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Zuckerman M, Wang S, Kaneoka A, Coster WJ, Leonard R, Langmore SE, Pisegna JM. Conceptualizing Adult Dysphagia in the United States Within the International Classification of Functioning, Disability and Health (ICF). Arch Phys Med Rehabil 2024; 105:1008-1018. [PMID: 38072229 DOI: 10.1016/j.apmr.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/10/2023] [Accepted: 11/28/2023] [Indexed: 02/26/2024]
Abstract
Despite the well-documented safety concerns and effect on quality of life, there does not yet exist a wide-reaching framework that links the etiologies of swallowing disorders to the potential short- and long-term outcomes in the context of International Classification of Functioning, Disability and Health (ICF). This paper introduces an expert-reviewed conceptual framework to highlight common etiologies of dysphagia as well as integrate immediate outcomes of dysphagia with long-term outcomes of dysphagia in terms of medical problems, health-related quality of life, functional effect, and psychosocial features. It also outlines the potential cyclical nature of long-term dysphagia outcomes perpetuating the original dysphagia. This framework serves to inform clinicians of important dysphagic outcomes and to bring awareness to long-term outcomes that should be monitored by health care professionals, caregivers, or people with dysphagia.
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Affiliation(s)
- Melani Zuckerman
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Shawn Wang
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Asako Kaneoka
- The University of Tokyo Hospital Rehabilitation Center, Tokyo, Japan
| | - Wendy J Coster
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Avenue, Boston, MA 02215, United States
| | - Rebecca Leonard
- University of California at Davis, Davis, CA 95616, United States
| | - Susan E Langmore
- Boston University Chobanian & Avedesian School of Medicine, 72 East Concord St, Boston, MA 02118, United States
| | - Jessica M Pisegna
- Boston Medical Center, 800 Harrison Ave, BCD Building, 5th Floor, Boston, MA 02118, United States; Department of Speech Language Pathology, Boston University, Sargent College, 635 Commonwealth Ave, Boston, MA 02215, United States.
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2
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Pan D, Chung S, Nielsen E, Niederman MS. Aspiration Pneumonia. Semin Respir Crit Care Med 2024; 45:237-245. [PMID: 38211629 DOI: 10.1055/s-0043-1777772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting that dysbiosis, repetitive injury, and inflammatory responses play a role in its development. Risk factors for aspiration events involve a complex interplay of anatomical and physiological dysfunctions in the nervous, gastrointestinal, and pulmonary systems. Current treatment strategies have shifted away from anaerobic organisms as leading pathogens. Prevention of aspiration pneumonia primarily involves addressing oropharyngeal dysphagia, a significant risk factor for aspiration pneumonia, particularly among elderly individuals and those with cognitive and neurodegenerative disorders.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Samuel Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Erik Nielsen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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3
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Sundar KM, Stark A, Morris MJ. Laryngeal Dysfunction Manifesting as Chronic Refractory Cough and Dyspnea: Laryngeal Physiology in Respiratory Health and Disease. Chest 2024:S0012-3692(24)00396-9. [PMID: 38508333 DOI: 10.1016/j.chest.2024.03.026] [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: 11/15/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024] Open
Abstract
TOPIC IMPORTANCE Laryngeal dysfunction as a cause of chronic refractory cough (CRC) and episodic dyspnea is often missed, which results in unnecessary testing and delays in diagnosis. Understanding laryngeal roles in breathing and airway protection can help to appreciate the propensity to laryngeal dysfunction with aging, chronic lung disease, and sleep apnea. REVIEW FINDINGS The human larynx is a complex muscular structure that is responsible for multiple roles of breathing, vocalization, coughing, and swallowing. To undertake these activities, the larynx has a high density of sensory and motor innervation. In addition to common embryological origins with the pharynx and esophagus, with which many laryngeal activities are shared, somatomotor and autonomic pathways regulate emotional, cognitive, and complex motor sequence-planning activities within the larynx. Due to its unique location, the larynx is susceptible to infectious and gastroesophageal reflux-related insults. Couple this with key roles in regulation of airflow and mediation of airway protective reflexes, it is not surprising that neuropathic abnormalities and muscle dysfunction frequently develop. The expression of laryngeal dysfunction as hypersensitivity to mechanical, thermal, chemical, and other stimuli leads to exaggerated airway protective reflexes (laryngeal adductor reflex and cough reflex) manifesting as dyspnea and cough. SUMMARY Pulmonologists should incorporate assessment of laryngeal dysfunction during evaluation of CRC and dyspnea. Recognition of laryngeal hypersensitivity in patient with CRC can identify patients who may benefit from cough suppression therapies. Similarly, timely identification of inducible laryngeal obstruction may not only resolve episodic dyspnea but lessen the need for unnecessary testing and treatments.
