1
|
Akhtar RN, Behn N, Morgan S. Understanding Dysphagia Care in Pakistan: A Survey of Current Speech Language Therapy Practice. Dysphagia 2024; 39:484-494. [PMID: 38006420 PMCID: PMC11127846 DOI: 10.1007/s00455-023-10633-7] [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: 03/29/2022] [Accepted: 10/19/2023] [Indexed: 11/27/2023]
Abstract
Dysphagia affects individuals across all ages and has pervasive and potentially life-threatening consequences. Individuals with dysphagia are assessed and treated by speech and language therapists (SLTs), however, little attention has been paid to their practices in Pakistan. This study aimed to explore SLTs practices for dysphagia assessment, signs and symptoms observed during evaluation, and management strategies, alongside barriers and facilitators to service delivery in Pakistan. A 45-item survey was distributed to SLTs online. Responses were received from 101 participants and analyzed descriptively, and open-text responses were analyzed using content analysis. Results revealed that 65.3% SLTs worked across the lifespan, and most (79.4%) had dysphagia-related experience of five years or less. SLTs were an active workforce engaged with varying ages, disorders, and settings, yet dysphagia contributed to a small caseload percentage for most. Analyses found informal clinical exams were more frequently used than instrumental assessments. A variety of service provision facilitators were described, such as supportive teams and accessible resources, and responses about barriers revealed gaps in awareness, education, and guidance. This exploratory study presents novel and unexplored data which provides a deeper understanding of dysphagia-related care in Pakistan.
Collapse
Affiliation(s)
- Rohma N Akhtar
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK.
- City University of London, London, UK.
| | - Nicholas Behn
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
| | - Sally Morgan
- Division of Language & Communication Science, Northampton Square, London, EC1V 0HB, UK
- City University of London, London, UK
| |
Collapse
|
2
|
Kimura S, Emoto T, Suzuki Y, Shinkai M, Shibagaki A, Shichijo F. Novel Approach Combining Shallow Learning and Ensemble Learning for the Automated Detection of Swallowing Sounds in a Clinical Database. SENSORS (BASEL, SWITZERLAND) 2024; 24:3057. [PMID: 38793908 PMCID: PMC11124773 DOI: 10.3390/s24103057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Cervical auscultation is a simple, noninvasive method for diagnosing dysphagia, although the reliability of the method largely depends on the subjectivity and experience of the evaluator. Recently developed methods for the automatic detection of swallowing sounds facilitate a rough automatic diagnosis of dysphagia, although a reliable method of detection specialized in the peculiar feature patterns of swallowing sounds in actual clinical conditions has not been established. We investigated a novel approach for automatically detecting swallowing sounds by a method wherein basic statistics and dynamic features were extracted based on acoustic features: Mel Frequency Cepstral Coefficients and Mel Frequency Magnitude Coefficients, and an ensemble learning model combining Support Vector Machine and Multi-Layer Perceptron were applied. The evaluation of the effectiveness of the proposed method, based on a swallowing-sounds database synchronized to a video fluorographic swallowing study compiled from 74 advanced-age patients with dysphagia, demonstrated an outstanding performance. It achieved an F1-micro average of approximately 0.92 and an accuracy of 95.20%. The method, proven effective in the current clinical recording database, suggests a significant advancement in the objectivity of cervical auscultation. However, validating its efficacy in other databases is crucial for confirming its broad applicability and potential impact.
Collapse
Affiliation(s)
- Satoru Kimura
- Division of Science and Technology, Graduate School of Sciences and Technology for Innovations, Tokushima University, Tokushima 770-8506, Japan;
| | - Takahiro Emoto
- Division of Science and Technology, Industrial and Social Science, Graduate School of Technology, Tokushima University, Tokushima 770-8506, Japan
| | - Yoshitaka Suzuki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Mizuki Shinkai
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Akari Shibagaki
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University, Tokushima 770-8504, Japan; (Y.S.); (M.S.); (A.S.)
| | - Fumio Shichijo
- Department of Neurosurgery, Suzue Hospital, Tokushima 770-0028, Japan;
| |
Collapse
|
3
|
Vergara J, Miles A, Lopes de Moraes J, Chone CT. Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:821-836. [PMID: 38437030 DOI: 10.1044/2023_jslhr-23-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.
