as clinical practice. Clinical implications of this study This intensive intervention using principles of neuroplasticity and motor programming with sEMG biofeedback led not only to positive swallowing outcomes but also to unexpected benefits such as improved voice production and general attention skills. No adverse events were reported. Improvement in function was retained at 3 months post-intervention. Despite the small sample size, participants described the benefits of the treatment, and enjoyed sEMG biofeedback tasks, especially using an sEMG game mode. This suggests that intensive biofeedback not only improved swallowing but also was acceptable to these participants. This intensive protocol has merit and is worth considering further in clinical practice.
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Affiliation(s)
- Irene Battel
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
- Department of Biomedical, Surgical and Dental Sciences, University 'La Statale', Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Ireland
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Hakiki B, Liuzzi P, Pansini G, Pancani S, Romoli A, Draghi F, Orlandini S, Mannini A, Della Puppa A, Macchi C, Cecchi F. Impact of decompressive craniectomy on functional outcome of severe acquired brain injuries patients, at discharge from intensive inpatient rehabilitation. Disabil Rehabil 2022; 44:8375-8381. [PMID: 34928755 DOI: 10.1080/09638288.2021.2015461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Decompressive craniectomy (DC) is a life-saving procedure conducted to treat refractory intracranial hypertension. Although DC reduces mortality of severe Acquired Brain Injury (sABI) survivors, it has been associated with severe long-term disability. This observational study compares functional outcomes at discharge from an Intensive Rehabilitative Unit (IRU) between sABI patients with and without DC. MATERIAL AND METHODS sABI patients undergoing DC before entering the Don Gnocchi Foundation IRU were compared with a group of sABI patients who did not undergo DC (No-DC group), after matching it by age, sex, aetiology, time post-onset, and clinical status. Inclusion criteria were: diagnosis of sABI, age 18+, time from the event <90 days. RESULTS A total of 87 (DC: 47) patients were included (median age: 60.5 [IQR = 17.47]). The two groups did not differ for admission clinical features except for the tracheostomy presence (more frequent in DC, p < 0.001). No significant differences were also found at discharge. DC group presented a significantly longer length-of-stay than No-DC group (p < 0.001) and a longer time to tracheostomy removal (p = 0.036). DC was not found to influence outcomes as consciousness improvement, tracheostomy removal, oral intake and functional independence. CONCLUSIONS sABI patients with DC improved after rehabilitation as much as No-DC patients did but they required a longer stay.Implications for RehabilitationDecompressive craniectomy (DC) is practiced during the acute phase after hemorrhagic, ischemic, traumatic severe brain injury as a life-saving procedure to treat refractory intracranial hypertensionDC has been associated with follow-up severe long-term disability, but no study yet addressed whether DC may affect intensive rehabilitation outcomes.Undergoing a DC is not a negative prognostic factor for achieving rehabilitation goals after a severe acquired brain injuryDC must be taken into account when customizing rehabilitation pathway especially because these patients required a longer time to reach the outcomes.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (Pi), Italy
| | - Gastone Pansini
- Neurosurgery Unit, Azienda Ospedaliera Universitaria Careggi, Largo Giovanni Alessandro Brambilla 3, Firenze (Fi), Italy
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy
| | - Annamaria Romoli
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy
| | - Francesca Draghi
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy
| | - Simone Orlandini
- Neurosurgery Unit, Azienda Ospedaliera Universitaria Careggi, Largo Giovanni Alessandro Brambilla 3, Firenze (Fi), Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio 34, Pontedera (Pi), Italy
| | - Alessandro Della Puppa
- Neurosurgery Unit, Azienda Ospedaliera Universitaria Careggi, Largo Giovanni Alessandro Brambilla 3, Firenze (Fi), Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy.,Department of Experimental and Clinical Medicine, Università di Firenze, Largo Giovanni Alessandro Brambilla 3, Firenze (Fi), Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci 269, Florence (Fi), Italy.,Department of Experimental and Clinical Medicine, Università di Firenze, Largo Giovanni Alessandro Brambilla 3, Firenze (Fi), Italy