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Affiliation(s)
- Krishna M Sundar
- Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT.
| | - Amanda Stark
- Department of Otolaryngology & Voice Disorders Center, University of Utah, Salt Lake City, UT
| | - Michael J Morris
- Pulmonary & Critical Care Service, Brooke Army Medical Center, JBSA Fort Sam Houston, TX
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Xiong S, Zhou Y, He W, Zhu J, He W, Ding M, Si D. Study on predictive models for swallowing risk in patients with AECOPD. BMC Pulm Med 2024; 24:95. [PMID: 38395811 PMCID: PMC10893668 DOI: 10.1186/s12890-024-02908-y] [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: 09/27/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Dysphagia is considered a complication in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, AECOPD may have risk factors for dysphagia. METHODS Through a cross-sectional study, which included 100 patients with AECOPD. General information, Pulmonary function, COPD assessment test (CAT) and modified Medical Research Council (mMRC) were collected by questionnaire. The questionnaires were administered by uniform-trained investigators using standard and neutral language, and swallowing risk was assessed by using a water swallow test (WST) on the day of patient admission. RESULTS Among the 100 included patients, 50(50%) were at risk of swallowing. Multivariate analysis using logistic regression analysis showed that age ≥ 74 years old, mMRC ≥ level 2, hospitalization days ≥ 7 days and the use of BIPAP assisted ventilation were important influencing factors for swallowing risk in patients with AECOPD. CONCLUSION Patients with AECOPD are at risk for dysphagia, assessing age, mMRC, hospitalization days and the use of BIPAP assisted ventilation can be used to screen for swallowing risk, thus contributing to the implementation of early prevention measures.
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Affiliation(s)
- Shuyun Xiong
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - You Zhou
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Wenfeng He
- Guangzhou Red Cross Hospital, 510000, Guangzhou, Guangdong, China
| | - Jinling Zhu
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Wenfang He
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Meizhu Ding
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China
| | - Dongxu Si
- Guangdong Provincial Hospital of Chinese Medicine, 510000, Guangzhou, Guangdong, China.
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Mancopes R, Steele CM. Videofluoroscopic measures of swallowing in people with stable COPD compared to healthy aging. Codas 2023; 36:e20220260. [PMID: 37878956 PMCID: PMC10727231 DOI: 10.1590/2317-1782/20232022260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/17/2023] [Indexed: 10/27/2023] Open
Abstract
PURPOSE Swallowing impairment is a serious extra-pulmonary manifestation of Chronic Obstructive Pulmonary Disease (COPD). Previous studies suggest that individuals with stable COPD show atypical values for several videofluoroscopy measures of swallowing, compared to healthy adults under age 60. However, it is unclear to what degree these changes are attributable to healthy aging. In this study, we aimed to clarify how swallowing in people with stable COPD differs from age-matched healthy controls. METHODS We performed a retrospective analysis of videofluoroscopy data from two previously-collected datasets: a) a sample of 28 adults with stable COPD (18 male); b) a sample of 76 healthy adults, from which 28 adults were selected, matched for sex and age to participants in the COPD cohort. In both prior studies, participants swallowed 20% w/v liquid barium prepared in different consistencies (thin; mildly, moderately, and extremely thick). Blinded duplicate ratings were performed according to a standard procedure, yielding measures of laryngeal vestibule closure (LVC) integrity and timing, swallow timing, upper esophageal sphincter (UES) opening, pharyngeal constriction and pharyngeal residue. Mann-Whitney U tests and odds ratios were performed to determine significant group differences (p<.05). RESULTS Across the consistencies tested, participants with COPD showed significantly shorter durations of LVC, earlier onsets and shorter durations of UES opening, and reduced pharyngeal constriction. No significant differences were seen in other measures. CONCLUSION These results point to features of swallowing in people with stable COPD that differ from changes seen with healthy aging, and which represent risks for potential aspiration.