Collapse
Affiliation(s)
- José Vergara
- Department of Surgery, Head and Neck Surgery, University of Campinas, São Paulo, Brazil
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, New Zealand
| | - Juliana Lopes de Moraes
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Campinas, São Paolo, Brazil
| |
Collapse
|
4
|
Dumican M, Thijs Z, Harper K. Clinical practice patterns of speech-language pathologists for screening and identifying dysphagia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:2062-2076. [PMID: 37376825 DOI: 10.1111/1460-6984.12921] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/06/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To identify how speech-language pathologists (SLPs) in the United States are screening for and identifying dysphagia. To do this, we examined the approaches most often used to screen for dysphagia and the influence of contextual factors such as setting, continuing education and means of staying up to date with the most current literature on screening approaches. METHOD A web-based survey composed of 32 questions was developed and field tested for content, relevance and workflow. The survey was distributed online, via social media, online SLP forums and through the American Speech-Language-Hearing Association's Special Interest Group 13 (swallowing disorders). One hundred and thirty-seven clinicians from the United States completed the survey and were included for analysis using descriptive statistics and linear regression modelling to assess associations of continuing education and years practicing with screening protocols and consumption of evidence. RESULTS Respondents worked in a variety of settings, including acute care, skilled nursing facilities, and inpatient rehabilitation. Most respondents worked with adult populations (88%). The most common screening protocols reported were a volume-dependent water swallow test (74%), subjective patient report (66%), and trials of solids/liquids (49%). Twenty-four percent (24%) reported using a questionnaire, the Eating Assessment Tool (80%) being most common. How clinicians consume their evidence was significantly associated with the types of screening approaches used. Continuing education hours were significantly associated with dysphagia screening protocol choice (p < 0.001) and how clinicians stayed up to date with evidence (p < 0.001). CONCLUSIONS Results from this study provide an in-depth look at the choices clinicians are making in the field regarding how to effectively screen patients for the presence of dysphagia. Contextual factors such as evidence base consumption patterns should serve researchers to continue seeking alternative ways to share evidence with clinicians, accessibly. Associations between continuing education and protocol choice show the need for continued evidence-based and high-quality continuing education opportunities. WHAT THIS PAPER ADDS This study provides an in-depth look at the choices clinicians are making in the field regarding effective dysphagia screening practices. Clinician screening choices are examined with contextual factors such as evidence base consumption patterns and continuing education. This paper increases knowledge of the most used dysphagia screening practices and context for clinicians and researchers to improve use, evidence and dissemination of best practices.
Collapse
Affiliation(s)
- Matthew Dumican
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo, Michigan, USA
| | - Zoe Thijs
- Molloy University, New York, New York, USA
| | - Kaitlynn Harper
- Department of Speech, Language, and Hearing Sciences, Western Michigan University, Kalamazoo, Michigan, USA
| |
Collapse
|
5
|
Lim HJ, Lai DKH, So BPH, Yip CCK, Cheung DSK, Cheung JCW, Wong DWC. A Comprehensive Assessment Protocol for Swallowing (CAPS): Paving the Way towards Computer-Aided Dysphagia Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2998. [PMID: 36833691 PMCID: PMC9963613 DOI: 10.3390/ijerph20042998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Dysphagia is one of the most common problems among older adults, which might lead to aspiration pneumonia and eventual death. It calls for a feasible, reliable, and standardized screening or assessment method to prompt rehabilitation measures and mitigate the risks of dysphagia complications. Computer-aided screening using wearable technology could be the solution to the problem but is not clinically applicable because of the heterogeneity of assessment protocols. The aim of this paper is to formulate and unify a swallowing assessment protocol, named the Comprehensive Assessment Protocol for Swallowing (CAPS), by integrating existing protocols and standards. The protocol consists of two phases: the pre-test phase and the assessment phase. The pre-testing phase involves applying different texture or thickness levels of food/liquid and determining the required bolus volume for the subsequent assessment. The assessment phase involves dry (saliva) swallowing, wet swallowing of different food/liquid consistencies, and non-swallowing (e.g., yawning, coughing, speaking, etc.). The protocol is designed to train the swallowing/non-swallowing event classification that facilitates future long-term continuous monitoring and paves the way towards continuous dysphagia screening.
Collapse
Affiliation(s)
- Hyo-Jung Lim
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Derek Ka-Hei Lai
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bryan Pak-Hei So
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| |
Collapse
|
6
|
Jaghbeer M, Sutt AL, Bergström L. Dysphagia Management and Cervical Auscultation: Reliability and Validity Against FEES. Dysphagia 2023; 38:305-314. [PMID: 35838785 PMCID: PMC9873722 DOI: 10.1007/s00455-022-10468-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/16/2022] [Indexed: 01/28/2023]
Abstract
This study investigated the reliability and validity (sensitivity and specificity) of cervical auscultation (CA) using both swallow and pre-post swallow-respiratory sounds, as compared with Flexible Endoscopic Evaluation of Swallowing (FEES). With 103 swallow-respiratory sequences from 23 heterogenic patients, these swallows sounds were rated by eight CA-trained Speech-Language Pathologists (SLPs) to investigate: (1) if the swallow was safe (primary outcome); (2) patient dysphagia status; (3) the influence of liquid viscosity on CA accuracy (secondary outcomes). Primary outcome data showed high CA sensitivity (85.4%), and specificity (80.3%) with all consistencies for the safe measurement, with CA predictive values of [Formula: see text] 90% to accurately detect unsafe swallows. Intra-rater reliability was good (Kappa [Formula: see text] 0.65), inter rater reliability moderate (Kappa [Formula: see text] 0.58). Secondary outcome measures showed high sensitivity (80.1%) to identify if a patient was dysphagic, low specificity (22.9%), and moderate correlation (rs [Formula: see text] 0.62) with FEES. A difference across bolus viscosities identified that CA sensitivities (90.1%) and specificities ([Formula: see text] 84.7%) for thin liquids were greater than for thick liquids (71.0-77.4% sensitivities, 74.0-81.3% specificities). Results demonstrate high validity and moderate-good reliability of CA-trained SLPs to determine swallow safety when compared with FEES. Data support the use of CA as an adjunct to the clinical swallow examination. CA should include pre-post respiratory sounds and requires specific training. Clinical implications: The authors advocate for holistic dysphagia management including instrumental assessment and ongoing CSE/review [Formula: see text] CA. Adding CA to the CSE/review does not replace instrumental assessment, nor should CA be used as a stand-alone tool.