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Li L, Liu J, Liang F, Chen H, Zhan R, Zhao S, Li T, Peng Y. Altered Brain Function Activity in Patients With Dysphagia After Cerebral Infarction: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurol 2022; 13:782732. [PMID: 35911901 PMCID: PMC9329512 DOI: 10.3389/fneur.2022.782732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 05/26/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Dysphagia after cerebral infarction (DYS) has been detected in several brain regions through resting-state functional magnetic resonance imaging (rs-fMRI). In this study, we used two rs-fMRI measures to investigate the changes in brain function activity in DYS and their correlations with dysphagia severity. Method In this study, a total of 22 patients with DYS were compared with 30 patients without dysphagia (non-DYS) and matched for baseline characteristics. Then, rs-fMRI scans were performed in both groups, and regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuation (fALFF) values were calculated in both groups. The two-sample t-test was used to compare ReHo and fALFF between the groups. Pearson's correlation analysis was used to determine the correlations between the ReHo and fALFF of the abnormal brain regions and the scores of the Functional Oral Intake Scale (FOIS), the Standardized Bedside Swallowing Assessment (SSA), the Videofluoroscopic Swallowing Study (VFSS), and the Penetration-Aspiration Scale (PAS). Results Compared with the non-DYS group, the DYS group showed decreased ReHo values in the left thalamus, the left parietal lobe, and the right temporal lobe and significantly decreased fALFF values in the right middle temporal gyrus and the inferior parietal lobule. In the DYS group, the ReHo of the right temporal lobe was positively correlated with the SSA score and the PAS score (r = 0.704, p < 0.001 and r = 0.707, p < 0.001, respectively) but negatively correlated with the VFSS score (r = −0.741, p < 0.001). The ReHo of the left parietal lobe was positively correlated with SSA and PAS (r = 0.621, p = 0.002 and r = 0.682, p < 0.001, respectively) but negatively correlated with VFSS (r = −0.679, p = 0.001). Conclusion The changes in the brain function activity of these regions are related to dysphagia severity. The DYS group with high ReHo values in the right temporal and left parietal lobes had severe dysphagia.
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Affiliation(s)
- Lei Li
- Department of Nuclear Medicine, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Jiayu Liu
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
| | - Fenxiong Liang
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Haidong Chen
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Rungen Zhan
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Shengli Zhao
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
| | - Tiao Li
- Department of Rehabilitation Medicine, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
- *Correspondence: Tiao Li
| | - Yongjun Peng
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Zhuhai, China
- Yongjun Peng
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Reverberi C, Gottardo G, Battel I, Castagnetti E. The neurogenic dysphagia management via telemedicine: a systematic review. Eur J Phys Rehabil Med 2022; 58:179-189. [PMID: 34605620 PMCID: PMC9980496 DOI: 10.23736/s1973-9087.21.06921-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Telerehabilitation is the provision of rehabilitation remotely through Information and Communication Technologies (ICT). Recently, there has been an increase of interest in its application thanks to increasing a new technology. The aim of this systematic review was to examine the evidence of the literature regarding the management of neurogenic dysphagia via telerehabilitation, compared to face-to-face rehabilitation treatment. The secondary aim was to create recommendations on telerehabilitation sessions for patients diagnosed with neurogenic dysphagia. EVIDENCE ACQUISITION The databases were: Medline, Embase, CINAHL, Scopus. A total of 235 records emerged from bibliographic research, manual search of full text and from gray literature, published until January 2021. Two blinded authors carried out titles and abstract screening and followed by full-text analysis. Sixteen articles were included in the systematic review and assessed through critical appraisal tools. EVIDENCE SYNTHESIS The research shows that the majority of the studies on neurogenic dysphagia involved the Clinical Swallow Examination via telerehabilitation, compared with the in-person modality. Significant levels of agreement and high satisfaction from clinicians and patients are reported to support the use of telerehabilitation. Based on the results of this systematic review and qualitative analysis, the authors developed practical recommendations for the management of telerehabilitation sessions for patients with neurogenic dysphagia. CONCLUSIONS Despite the presence of barriers, telerehabilitation allowed healthcare provision and increasing access to care and services with specialized professionals, remote rehabilitation can be a valid resource during the health emergency due to COVID-19.