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Affiliation(s)
- Renata Mancopes
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute - Toronto Rehabilitation Institute, University Health Network - Toronto (ON), Canada.
| | - Catriona Margaret Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute - Toronto Rehabilitation Institute, University Health Network - Toronto (ON), Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto - Toronto (ON), Canada.
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6
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Huff A, Karlen-Amarante M, Oliveira LM, Ramirez JM. Role of the postinspiratory complex in regulating swallow-breathing coordination and other laryngeal behaviors. eLife 2023; 12:e86103. [PMID: 37272425 PMCID: PMC10264072 DOI: 10.7554/elife.86103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023] Open
Abstract
Breathing needs to be tightly coordinated with upper airway behaviors, such as swallowing. Discoordination leads to aspiration pneumonia, the leading cause of death in neurodegenerative disease. Here, we study the role of the postinspiratory complex (PiCo) in coordinating breathing and swallowing. Using optogenetic approaches in freely breathing anesthetized ChATcre:Ai32, Vglut2cre:Ai32 and intersectional recombination of ChATcre:Vglut2FlpO:ChR2 mice reveals PiCo mediates airway protective behaviors. Activation of PiCo during inspiration or the beginning of postinspiration triggers swallow behavior in an all-or-nothing manner, while there is a higher probability for stimulating only laryngeal activation when activated further into expiration. Laryngeal activation is dependent on stimulation duration. Sufficient bilateral PiCo activation is necessary for preserving the physiological swallow motor sequence since activation of only a few PiCo neurons or unilateral activation leads to blurred upper airway behavioral responses. We believe PiCo acts as an interface between the swallow pattern generator and the preBötzinger complex to coordinate swallow and breathing. Investigating PiCo's role in swallow and laryngeal coordination will aid in understanding discoordination with breathing in neurological diseases.
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Affiliation(s)
- Alyssa Huff
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Marlusa Karlen-Amarante
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Luiz M Oliveira
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research InstituteSeattleUnited States
- Department of Neurological Surgery, University of Washington School of MedicineSeattleUnited States
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7
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Lin TF, Shune S. The Mind-Body-Breath Link During Oral Intake in Chronic Obstructive Pulmonary Disease: A Grounded Theory Analysis. Dysphagia 2023; 38:367-378. [PMID: 35713729 DOI: 10.1007/s00455-022-10473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
Both chronic obstructive pulmonary disease (COPD) and dysphagia can be complicated by the shared physiological-psychoemotional manifestations of the conditions, such as anxiety and respiratory dysfunction. Despite their shared comorbidities, clinical research and management often focus on the isolated physiological impairments of each condition separately. Crucially, the oral intake experience of individuals with COPD-central for improved quality of life-remains underexplored. Thus, the purpose of this study was to understand the oral intake experience among individuals with COPD, including perceived barriers, behaviors, and emotions. Fourteen individuals with COPD (mean age 68.9; 7 females; 2 with diagnosed dysphagia) participated. Using grounded theory methodology, semi-structured interviews were conducted and analyzed. Four themes surfaced: (a) participants experience physiological manifestations of COPD (dyspnea, coughing) during eating/drinking; (b) emotions related to eating/drinking, such as concern, fear, anxiety, panic, and frustration stem from the physiological manifestations; (c) these emotions worsen the physiological manifestations; and (d) as a result of the physiological manifestations, they adapt eating/drinking behaviors (e.g., choose easier to eat foods, reduce intake size). The theory 'the mind-body-breath feedback and feedforward loops as a contributor to the oral intake experience in individuals with COPD' is subsequently proposed. Of clinical importance, many participants did not recognize their swallowing status as an issue. Ultimately, to promote patient-centered care, we need to view the oral intake experience for individuals with COPD through a more comprehensive lens that incorporates the interrelationships between the physiological and psychoemotional manifestations of COPD and better educate patients on COPD's impact on eating and drinking.