Collapse
Affiliation(s)
- Mariam Jaghbeer
- Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Speech and Language Pathology Unit, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- , Alian Al Aajalain Street, Amman, Jordan
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Adult Intensive Care Services, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Liza Bergström
- Remeo Stockholm, Torsten Levenstamsväg 8, Stockholm, Sweden.
- Division of Neurology, Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden.
| |
Collapse
|
7
|
So BPH, Chan TTC, Liu L, Yip CCK, Lim HJ, Lam WK, Wong DWC, Cheung DSK, Cheung JCW. Swallow Detection with Acoustics and Accelerometric-Based Wearable Technology: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:170. [PMID: 36612490 PMCID: PMC9819201 DOI: 10.3390/ijerph20010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Swallowing disorders, especially dysphagia, might lead to malnutrition and dehydration and could potentially lead to fatal aspiration. Benchmark swallowing assessments, such as videofluoroscopy or endoscopy, are expensive and invasive. Wearable technologies using acoustics and accelerometric sensors could offer opportunities for accessible and home-based long-term assessment. Identifying valid swallow events is the first step before enabling the technology for clinical applications. The objective of this review is to summarize the evidence of using acoustics-based and accelerometric-based wearable technology for swallow detection, in addition to their configurations, modeling, and assessment protocols. Two authors independently searched electronic databases, including PubMed, Web of Science, and CINAHL. Eleven (n = 11) articles were eligible for review. In addition to swallowing events, non-swallowing events were also recognized by dry (saliva) swallowing, reading, yawning, etc., while some attempted to classify the types of swallowed foods. Only about half of the studies reported that the device attained an accuracy level of >90%, while a few studies reported poor performance with an accuracy of <60%. The reviewed articles were at high risk of bias because of the small sample size and imbalanced class size problem. There was high heterogeneity in assessment protocol that calls for standardization for swallowing, dry-swallowing and non-swallowing tasks. There is a need to improve the current wearable technology and the credibility of relevant research for accurate swallowing detection before translating into clinical screening for dysphagia and other swallowing disorders.
Collapse
Affiliation(s)
- Bryan Pak-Hei So
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Tim Tin-Chun Chan
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Liangchao Liu
- Physical Education Department, University of International Business and Economics, Beijing 100029, China
| | | | - Hyo-Jung Lim
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Daphne Sze Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
8
|
Oinuma M, Kato R, Okumura T, Hara K. Bio-signal Feature Analysis to Detect Aspiration Caused by Dysphagia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:414-417. [PMID: 36085808 DOI: 10.1109/embc48229.2022.9871927] [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
Dysphagia causes aspiration symptoms and can trigger aspiration pneumonia, poor nutritional status, etc. To address these risks, it is important to properly evaluate dysphagia and link it with treatment and training. However, current dysphagia evaluation methods cannot assess a swallowing function equivalent to that in daily life, owing to the examination method and environment. In this study, we analyzed bio-signal features to realize a system that can detect aspiration symptoms in daily life. Focusing on the neck electrical impedance, swallowing sounds, and a surface electromyogram of the suprahyoid muscles, we created a swallowing-measurement device and analyzed the bio-signals of the throat movement during swallowing. By measuring the swallowing of dysphagic patients, we investigated the characteristic differences, depending on the presence or absence of aspiration symptoms. The analysis results suggest that there were differences in each bio-signal depending on the presence or absence of aspiration symptoms, and these bio-signals could detect aspiration symptoms. This method can detect aspiration symptoms in daily life and evaluate dysphagia more appropriately and simply than current evaluation methods.
Collapse
|
9
|
Ng ML, Ki A. Acoustic characteristics associated with liquid swallowing sounds of different bolus consistencies in young healthy adults. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:552-564. [PMID: 35166419 DOI: 10.1111/1460-6984.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cervical auscultation has been used clinically as an augmentative procedure for swallow examination. Despite its frequent use for screening and preliminary assessment of swallowing, the usefulness of cervical auscultation is controversial due to a lack of sufficient research, particularly in quantifying swallowing sounds. AIMS To document the acoustic characteristics of normal swallowing sound associated with swallowing bolus of different consistencies among younger healthy adults. METHODS & PROCEDURES A total of 30 healthy young adult participants swallowed 5 ml thickened liquids of four different consistencies (slightly thick, mildly thick, moderately thick and extremely thick) prepared using a starch-based commercial thickener, and the corresponding swallowing sounds were recorded using a wireless accelerometric stethoscope. An array of acoustic measures including duration of swallowing sound (DSS), duration to peak intensity (DPI), frequency at peak intensity (FPI), peak intensity (PI), average intensity (AI), and difference between peak and average intensity (DPAI) values associated with the swallowing signals were obtained. OUTCOMES & RESULTS In general, increased durational measures of the swallowing sounds were associated with an increase in bolus consistency. Intensity measures including PI, AI and DPAI were found to be stable across different consistencies. The change in FPI did not appear to be particularly meaningful due to its high variability. In addition, no significant differences were observed between men and women. CONCLUSIONS & IMPLICATIONS Swallow sounds associated with different bolus consistencies could be quantified and used to differentiate consistencies. The present findings could serve as a reference for future swallowing research of normal and dysphagic population. WHAT THIS PAPER ADDS What is already known on the subject Cervical auscultation using traditional stethoscope has been used as part of an informal clinical swallow examination by practitioners. Validity of cervical auscultation is controversial, possibly due to the lack of normative data on swallow sounds. What this paper adds to existing knowledge The present study explored the possibility of using wireless accelerometric stethoscopy for cervical auscultation for dysphagia screening. Acoustic profiles of swallow sounds associated with boluses of different consistencies in healthy individuals were examined. What are the potential or actual clinical implications of this work? Findings contribute to our knowledge about the acoustic characteristics of swallow sounds of boluses of different consistencies in healthy young individuals. The study provides normative clinical data on cervical auscultation using wireless accelerometric stethoscope for normal swallow.