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Affiliation(s)
- Cristina Reverberi
- Department of Health Professions, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Irene Battel
- Department of Physical and Medical Rehabilitation, San Giovanni e Paolo Civil Hospital, Azienda ULSS3 Serenissima, Venice, Italy -
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Hakiki B, Grippo A, Scarpino M, Liuzzi P, Mannini A, Macchi C, Cecchi F. Effects of COVID-19 pandemic on intensive rehabilitation after severe acquired brain injuries. Neurol Sci 2022; 43:791-798. [PMID: 34762195 PMCID: PMC8581285 DOI: 10.1007/s10072-021-05709-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/29/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE COVID-19 pandemic has affected most components of health systems including rehabilitation. The study aims to compare demographic and clinical data of patients admitted to an intensive rehabilitation unit (IRU) after severe acquired brain injuries (sABIs), before and during the pandemic. MATERIALS AND METHODS In this observational retrospective study, all patients admitted to the IRU between 2017 and 2020 were included. Demographics were collected, as well as data from the clinical and functional assessment at admission and discharge from the IRU. Patients were grouped in years starting from March 2017, and the 2020/21 cohort was compared to those admitted between March 2017/18, 2018/19, and 2019/20. Lastly, the pooled cohort March 2017 to March 2020 was compared with the COVID-19 year alone. RESULTS This study included 251 patients (F: 96 (38%): median age 68 years [IQR = 19.25], median time post-onset at admission: 42 days, [IQR = 23]). In comparison with the pre-pandemic years, a significant increase of hemorrhagic strokes (p < 0.001) and a decrease of traumatic brain injuries (p = 0.048), a reduction of the number of patients with a prolonged disorder of consciousness admitted to the IRU (p < 0.001) and a lower length of stay (p < 0.001) were observed in 2020/21. CONCLUSIONS These differences in the case mix of sABI patients admitted to IRU may be considered another side-effect of the pandemic. Facing this health emergency, rehabilitation specialists need to adapt readily to the changing clinical and functional needs of patients' addressing the IRUs.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci, 269 - 50143, Florence, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci, 269 - 50143, Florence, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci, 269 - 50143, Florence, Italy.
| | - Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci, 269 - 50143, Florence, Italy
- Istituto Di Biorobotica, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio, 34, 56025, Pontedera (Pisa), Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci, 269 - 50143, Florence, Italy
- Istituto Di Biorobotica, Scuola Superiore Sant'Anna, Viale Rinaldo Piaggio, 34, 56025, Pontedera (Pisa), Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci, 269 - 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi-ONLUS, Via di Scandicci, 269 - 50143, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, Florence, Italy
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Nordio S, Arcara G, Berta G, Dellai A, Brisotto C, Koch I, Cazzador D, Aspidistria M, Ventura L, Turolla A, D'Imperio D, Battel I. Biofeedback as an Adjunctive Treatment for Post-stroke Dysphagia: A Pilot-Randomized Controlled Trial. Dysphagia 2021; 37:1207-1216. [PMID: 34767083 DOI: 10.1007/s00455-021-10385-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 10/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Post-stroke dysphagia affects almost half of the survivors and severely influences quality of life, thus becoming swallowing rehabilitation of paramount importance. However, there is little adequate evidence on which the best rehabilitative strategy can be. Surface electromyography (sEMG) allows for recording swallowing muscles' activity and provides real time visual feedback, as a biofeedback adjunctive technique to improve treatment outcome. This study aimed to analyze the effectiveness of biofeedback rehabilitation of swallowing through sEMG compared to standard techniques, in post-stroke dysphagia. METHODS A pilot-randomized controlled trial included 17 patients diagnosed with post-stroke dysphagia. Nine underwent sEMG-biofeedback rehabilitation; seven controls were submitted to control treatment, one dropout. The primary outcome was the functional oral intake scale (FOIS), secondary outcomes was pharyngeal clearance and safe swallowing, assessed through fiberoptic endoscopic evaluation of swallowing (FEES). RESULTS FOIS improved in all patients, regardless of treatment. sEMG-biofeedback rehabilitation led to improvements of the pharyngeal clearance and swallowing safety. The rehabilitative effects appeared stable at 2-months follow-up. CONCLUSIONS The application of biofeedback based on sEMG in post-stroke dysphagia patients resulted in an effective rehabilitative technique, in particular for pharyngeal clearance improvements and safe swallowing, thus reducing the risk of aspiration and malnutrition.