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Affiliation(s)
- Ting-Fen Lin
- Department of Communicative Sciences and Deaf Studies, California State University, Fresno, 93740, USA.
| | - Samantha Shune
- Communication Disorders and Sciences Program, University of Oregon, Eugene, 97403, USA
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8
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Huff A, Karlen-Amarante M, Oliveira LM, Ramirez JM. Postinspiratory complex acts as a gating mechanism regulating swallow-breathing coordination and other laryngeal behaviors. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.18.524513. [PMID: 36712111 PMCID: PMC9882227 DOI: 10.1101/2023.01.18.524513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Breathing needs to be tightly coordinated with upper airway behaviors, such as swallowing. Discoordination leads to aspiration pneumonia, the leading cause of death in neurodegenerative diseases. Here we study the role of the postinspiratory complex, (PiCo) in coordinating breathing and swallowing. Using optogenetic approaches in freely breathing-anesthetized ChATcre, Vglut2cre and co-transmission of ChATcre/Vglut2FlpO mice reveals this small brainstem microcircuit acts as a central gating mechanism for airway protective behaviors. Activation of PiCo during inspiration or the beginning of postinspiration triggers swallow behavior, while there is a higher probability for stimulating laryngeal activation when activated further into expiration, suggesting PiCo's role in swallow-breathing coordination. PiCo triggers consistent swallow behavior and preserves physiologic swallow motor sequence, while stimulates laryngeal activation variable to stimulation duration. Sufficient bilateral PiCo activation is necessary for gating function since activation of only a few PiCo neurons or unilateral activation leads to blurred behavioral response. Viral tracing experiments reveal projections from the caudal nucleus of the solitary tract (cNTS), the presumed swallow pattern generator (SPG), to PiCo and vice versa. However, PiCo does not directly connect to laryngeal muscles. Investigating PiCo's role in swallow and laryngeal coordination will aid in understanding discoordination in breathing and neurological diseases.
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Affiliation(s)
- Alyssa Huff
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, 98101
| | - Marlusa Karlen-Amarante
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, 98101
| | - Luiz Marcelo Oliveira
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, 98101
| | - Jan Marino Ramirez
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA, 98101,Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA, 98108
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9
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Welden K, Kelchner L, Silbert N, Rule DW. Listening for Dysphagia: Voice Quality Sequelae of Material in the Airway. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3337-3364. [PMID: 35998282 DOI: 10.1044/2022_jslhr-22-00120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Postswallow voice abnormality is often assumed to indicate the presence of material in the laryngeal airway (MIA), but prior research has not shown definitive evidence of a causal relationship. This study investigated if endoscopically confirmed MIA (prandial material or secretions) generates specific voice quality attributes that can be perceptually identified by experienced listeners. METHOD Forty-four dysphagic adults underwent endoscopic evaluation of swallowing. Time-linked audiovisual recordings of pre- and postswallow phonation were analyzed to determine the presence, amount, and location of prandial material or secretions in the larynx during phonation. Expert listeners completed auditory-perceptual ratings of phonation samples. RESULTS Voice quality ratings did not differ significantly when there was MIA during postswallow phonation. However, judgments of voice quality abnormality for MIA samples were elevated when analyses controlled for effects of baseline dysphonia. Listeners were most likely to perceive voice quality abnormality when larger amounts of secretions were present, as compared to prandial material. Interrater reliability was variable and ranged from low to moderate across perceptual parameters. CONCLUSIONS MIA during phonation occurred for many participants, but perception of voice quality abnormality was variable when MIA was present. Baseline dysphonia is common among individuals with dysphagia and may limit perception of voice quality abnormalities generated by MIA. Secretions in the laryngeal airway may have a greater impact on voice quality parameters.
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Affiliation(s)
- Kathy Welden
- Cincinnati Veterans Affairs Medical Center, OH
- Department of Communication Sciences & Disorders, College of Allied Health, University of Cincinnati, OH
| | - Lisa Kelchner
- Department of Communication Sciences & Disorders, College of Allied Health, University of Cincinnati, OH
| | | | - David W Rule
- Department of Otolaryngology, College of Medicine, University of Cincinnati, OH
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10
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Li W, Gao M, Liu J, Zhang F, Yuan R, Su Q, Wang Y, Wang Y. The prevalence of oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Expert Rev Respir Med 2022; 16:567-574. [PMID: 35670185 DOI: 10.1080/17476348.2022.2086123] [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: 02/08/2023]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) in chronic obstructive pulmonary disease (COPD) patients seriously influence the long-term prognosis of COPD patients. The aim of this study was to assess the prevalence and risk factors of OD in patients with COPD through a systematic review and meta-analysis of observational studies. METHODS We identified all observational studies on the prevalence of OD in COPD patients by searching PubMed, Embase, the Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), the China Biomedical Literature Service System (CBM), the Wanfang Database, and the WeiPu (VIP) databases from database establishment to 1 December 2020. RESULTS Results of the meta-analysis showed that the prevalence of OD in COPD patients was 32.7% (95%CI=30.1, 35.4, I2=91.5%). Dyspnea, gastroesophageal reflux disease(GERD), xerostomia, sputum bacteria, poor physical capacity, poor quality of life, and high CRP level are the risk factors for OD in COPD patients. CONCLUSION : The prevalence of OD in COPD patients is high. There were some differences in OD among COPD patients with different sex, ages, continents, evaluation methods, patient source and COPD exacerbation.