Collapse
Affiliation(s)
- Manwa L Ng
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Anthony Ki
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| |
Collapse
|
10
|
Bergström L, Cichero JA. Dysphagia management: Does structured training improve the validity and reliability of cervical auscultation? INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:77-87. [PMID: 34328050 DOI: 10.1080/17549507.2021.1953592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: Cervical auscultation (CA) uses a stethoscope or microphone to complement the clinical swallow examination by interpreting swallowing sounds and swallow-respiratory coordination. This study investigated the effects of structured CA training on CA-rating agreement with Flexible Endoscopic Evaluation of Swallowing (FEES) and CA rater reliability.Method: Thirty-nine speech-language pathologists participated in a structured CA training course at Gothenburg University. They rated nine swallow-respiratory sound recordings which were simultaneously recorded during FEES. Swallow sounds were rated six weeks prior to the CA-workshop using two binary yes/no questions, (1) Safe, (2) Dysphagia, and a third Dysphagia Severity rating. Swallow sounds were rated again (re-randomised) one month post CA-workshop.Result: Agreement with FEES (validity) improved significantly (p < 0.05) pre-post training for the Safe and Dysphagia questions, with post training sensitivities >90% and specificities at 76% and 85% respectively. Dysphagia severity rating improved non-significantly. Intra-rater reliability improved significantly with kappa statistics >0.90 post training. Improvements for inter-rater reliability were noted, though non-significant.Conclusion: Results demonstrate that with structured training, the validity of CA (to detect a Safe/Dysphagic swallow) significantly improves, as does intra-rater reliability. This is congruent with literature identifying the positive effects of structured training improving instrumental dysphagia assessment.
Collapse
Affiliation(s)
- Liza Bergström
- Institute of Neuroscience & Physiology, Department of Health & Rehabilitation, Speech and Language Pathology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg 405 30, Sweden
- Speech Therapy Clinic, Danderyd Hospital, Stockholm, Sweden
- REMEO Stockholm, Sköndal, Sweden
| | - Julie Ay Cichero
- School of Pharmacy, PACE, The University of Queensland, Woolloongabba, Australia
- Mater Research, South Brisbane, Australia
| |
Collapse
|
11
|
Schepers FV, van Hulst K, Spek B, Erasmus CE, van den Engel‐Hoek L. Dysphagia limit in children with cerebral palsy aged 4 to 12 years. Dev Med Child Neurol 2022; 64:253-258. [PMID: 34418067 PMCID: PMC9291064 DOI: 10.1111/dmcn.15031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 12/02/2022]
Abstract
AIM To assess the dysphagia limit in children with cerebral palsy (CP) according to Eating and Drinking Ability Classification System (EDACS) level, sex, and age compared to typically developing children. METHOD Seventy-seven children with CP (54 males, 23 females; mean age 7y 6mo, SD 2y 2mo, age range 4-12y) were assessed with the Maximum Volume Water Swallow Test. Median dysphagia limit in the CP group was compared with data of typically developing children. RESULTS The dysphagia limit of children with CP differed significantly (p<0.001) from typically developing children. The latter showed a threefold higher median dysphagia limit (22mL) compared to children with CP in EDACS level I (7mL). The higher the EDACS level, the lower the dysphagia limit in children with CP. EDACS level explained 55% of the variance in the dysphagia limit of the CP group. INTERPRETATION Where children with CP in EDACS levels IV and V showed that their capacity met the level of their performance, children in EDACS level I had the ability to perform a maximum capacity task, but still had a threefold lower median dysphagia limit than typically developing children. Establishment of the dysphagia limit should be part of general swallowing assessment in children with CP.