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Affiliation(s)
- Sara Nordio
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy.
| | - Giorgio Arcara
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Giulia Berta
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Angela Dellai
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Camilla Brisotto
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Isabella Koch
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Diego Cazzador
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padua, Via Giustiniani 5, 35128, Padua, Italy.,Section of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Marta Aspidistria
- Department of Statistical Sciences, University of Padua, Via Cesare Battisti 241, 35121, Padua, Italy
| | - Laura Ventura
- Department of Statistical Sciences, University of Padua, Via Cesare Battisti 241, 35121, Padua, Italy
| | - Andrea Turolla
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Daniela D'Imperio
- IRCCS San Camillo Hospital, Via Alberoni 70, 30126, Venice, Lido di Venezia, Italy
| | - Irene Battel
- Unità Operativa Medicina Fisica e Riabilitativa, Ulss 3 Serenissima, Ospedale Civile di Venezia, Castello, 6667, Venice, Italy.,Department of Clinical Speech & Language Studies, Trinity College, University of Dublin, College Green, Dublin 2, Ireland
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External Validation and Calibration of the DecaPreT Prediction Model for Decannulation in Patients with Acquired Brain Injury. Brain Sci 2021; 11:brainsci11060799. [PMID: 34204352 PMCID: PMC8234369 DOI: 10.3390/brainsci11060799] [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: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
We propose a new set of clinical variables for a more accurate early prediction of safe decannulation in patients with severe acquired brain injury (ABI), during a post-acute rehabilitation course. Starting from the already validated DecaPreT scale, we tested the accuracy of new logistic regression models where the coefficients of the original predictors were reestimated. Patients with tracheostomy were retrospectively selected from the database of the neurorehabilitation unit at the S. Anna Institute of Crotone, Italy. New potential predictors of decannulation were screened from variables collected on admission during clinical examination, including (a) age at injury, (b) coma recovery scale-revised (CRS-r) scores, and c) length of ICU period. Of 273 patients with ABI (mean age 53.01 years; 34% female; median DecaPreT = 0.61), 61.5% were safely decannulated before discharge. In the validation phase, the linear logistic prediction model, created with the new multivariable predictors, obtained an area under the receiver operating characteristics curve of 0.901. Our model improves the reliability of simple clinical variables detected at the admission of the post-acute phase in predicting decannulation of ABI patients, thus helping clinicians to plan better rehabilitation.