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Affiliation(s)
- Wenyan Li
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.,West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingjing Gao
- Department of Anesthesia Surgery, the First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jin Liu
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Fengwa Zhang
- First Department of Gynecology, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Rongjing Yuan
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Qingling Su
- First Department of Gynecology, the First Affiliated Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yetong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
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11
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Dysphagia management during COVID-19 pandemic: A review of the literature and international guidelines. Turk J Phys Med Rehabil 2021; 67:267-274. [PMID: 34870112 DOI: 10.5606/tftrd.2021.8427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023] Open
Abstract
In this review, we present the safest and most effective diagnosis and treatment approaches to dysphagia during the novel coronavirus-2019 (COVID-19) pandemic in the light of available data, relevant literature, and personal experiences. Evaluations for dysphagia patients should be based on clinical assessment during the COVID-19 pandemic and instrumental assessment should be planned for very few number of patients. The main approach to rehabilitation must depend on compensatory methods, texture-modified foods, and postural strategies. Direct treatment methods should be avoided and home-based exercise programs should be encouraged. It is also obvious that there is a need for the development of new strategies for telemedicine/telerehabilitation practices in the new world order.
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12
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Cvejic L, Bardin PG. Breathing-swallow dysfunction in COPD: How silent aspiration may be contributing to exacerbations. Respirology 2021; 26:1110-1111. [PMID: 34590764 DOI: 10.1111/resp.14157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Lydia Cvejic
- Monash Lung & Sleep, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Hudson Institute and Monash University, Melbourne, Victoria, Australia
| | - Philip G Bardin
- Monash Lung & Sleep, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Hudson Institute and Monash University, Melbourne, Victoria, Australia
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13
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Cvejic L, Guiney N, Lau KK, Finlay P, Hamza K, Leong P, MacDonald M, King PT, Bardin PG. Swallow patterns associated with aspiration in COPD: a prospective analysis. ERJ Open Res 2021; 7:00170-2021. [PMID: 34322554 PMCID: PMC8311140 DOI: 10.1183/23120541.00170-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/05/2021] [Indexed: 12/20/2022] Open
Abstract
Few studies have examined swallow of large liquid volumes representative of everyday drinking in COPD. Swallow by cup-drinking was evaluated in COPD using videofluoroscopy. Slower swallow was linked to aspiration indicating altered swallow habits in COPD. https://bit.ly/3wpdnO3.