Collapse
Affiliation(s)
- Florentine V Schepers
- Department of Rehabilitation MedicineUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
| | - Karen van Hulst
- Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
| | - Bea Spek
- Department of Epidemiology and DatascienceAmsterdam University Medical CentresUniversity of AmsterdamAmsterdamthe Netherlands
| | - Corrie E Erasmus
- Department of Paediatric NeurologyDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
| | - Lenie van den Engel‐Hoek
- Department of RehabilitationDonders Institute for Brain, Cognition and BehaviourRadboud University Medical CentreAmalia Children’s HospitalNijmegenthe Netherlands
| |
Collapse
|
12
|
Are Oropharyngeal Dysphagia Screening Tests Effective in Preventing Pneumonia? J Clin Med 2022; 11:jcm11020370. [PMID: 35054063 PMCID: PMC8780873 DOI: 10.3390/jcm11020370] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 12/15/2022] Open
Abstract
Oropharyngeal dysphagia, a clinical condition that indicates difficulty in moving food and liquid from the oral cavity to the esophagus, has a markedly high prevalence in the elderly. The number of elderly people with oropharyngeal dysphagia is expected to increase due to the aging of the world's population. Understanding the current situation of dysphagia screening is crucial when considering future countermeasures. We report findings from a literature review including citations on current objective dysphagia screening tests: the Water Swallowing Test, Mann Assessment of Swallowing Ability, and the Gugging Swallowing Screen. Pneumonia can be predicted using the results of the screening tests discussed in this review, and the response after the screening tests is important for prevention. In addition, although interdisciplinary team approaches prevent and reduce aspiration, optimal treatment is a challenging. Intervention studies with multiple factors focusing on the elderly are needed.
Collapse
|
13
|
Wen X, Li L, Onoda K, Maruyama H. The effects of neuromuscular joint facilitation treatment using neck patterns on the acoustic analysis of swallowing sounds in healthy adults. J Phys Ther Sci 2021; 33:753-757. [PMID: 34658519 PMCID: PMC8516609 DOI: 10.1589/jpts.33.753] [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: 06/14/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] We aimed to investigate the changes in the swallowing sounds of healthy adults
during neuromuscular joint facilitation treatment using neck patterns. [Participants and
Methods] A total of 20 healthy adults (10 males and 10 females; mean age, 29.2 ± 6.3
years) swallowed 10 mL of water four times under three conditions (after the neuromuscular
joint facilitation neck-flexion resistance pattern, after the Shaker-type exercise, and
during relaxed sitting without prior exercise [control]), randomly ordered with an
interval greater than 3 days. Swallowing sounds for each water swallow were recorded using
cervical auscultation. [Results] The mean amplitude of swallowing sound intensity and the
mean spectral frequency were significantly higher after the neuromuscular joint
facilitation neck-flexion resistance pattern and the Shaker-type exercise, in comparison
with those in the control group. [Conclusion] Neuromuscular joint facilitation training
with the neck-flexion resistance pattern influenced swallowing sounds to the same degree
as the Shaker-type exercise, implying that this resistance pattern may enhance suprahyoid
muscle contraction.
Collapse
Affiliation(s)
- Xiao Wen
- Narita Campus, International University of Health and Welfare, Japan.,Department of Speech, Language and Hearing Sciences, China Rehabilitation Research Center: No. 10, Jiaomen North Road, Fengtai District, Beijing 100068, China
| | - Luping Li
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Japan
| | - Ko Onoda
- Department of Physical Therapy, School of Health Sciences, International University of Health and Welfare, Japan
| | - Hitoshi Maruyama
- Fukuoka Campus, International University of Health and Welfare, Japan
| |
Collapse
|
14
|
Miura Y, Tamai N, Kitamura A, Yoshida M, Takahashi T, Mugita Y, Tobita I, Arita M, Urai T, Dai M, Noguchi H, Matsumoto M, Mukai K, Nakagami G, Ota E, Sugama J, Sanada H. Diagnostic accuracy of ultrasound examination in detecting aspiration and pharyngeal residue in patients with dysphagia: A systematic review and meta-analysis. Jpn J Nurs Sci 2021; 18:e12396. [PMID: 33843140 DOI: 10.1111/jjns.12396] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023]
Abstract
AIM To estimate diagnostic accuracy of ultrasonography for detecting aspiration and pharyngeal residue in patients with dysphagia. METHODS A systematic search was conducted in MEDLINE (via PubMed), CINAHL, EMBASE, Ichushi-Web, and Cochrane Library databases to identify articles that showed diagnostic accuracy of ultrasonography for detecting aspiration and residue published in English and Japanese until August 2019. Cross-sectional studies, case-control studies, and cohort studies were included. The diagnostic accuracy results were extracted and the pooled estimated sensitivity and specificity were calculated. The risk of bias of the studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies 2. The certainty of the evidence was assessed using the Grades of Recommendation Assessment, Development, and Evaluation methodology. RESULTS Five studies were included in this review. The pooled estimated sensitivity and specificity for detecting aspiration were 0.82 (95% CI: 0.72-0.89) and 0.87 (95% CI: 0.81-0.92), respectively. One study was included that evaluated ultrasound assessments of pharyngeal residue. The sensitivity and specificity were 0.62 (95% CI: 0.32-0.86) and 0.67 (95% CI: 0.22-0.96), respectively. The certainty of the evidence was low and very low for the diagnostic accuracy of aspiration and pharyngeal residue, respectively. CONCLUSION Ultrasound is a non-invasive method with good sensitivity and specificity in detecting aspiration as well as reference standards. While risk of bias and small number of studies limited the strength of this systematic review, our results suggested that ultrasound examination was useful as a bedside screening tool for detecting aspiration.