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Bakhtiyari J, Tohidast SA, Mansuri B, Azimi H, Ebadi A. The Persian version of the Functional Oral Intake Scale (FOIS-P): a validation study on stroke patients with dysphagia. LOGOP PHONIATR VOCO 2021; 47:133-138. [PMID: 33724141 DOI: 10.1080/14015439.2021.1896778] [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: 10/21/2022]
Abstract
PURPOSE The present study aimed to validate the Persian version of the Functional Oral Intake Scale (FOIS-P) for stroke patients. MATERIALS AND METHODS The current study was conducted in two phases: (1) translation and cross-cultural adaptation of the FOIS into Persian and (2) validation of the FOIS-P. Phase 1 included forward translation, synthesis, back-ward translation, expert panel, and pretesting. To validate the FOIS-P, inter-rater reliability, cross-validity, and sensitivity to change of the scale were investigated. To evaluate the inter-rater reliability of the FOIS-P, two speech-language pathologists, who were blind to the study aims and procedure, applied the FOIS-P to assess the oral intake of 60 stroke survivors. The cross-validity was assessed by investigating the correlation between the FOIS scores and the Video Fluoroscopy Swallowing Study (VFSS). Also, we applied the FOIS-P on 60 patients with stroke at three different times to investigate the sensitivity to change. RESULTS Inter-rater reliability of the FOIS-P was excellent according to Cohen's Kappa calculation (K = 0.89, p<.001). Investigation of cross-validity showed that there were significant correlations between the FOIS scores and presence of dysphagia, presence of aspiration, and severity of dysphagia (p<.001). The changes of the FOIS-P scores over follow-ups revealed that the FOIS-P was sensitive to the patient's oral intake changes. CONCLUSIONS The FOIS-P is a valid and reliable tool for assessing oral intake in stroke survivors with dysphagia. Hence, the FOIS-P may be suitable for clinical and research in the field of stroke.
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Affiliation(s)
- Jalal Bakhtiyari
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Seyed Abolfazl Tohidast
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Banafshe Mansuri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hadi Azimi
- English Language Teaching Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Validation of the Italian Version of the Functional Oral Intake Scale (FOIS-It) Against Fiberoptic Endoscopic Evaluation of Swallowing and Nutritional Status. Dysphagia 2021; 37:137-147. [PMID: 33591464 PMCID: PMC8844182 DOI: 10.1007/s00455-021-10257-9] [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: 06/03/2020] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
The Functional Oral Intake Scale (FOIS) is a reliable and valid tool to assess functional oral intake of food and liquids in patients with oropharyngeal dysphagia (OD). Its validity was established for stroke patients against Videofluoroscopic Swallowing Study in English and Chinese and against Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in German. FOIS was cross-culturally validated into Italian (FOIS-It), but construct validity against instrumental assessment and nutritional status was not investigated. The study aims at contributing to the validation of the FOIS-It, by performing convergent and known-group validity against FEES and nutritional status in patients with OD of different etiologies. Overall, 220 adult patients with OD of etiological heterogeneity were recruited. FOIS-It score and Body Mass Index (BMI) were collected. FEES was performed to assess swallowing safety and efficiency based on the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Moderate to weak associations with PAS (ρ = - .37, p < .01), YPRSRS in the pyriform sinuses (ρ = - .20, p < .01), and BMI (ρ = .24, p < .01) were detected with Spearman's correlation. FOIS-It distribution was compared with the Mann-Whitney U and Kruskal-Wallis tests. Significantly lower FOIS-It scores were detected among patients with penetration/aspiration (PAS > 2) and penetration (PAS > 2 ≤ 5) for all consistencies (p < .01), aspiration (PAS > 5) of liquids and semisolids (p < .001), residue in the pyriform sinuses (YPRSRS > 3) with semisolids (p < .001) and solids (p = .02), and malnutrition (BMI ≤ 18.5; p = .019). FOIS-It appears as a valid tool to assess functional oral intake against FEES' measures of swallowing safety and efficiency and nutritional status in patients with OD of etiological heterogeneity.