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Affiliation(s)
- Lydia Cvejic
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Nadine Guiney
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Kenneth K Lau
- School of Clinical Sciences, Monash University, Melbourne, Australia.,Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Paul Finlay
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Kais Hamza
- School of Mathematical Sciences, Monash University, Melbourne, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Martin MacDonald
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul T King
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
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14
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Epiu I, Gandevia SC, Boswell-Ruys CL, Wallace E, Butler JE, Hudson AL. Tongue strength and swallowing dynamics in chronic obstructive pulmonary disease. ERJ Open Res 2021; 7:00192-2021. [PMID: 34262969 PMCID: PMC8273391 DOI: 10.1183/23120541.00192-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/27/2021] [Indexed: 01/25/2023] Open
Abstract
Background Swallowing disorders occur in COPD, but little is known about tongue strength and mastication. This is the first assessment in COPD of tongue strength and a test of mastication and swallowing solids (TOMASS). Methods Anterior tongue strength measures were obtained in 18 people with COPD, aged 73±11 years (mean±sd), and 19 healthy age-matched controls, aged 72±6 years. Swallowing dynamics were assessed using an eating assessment tool (EAT-10), timed water swallow test (TWST), and TOMASS. Swallowing measures were compared to an inhibitory reflex (IR) in the inspiratory muscles to airway occlusion (recorded previously in the same participants). Results Tongue strength was similar between COPD and controls (p=0.715). Self-assessed scores of dysphagia EAT-10 were higher (p=0.024) and swallowing times were prolonged for liquids (p=0.022) and solids (p=0.003) in the COPD group. During TWST, ∼30% of COPD group showed clinical signs of airway invasion (cough and wet voice), but none in the control group. For solids, the COPD group had ∼40% greater number of chews (p=0.004), and twofold-higher number of swallows (p=0.0496). Respiratory rate was 50% higher in COPD group than controls (p <0.001). The presence of an IR was not related to better swallowing outcomes, but signs of airway invasion were associated with a delayed IR. Conclusion Dysphagia in stable COPD is not due to impaired anterior tongue strength, but rather swallowing–breathing discoordination. To address dysphagia, aspiration and acute exacerbations in COPD, therapeutic targets to improve swallowing dynamics could be investigated further. In this novel study of swallowing in COPD, there was no difference in tongue strength when compared to healthy controls, and in COPD participants with airway invasion, the inhibitory reflex to airway occlusion in inspiratory muscles was delayedhttps://bit.ly/3h4EeKw
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Affiliation(s)
- Isabella Epiu
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia.,Prince of Wales Hospital, Sydney, NSW, Australia
| | - Emma Wallace
- Neuroscience Research Australia, Sydney, NSW, Australia.,Flinders University, Adelaide, SA, Australia
| | - Jane E Butler
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, Sydney, NSW, Australia.,University of New South Wales Sydney, NSW, Australia
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15
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Cvejic L, Guiney N, Nicholson T, Lau KK, Finlay P, Hamza K, Osadnik C, Leong P, MacDonald M, King PT, Bardin PG. Aspiration and severe exacerbations in COPD: a prospective study. ERJ Open Res 2021; 7:00735-2020. [PMID: 33532466 PMCID: PMC7836559 DOI: 10.1183/23120541.00735-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known. Objectives We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months. Methods Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months. Measurements and main results Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038). Conclusions Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD. This study demonstrates that prandial aspiration occurs in ∼20% of patients with stable COPD and portends severe COPD exacerbations over the next 12 monthshttps://bit.ly/2Tx5btj
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Affiliation(s)
- Lydia Cvejic
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Nadine Guiney
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | | | - Kenneth K Lau
- School of Clinical Sciences, Monash University, Melbourne, Australia.,Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Paul Finlay
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Kais Hamza
- School of Mathematical Sciences, Monash University, Melbourne, Australia
| | - Christian Osadnik
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Martin MacDonald
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul T King
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
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16
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Schwarz M, Ward EC, Cornwell P, Coccetti A, D'Netto P, Smith A, Morley-Davies K. Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1944-1955. [PMID: 32780593 DOI: 10.1044/2020_ajslp-19-00060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs (n = 7) and SLPs (n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase (n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.