Collapse
Affiliation(s)
- Yuka Miura
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nao Tamai
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Kitamura
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toshiaki Takahashi
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuko Mugita
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Itoko Tobita
- Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | - Mikiko Arita
- Department of Nursing, Baika Women's University, Osaka, Japan
| | - Tamae Urai
- Faculty of Nursing, Toyama Prefectural University, Toyama, Japan
| | - Misako Dai
- Department of Skincare Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Noguchi
- Department of Engineering, Osaka City University, Osaka, Japan
| | - Masaru Matsumoto
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kanae Mukai
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Ishikawa, Japan
| | - Gojiro Nakagami
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Sciences, St. Luke's International University, Tokyo, Japan
| | - Junko Sugama
- Institute for Frontier Science Initiative, Kanazawa University, Ishikawa, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
15
|
Lindroos E, Johansson K. Free from Dysphagia? A Test Battery to Differentiate Between Mild and No Dysphagia. Dysphagia 2021; 37:501-509. [PMID: 33846833 DOI: 10.1007/s00455-021-10295-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
Assessing mild oropharyngeal dysphagia (OD) raises the question where to draw the line between normal and pathological swallowing. There is a lack of clinical test methods appropriate in the subacute phase of recovery from dysphagia following stroke and other brain injuries. The aim of this pilot study was to investigate the diagnostic accuracy of a new test battery, called the Swallow Battery (SwaB), in relation to Fiberoptic Endoscopic Evaluation of Swallowing (FEES). SwaB consists of the validated tests Repetitive Saliva Swallowing Test (RSST), Timed Water Swallowing Test (TWST) and parts of the Test of Masticating and Swallowing Solids (ToMaSS). Nineteen adult patients with acquired brain injury who were enrolled in a rehabilitation programme underwent the SwaB and a FEES, both resulting in a pass or fail outcome. The pass or fail results were based on RSST's and TWST's suggested cutoffs, normative values of ToMaSS and on established rating scales used for FEES. The SwaB's ability to predict FEES results was 74% according to a binary logistic regression analysis, with a 92% correct prediction of fail results and 33% correct prediction of pass results. The ToMaSS was sensitive to small changes in eating ability, failing 13 out of 19 patients using 95% CI normative values as cutoff, including patients with a passed FEES. Alternative cutoffs were therefore suggested, depending on purpose of dysphagia assessment. The results of this study indicate that the SwaB may be a useful tool when assessing mild dysphagia following brain injury. Further studies of SwaB's validity and clinical utility are suggested.
Collapse
Affiliation(s)
- Emma Lindroos
- Department of Rehabilitation Medicine, Danderyd University Hospital, 182 88, Stockholm, Sweden.
| | - Kerstin Johansson
- Department of Speech and Language Pathology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Shu K, Coyle JL, Perera S, Khalifa Y, Sabry A, Sejdić E. Anterior-posterior distension of maximal upper esophageal sphincter opening is correlated with high-resolution cervical auscultation signal features. Physiol Meas 2021; 42. [PMID: 33601360 DOI: 10.1088/1361-6579/abe7cb] [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: 08/02/2020] [Accepted: 02/18/2021] [Indexed: 12/22/2022]
Abstract
Objective. Adequate upper esophageal sphincter (UES) opening is essential during swallowing to enable clearance of material into the digestive system, and videofluoroscopy (VF) is the most commonly deployed instrumental examination for assessment of UES opening. High-resolution cervical auscultation (HRCA) has been shown to be an effective, portable and cost-efficient screening tool for dysphagia with strong capabilities in non-invasively and accurately approximating manual measurements of VF images. In this study, we aimed to examine whether the HRCA signals are correlated to the manually measured anterior-posterior (AP) distension of maximal UES opening from VF recordings, under the hypothesis that they would be strongly associated.Approach. We developed a standardized method to spatially measure the AP distension of maximal UES opening in 203 swallows VF recording from 27 patients referred for VF due to suspected dysphagia. Statistical analysis was conducted to compare the manually measured AP distension of maximal UES opening from lateral plane VF images and features extracted from two sets of HRCA signal segments: whole swallow segments and segments excluding all events other than the duration of UES is opening.Main results. HRCA signal features were significantly associated with the normalized AP distension of the maximal UES opening in the longer whole swallowing segments and the association became much stronger when analysis was performed solely during the duration of UES opening.Significance. This preliminary feasibility study demonstrated the potential value of HRCA signals features in approximating the objective measurements of maximal UES AP distension and paves the way of developing HRCA to non-invasively and accurately predict human spatial measurement of VF kinematic events.
Collapse
Affiliation(s)
- Kechen Shu
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, United States of America
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, Department of Otolaryngology, School of Medicine, University of Pittsburgh, PA, 15260, United States of America
| | - Subashan Perera
- Division of Geriatrics, Department of Medecine, University of Pittsburgh, Pittsburgh, PA, 15261, United States of America
| | - Yassin Khalifa
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, 15261, United States of America
| | - Aliaa Sabry
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA, 15260, United States of America
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, Department of Bioengineering, Swanson School of Engineering, Department of Biomedical informatics, School of Medecine, Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, PA, 15260, United States of America
| |
Collapse
|
17
|
White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults. Dysphagia 2021; 37:333-349. [PMID: 33787994 PMCID: PMC8009935 DOI: 10.1007/s00455-021-10283-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/08/2021] [Indexed: 02/07/2023]
Abstract
This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.