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Hakiki B, Draghi F, Scarpino M, Portaccio E, Romoli A, Mannini A, Atzori T, Lolli F, Macchi C, Grippo A. Critical illness polyneuromyopathy: Functional impact after severe acquired brain injuries. Acta Neurol Scand 2020; 142:574-584. [PMID: 32740902 DOI: 10.1111/ane.13324] [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: 03/28/2020] [Revised: 06/29/2020] [Accepted: 07/24/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Critical illness polyneuropathy and myopathy (CIPNM) frequently affects critical patients and can occur after severe acquired brain injuries (sABI) influencing the functional recovery. We aimed to assess how the concomitance between CIPNM and sABI might influence the rehabilitative outcomes in terms of functional autonomy, oral feeding recovery and endotracheal tube weaning. MATERIALS AND METHODS Adult patients with sABI admitted to an intensive rehabilitation unit and underwent an electromyography examination within seven days after admission were included. Assessed rehabilitative outcomes at discharge were decannulation success and its timing, functional autonomy measured by the Functional Independence Measure (FIM) and the Glasgow outcome scale expanded (GOS-E) and oral feeding recovery assessed by the Functional Oral Intake Scale (FOIS) score. RESULTS Among the 224 included patients (81 (36%) females, age (median[IQR]): 68.73[21.66] years), 119 (53.1%) presented CIPNM at admission. Albeit the change of rehabilitative outcomes between admission and discharge was significant in all the sABI patients (P < .001 for ΔFOIS, ΔFIM and ΔGOS-E), those with a concomitant CIPNM achieved significantly lower scores as evaluated by Mann-Whitney tests (P < .001 for ΔFIM Δ and GOS-E; P < .005 for ΔFOIS). The CIPNM absence was associated with a higher probability to achieve functional autonomy (GOS-E > 4) (OR:4.57 (1.49/14.06); P < .01) and oral feeding recovery (FOIS ≥ 4) (OR:2.07 (1.07/3.99); P = .03) at discharge. CIPNM presence did not influence decannulation success but a longer time to cannula weaning was required (P < .01 in the log-rank test). CONCLUSIONS CIPMN significantly affects the rehabilitative outcomes after a sABI and should be taken into account for better rehabilitative handling.
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Affiliation(s)
- Bahia Hakiki
- Intensive Rehabilitation Unit IRCCS Fondazione Don Carlo Gnocchi Florence Italy
| | - Francesca Draghi
- Intensive Rehabilitation Unit IRCCS Fondazione Don Carlo Gnocchi Florence Italy
| | - Maenia Scarpino
- Intensive Rehabilitation Unit IRCCS Fondazione Don Carlo Gnocchi Florence Italy
- SODc Neurofisiopatologia DAI Neuro‐muscolo‐scheletrico e organi di senso Azienda Ospedaliero‐Universitaria Careggi Florence Italy
| | - Emilio Portaccio
- SOC Neurology Ospedale San Giovanni di Dio AUSL Toscana Centro Florence Italy
| | - Annamaria Romoli
- Intensive Rehabilitation Unit IRCCS Fondazione Don Carlo Gnocchi Florence Italy
| | - Andrea Mannini
- Istituto di Biorobotica Scuola Superiore Sant’Anna Pisa Italy
- MARE Lab IRCCS Fondazione Don Carlo Gnocchi Florence Italy
| | - Tiziana Atzori
- Intensive Rehabilitation Unit IRCCS Fondazione Don Carlo Gnocchi Florence Italy
| | - Francesco Lolli
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio” University of Florence Florence Italy
| | - Claudio Macchi
- Intensive Rehabilitation Unit IRCCS Fondazione Don Carlo Gnocchi Florence Italy
- Department of Experimental and Clinical Medicine University of Florence Florence Italy
| | - Antonello Grippo
- Intensive Rehabilitation Unit IRCCS Fondazione Don Carlo Gnocchi Florence Italy
- SODc Neurofisiopatologia DAI Neuro‐muscolo‐scheletrico e organi di senso Azienda Ospedaliero‐Universitaria Careggi Florence Italy
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14