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Affiliation(s)
- Maria Schwarz
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Elizabeth C Ward
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Queensland Health, Brisbane, Australia
| | - Petrea Cornwell
- Menzies Health Institute, School of Allied Health Sciences, Griffith University, Mount Gravatt, Queensland, Australia
| | - Anne Coccetti
- Speech Pathology and Audiology Department, Logan Hospital, Metro South Hospital and Health Service, Meadowbrook, Queensland, Australia
| | - Pamela D'Netto
- Speech Pathology Department, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Aimee Smith
- Speech Pathology Department, Wide Bay Hospital and Health Service, Queensland, Australia
| | - Katharine Morley-Davies
- Speech Pathology Department, QEII Hospital, Metro South Hospital and Health Service, Coopers Plains, Queensland, Australia
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17
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Affiliation(s)
- Homer Boushey
- Emeritus Professor of Medicine, UCSF, San Francisco, California, USA
| | - Igor Gonda
- Respidex LLC, Dennis, Massachusetts, USA
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18
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Lin TF, Shune S. Chronic Obstructive Pulmonary Disease and Dysphagia: A Synergistic Review. Geriatrics (Basel) 2020; 5:geriatrics5030045. [PMID: 32847110 PMCID: PMC7554843 DOI: 10.3390/geriatrics5030045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 01/21/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading global cause of death and disability. The literature has previously established clear physiological characteristics of COPD-related dysphagia (swallowing difficulties). However, COPD and dysphagia are both also intimately tied to breathing and contribute to a cascade of secondary physio-psycho-emotional sequalae, such as COPD exacerbation, anxiety, depression, increased economic burden, social isolation, and decreased quality of life. Further, the collective impact of these comorbidities may magnify disease impact, resulting in a downward spiral of well-being. Thus, the clinical relevance of COPD’s and dysphagia’s frequently occurring and overlapping sequelae cannot be overlooked, as the disease-related burden of both disorders is deeply rooted in the presence of concomitant physiological and psycho-emotional consequences. The current review explores the complex network of interactions between COPD, dysphagia, and their outcomes, framing this relationship within a mind-body-breath framework. Ultimately, we propose a model that more comprehensively captures the constellation of interrelated disease characteristics and consequences, highlighting a need for researchers and healthcare providers to consider disease impact more broadly in order to maximize treatment outcomes.
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19
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Hori R, Ishida R, Isaka M, Nakamura T, Oku Y. Effects of noninvasive ventilation on the coordination between breathing and swallowing in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:1485-1494. [PMID: 31371935 PMCID: PMC6627177 DOI: 10.2147/copd.s205543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/14/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose As shown in our previous study, inspiration after swallowing (SW-I) increases during the bi-level positive airway pressure ventilation (BiPAP) in healthy subjects because swallowing-associated non-inspiratory flow (SNIF) triggers inspiratory support, while SW-I during continuous positive pressure ventilation (CPAP) is rare. In the present study, we evaluated the coordination between breathing and swallowing during spontaneous breathing, BiPAP, and CPAP in patients with chronic obstructive pulmonary disease (COPD). Patients and methods This study is a prospective intervention study at the Hoshigaoka Medical Center (November 01, 2015–April 30, 2018). We simultaneously recorded the respiratory flow, laryngeal motion, and swallowing sounds during saliva swallowing in patients with COPD. We estimated the respiratory phase after swallowing, frequency of SNIF, the duration of the respiratory pause during swallowing, and timing of swallowing in the respiratory cycle and compared these parameters among control, CPAP, and BiPAP conditions. Results The expiration after swallowing (SW-E) frequency was associated with the occurrence of SNIF (p<0.01), pause duration ≤0.8 s (p<0.01), and timing of swallowing at the intermediate respiratory phase (50–80% of the respiratory cycle from the onset of inspiration) (p<0.01). In particular, the occurrence of SNIF most substantially affected the SW-E frequency. The SW-I frequencies under the control, CPAP, and BiPAP conditions were 35.0%, 3.0%, and 37.7%, respectively. The pause durations were shorter during CPAP and BiPAP than under the control condition (p<0.01). During CPAP, the occurrence rates of SW-E. Residual denotes the percentage difference between observed and expected values (residual =10.8: p<0.01) and SNIF (residual =9.1: p<0.01) were significantly increased, and timing of swallowing shifted toward the intermediate respiratory phase (residual=3.5: p<0.01). Conclusion CPAP decreases the SW-I frequency, increases the SNIF occurrence, and normalizes the timing of swallowing, all of which suggest that CPAP alleviates the risk of aspiration in patients with COPD.
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Affiliation(s)
- Ryuji Hori
- Department of Physical Therapy, Morinomiya University of Medical Science, Suminoe-ku, Osaka 559-8611, Japan.,Department of Rehabilitation, Hoshigaoka Medical Center, Hirakata, Osaka 573-8511, Japan
| | - Rika Ishida
- Department of Physical Therapy, Morinomiya University of Medical Science, Suminoe-ku, Osaka 559-8611, Japan
| | - Masaaki Isaka
- Department of Physical Therapy, Osaka Yukioka College of Health Science, Ibaraki, Osaka 567-0801, Japan
| | - Takahito Nakamura
- Center of Respiratory Disease, Hoshigaoka Medical Center, Hirakata, Osaka 573-8511, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo College of Medicine, Nishinomiya, Hyogo 663-8501, Japan
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