Collapse
|
18
|
|
19
|
Baqays A, Johannsen W, Rashid M, Jaffal H, Hicks A, Jeffery C, Seikaly H, El-Hakim H. Parent-Reported Outcome Questionnaire for Swallowing Dysfunction in Healthy Infants and Toddlers: Construction and Content Validation. Otolaryngol Head Neck Surg 2020; 165:197-205. [PMID: 33287657 DOI: 10.1177/0194599820970950] [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: 11/15/2022]
Abstract
OBJECTIVES There is limited epidemiological information on swallowing dysfunction (SwD) in otherwise healthy infants and toddlers (OHITs). Cost, invasiveness, expertise, and resources constrain the repeatability and utility of instrumental diagnostic tests. A parent-reported outcomes (PRO) tool has the potential to mitigate these disadvantages. Hence, we set out to develop and validate a novel PRO tool to assess SwD in OHITs. STUDY DESIGN A mixed-method study. SETTING Tertiary pediatric center. METHODS We recruited parents of OHITs with SwD and excluded those with a confounding diagnosis (syndromes or neurological impairment). Interviews were conducted and thematically analyzed to extract the relevant domains and items. A similar analytical method was performed on the reports from a systematic review and literature search. Four verification sessions of parents and experts were conducted to maintain rigor. A panel of experts assessed and established the content validity of the items using a modified Delphi technique. RESULTS We achieved information saturation after interviewing 10 parents and generated 7 domains with 72 items. Over the course of 3 rounds of modified Delphi content validation, the domains were reduced to 3 (swallowing, breathing, and illness) containing 21 items; a content validity index of 82.1% was achieved. CONCLUSION We validated the content of a new PRO instrument to assess SwD in OHITs. The instrument is composed of 3 primary domains representing 21 items. This tool has the potential to screen for swallowing dysfunction and can assess management outcomes specifically for this population at a community level.
Collapse
Affiliation(s)
- Abdulsalam Baqays
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada.,Division of Otolaryngology, King Saud University, Riyadh, Saudi Arabia
| | - Wendy Johannsen
- Department of Pediatric Speech Language Pathology, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Marghalara Rashid
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hussein Jaffal
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Hicks
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Caroline Jeffery
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
20
|
Avoiding the Downward Spiral After Stroke: Early Identification and Treatment of Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
21
|
Fong R, Tsai KCF, Tong MCF, Lee KYS. Management of Dysphagia in Nursing Homes During the COVID-19 Pandemic: Strategies and Experiences. ACTA ACUST UNITED AC 2020; 2:1361-1365. [PMID: 32838197 PMCID: PMC7433678 DOI: 10.1007/s42399-020-00464-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 12/05/2022]
Abstract
The global 2019 novel coronavirus disease (COVID-19) pandemic has had devastating effects not only on healthcare systems worldwide but also on different aspects of the care provided to nursing home residents. Dysphagia management is a crucial component of the care provided to many nursing home residents. This article presents the dysphagia management strategies applied in Hong Kong during the COVID-19 pandemic and the related experiences. A two-tier protection system was implemented wherein residents were categorised according to their contact and hospitalisation histories. The provided swallowing management and personal protective equipment level differed between the two tiers. The article also discusses the referral and prioritisation of clinical services for residents requiring swallowing management, as well as the adaptations of swallowing assessment and management during the pandemic. The possible effects of COVID-19 on mealtime arrangements in nursing homes, the implications of the pandemic on the use of personal protective equipment and the use of telepractice in nursing homes were also discussed. This article has summarised the actions taken in this regard and may serve as a reference to clinicians who are responsible for swallowing assessments and dysphagia management in nursing homes.
Collapse
Affiliation(s)
- Raymond Fong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Michael C. F. Tong
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathy Y. S. Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Human Communicative Research, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
22
|
Influence of Inhalation Injury on Incidence, Clinical Profile and Recovery Pattern of Dysphagia Following Burn Injury. Dysphagia 2020; 35:968-977. [PMID: 32103328 PMCID: PMC7223884 DOI: 10.1007/s00455-020-10098-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/17/2020] [Indexed: 11/26/2022]
Abstract
Inhalation injury is predictive of dysphagia post burns; however, the nature of dysphagia associated with inhalation burns is not well understood. This study describes the clinical profile and recovery pattern of swallowing following inhalation burn injury. All patients admitted 2008–2017 with confirmed inhalation burns on laryngoscopy and managed by speech-language pathology (SLP) were included. Initial dysphagia presentation and dysphagia recovery pattern were documented using the FOIS. Co-presence of dysphonia was determined clinically and rated present/absent. Persistent laryngeal/pharyngeal injury at 6 months was documented using laryngoscopy. Data were compared to published data from a large adult burn cohort. All patients with confirmed inhalation burns during the study period received SLP input, enabling review of 38 patients (68% male; m = 40.8 years). Percent Total Body Surface Area burn ranged 1–90%, 100% had head and neck burns, 97% required mechanical ventilation (mean 9.4 days), 18% required tracheostomy and 100% had dysphonia. Comparing to non-inhalation burn patients, the inhalation cohort had significantly (p < 0.01) higher dysphagia incidence (89.47% vs 5.6%); more with severe dysphagia at presentation (78.9% vs 1.7%); increased duration to initiate oral intake (m = 24.69 vs 0.089 days); longer duration of enteral feeding (m = 45.03 vs 1.96 days); and longer duration to resolution of dysphagia (m = 29.79 vs 1.67 days). Persistent laryngeal pathology was present in 47.37% at 6 months. This study shows dysphagia incidence in burn patients with inhalation injury is 16 times greater than for those without inhalation injury. Laryngeal pathology due to inhalation injury increases dysphagia severity and duration to dysphagia recovery.