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Pizzorni N, Ginocchio D, Bianchi F, Feroldi S, Vedrodyova M, Mora G, Schindler A. Association between maximum tongue pressure and swallowing safety and efficacy in amyotrophic lateral sclerosis. Neurogastroenterol Motil 2020; 32:e13859. [PMID: 32337820 DOI: 10.1111/nmo.13859] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/22/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) is common in amyotrophic lateral sclerosis (ALS), leading to a reduction of swallowing safety and efficacy. The tongue has an important role in swallowing function for oral processing and bolus propulsion through the pharynx. The study aims to analyze the association between instrumental findings of OD and tongue pressure. METHODS Patients with ALS referred for fiberoptic endoscopic evaluation of swallowing (FEES) were recruited. FEES was conducted to test swallowing function with liquid (5, 10, and 20 ml), semisolid (5, 10, and 20 ml), and solid. FEES recordings were assessed for swallowing safety, using the penetration-aspiration scale (PAS), and for swallowing efficacy, using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). PAS scores >2 were suggestive of penetration, PAS scores >5 of aspiration, and YPRSRS scores >2 of residue. Maximum tongue pressure (MTP) and tongue endurance were measured using the Iowa Oral Performance Instrument. Tongue pressure measurements were compared between patients with and without penetration, aspiration, or residue. KEY RESULTS Fifty-five patients with ALS were included. Mean MTP was 29.7 kPa, and median tongue endurance was 10 seconds. Patients with residue in the pyriform sinus had a significantly lower MTP than patients without residue in the pyriform sinus with semisolids 10 ml (P = .011) and 20 ml (P = .032). Patients with a tongue endurance <10 seconds exhibited higher frequency of penetration with liquids 5 ml (P = .046), liquids 10 ml (P = .015), and solids (P = .22). CONCLUSION AND INFERENCES In patients with ALS, MTP is significantly associated with an impairment of swallowing efficacy and tongue endurance was significantly associated with an impairment of swallowing safety.
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Affiliation(s)
- Nicole Pizzorni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Daniela Ginocchio
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Federica Bianchi
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Sarah Feroldi
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Miriam Vedrodyova
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Gabriele Mora
- ALS Center, Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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Validation of the German Version of Functional Oral Intake Scale (FOIS-G) for Flexible Endoscopic Evaluation of Swallowing (FEES). Dysphagia 2020; 36:130-139. [PMID: 32342178 PMCID: PMC7803872 DOI: 10.1007/s00455-020-10114-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
The Functional Oral Intake Scale (FOIS) is the most frequently used scale for the evaluation of functional oral intake by dysphagia patients. FOIS was validated using data from Videofluoroscopic Swallowing Study (VFSS). Until now, a validated German version of FOIS for Flexible Endoscopic Evaluation of Swallowing (FEES) is lacking. The aim of this study was a cross-cultural validation of the German version of FOIS (FOIS-G) for FEES. The translation of the original FOIS was carried out according to the Translation, Review, Adjudication, Pretesting, Documentation (TRAPD) translation methodology. For the validation process, six experienced language therapists (SLT) retrospectively analyzed charts of 93 stroke patients. Inclusion criteria were comprised of stroke, clinical examination by an SLT within 24 h of admission, and FEES within 72 h of admission. The validity was calculated by comparison with Modified Rankin Scale (MRS), Barthel Index (BI), the Penetration-Aspiration-Scale (PAS), and a water swallow test. Spearman rank correlation of all paired raters ranged from rs = 0.96 to rs = 0.99, and percentage agreement ranged from 81 to 94%. The overall agreement between all raters was calculated by Fleiss kappa (0.83) (s.e. 0.02). There is a significant correlation between the BI and the MRS with the FOIS-G (rs = 0.301, p = 0.003 for BI; rs = – 0.366, p < 0.001 for MRS), between the PAS and the FOIS-G (rs = − 0.758, p < 0.001), as well as between the 70 ml-water-test and the FOIS-G (rs = 0.470, p < 0.001). FOIS-G is a valid instrument for the evaluation of the functional oral intake of food and liquids in dysphagia patients.
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The assessment of the peak of reflex cough in subjects with acquired brain injury and tracheostomy and healthy controls. Respir Physiol Neurobiol 2020; 274:103356. [PMID: 31899352 DOI: 10.1016/j.resp.2019.103356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION There is no standard procedure to evaluated the peak of reflex cough flow (PCF-reflex) in the literature, which is important assessment in subjects with acquired brain injury and tracheostomy cannula. The present study aims to investigate the PCF of the reflex cough in a broad sample of healthy controls and, furthermore, the presence and the strength of voluntary and reflex cough in subjects with ABI with tracheostomy cannula. MATERIALS AND METHODS We recruited 147 participants including the healthy subjects (n = 105) and acquired brain injury subjects (n = 43), who underwent respiratory assessment: the Tidal Volume, Forced Vital Capacity, PCF of voluntary cough (PCF-voluntary) and PCF-reflex (using a spirometer connected with a nebulizer by a bidirectional). RESULTS The PCF-reflex of controls and subjects was significant lower than the PCF-voluntary (P < 0.01). The PCF-voluntary was not assessed in 26 (60.5 %) subjects due to severe cognitive deficit. In subjects without cognitive deficits (n = 17; 39.5 %), it was significantly lower than in healthy controls (p < 0.01). In contrast, the PCF-reflex was completed in all subjects and it was not significantly different from healthy controls. Furthermore, the strength of the PCF-reflex decreased with increasing inhalation numbers of nebulised air. CONCLUSION Reflex cough behaviour differs largely from voluntary cough and the PCF results reflect this great discrepancy. PCF-reflex could be useful parameter for assessing the airway protection whereas PCF-voluntary for measuring airway clearance.
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Reverberi C, Lombardi F, Lusuardi M, Pratesi A, Di Bari M. Development of the Decannulation Prediction Tool in Patients With Dysphagia After Acquired Brain Injury. J Am Med Dir Assoc 2018; 20:470-475.e1. [PMID: 30455047 DOI: 10.1016/j.jamda.2018.09.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Patients with acquired brain injuries (ABIs) often need tracheostomy because of dysphagia. However, many of them may recover over time and be eventually decannulated during post-acute rehabilitation. We developed the Decannulation Prediction Tool (DecaPreT) to identify, early in the post-acute course, patients with ABIs who can be safely decannulated. DESIGN Nonconcurrent cohort study. SETTING AND PARTICIPANTS Patients with ABI, as well as with dysphagia and tracheostomy, were retrospectively selected from the database of a neurorehabilitation unit in Correggio, Reggio Emilia, Italy. MEASURES Potential bivariate predictors of decannulation were screened from variables collected on admission during clinical examination, conducted by an expert speech therapist. Multivariable prediction was then obtained in 2 separate random subsamples to develop and validate the logistic regression model of the DecaPreT. RESULTS Of 463 patients with ABI (mean age 52.2 years) selected, 73.0% could be safely decannulated before discharge. After bivariate screening, multivariable predictors of decannulation were identified in the development subsample and confirmed in the validation subsample, each with its odds ratio and 95% confidence interval as follows: age tertile (1.77, 1.08-2.89; P = .024), no saliva aspiration (3.89, 1.73-8.64; P = .001), pathogenesis of ABI (trauma vs other causes vs stroke vs anoxia: 2.23, 1.41-3.54; P = .001), no vegetative status (8.47; 2.91-24.63; P < .001), and coughing score (voluntary and reflex vs voluntary vs reflex vs neither voluntary nor reflex cough: 2.62, 1.70-4.05; P < .001). In the validation subsample, the predicting equation obtained an area under the receiver operating characteristics curve of 0.836. IMPLICATIONS The DecaPreT predicts safe decannulation in patients with dysphagia and tracheostomy, using simple clinical variables detected early in the post-acute phase of ABI. The tool can help clinicians choose timing and intensity of rehabilitation interventions and plan discharge.
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Affiliation(s)
| | | | - Mirco Lusuardi
- Department of Rehabilitation, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Alessandra Pratesi
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Geriatrics, Department of Medicine and Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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