Collapse
|
23
|
Frakking TT, Chang AB, David M, Orbell‐Smith J, Weir KA. Clinical feeding examination with cervical auscultation for detecting oropharyngeal aspiration: A systematic review of the evidence. Clin Otolaryngol 2019; 44:927-934. [DOI: 10.1111/coa.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 05/16/2019] [Accepted: 07/07/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Thuy T. Frakking
- Speech Pathology Department & Research Development Unit, Metro North Hospital & Health Service, Queensland Health Caboolture Hospital Caboolture QLD Australia
- School of Health and Rehabilitation Sciences The University of Queensland St Lucia QLD Australia
| | - Anne B. Chang
- Department of Respiratory Medicine Queensland Children's Hospital QLD Australia
- Child Health Division, Menzies School of Health Research Charles Darwin University Casuarina NT Australia
- Centre for Children's Health Research Queensland University of Technology QLD Australia
| | - Michael David
- School of Medicine and Public Health The University of Newcastle Gosford NSW Australia
| | - Jane Orbell‐Smith
- Library Services, Metro North Hospital & Health Service Caboolture Hospital Caboolture QLD Australia
| | - Kelly A. Weir
- School of Allied Health Sciences, Menzies Health Institute Queensland Griffith University Brisbane QLD Australia
- Clinical Governance, Education & Research Gold Coast University Hospital Southport QLD Australia
| |
Collapse
|
24
|
The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) Is a Valid and Low-Cost Tool for Evaluation of Dysphagia: A Gold-Standard Comparison Study. J Aging Res 2019; 2019:7984635. [PMID: 31001435 PMCID: PMC6436359 DOI: 10.1155/2019/7984635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/05/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background Dysphagia is a predictor of mortality in Parkinson's disease (PD). Developing alternative methods to videofluoroscopy swallowing study (VFSS) for the evaluation of dysphagia is a public health necessity. The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) is an alternative and low-cost tool for diagnosis of dysphagia, but had not been properly validated in comparison to the gold-standard method. The objective of this study was to assess the validity and reliability of the SCAS-PD. Methods SCAS-PD was applied to 31 patients with PD, and VFSS was conducted concurrently. This clinical assessment uses different volumes and viscosities to identify signs of swallowing impairments. For validation purposes, the interclass correlation coefficient and the weighted kappa were calculated. The AUC of the ROC curve, sensitivity, and specificity values for detection of penetration/aspiration (PA) were assessed. Internal consistency was calculated by Cronbach's alpha. Results Fifty-one percent of patients were classified with dysphagia. SCAS-PD was differentiated between normal/functional deglutition and dysphagia with AUC 0.97, 95% CI 0.92-1.00, and an optimal cutoff at 19 (sensitivity 100% and specificity 87.5%). The internal consistency was α = 0.91 for the total score. The internal consistency of the SCAS-PD domains was oral phase (α = 0.73), pharyngeal phase (α = 0.86), and signs of PA (α = 0.95). The weighted kappa analysis demonstrated a high rate of concordance at 0.71 (p < 0.001) between SCAS-PD and VFSS. Conclusions SCAS-PD has been shown to have a good concordance with the VFSS. Considering this, SCAS-PD is highly applicable in clinical settings, since it is a simple and low-cost diagnostic tool for detecting dysphagia in PD patients.
Collapse
|
25
|
Perren A, Zürcher P, Schefold JC. Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill. Dysphagia 2019; 34:475-486. [PMID: 30684017 DOI: 10.1007/s00455-019-09977-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients. Systematic screening of all potential ICU patients for oropharyngeal dysphagia (OD) seems key for early recognition and follow-up, as well as the design and testing of novel therapeutic interventions. Today, screening methods and clinical investigations for dysphagia differ considerably. In the context of a recently proposed pragmatic screening algorithm introduced by us, we provide a concise review on currently available non-instrumental techniques that could potentially serve for non-instrumental OD assessment in critically ill patients. Following systematic literature review, we find that non-instrumental OD assessments were mostly tested in different patient populations with only a minority of studies performed in critically ill patients. Due to little available data on non-instrumental dysphagia assessment in the ICU, future investigations should aim to validate respective approaches in the critically ill against an instrumental (gold) standard, for example, flexible endoscopic evaluation of swallowing. An international expert panel is encouraged to addresses critical illness-related definitions, screening and confirmatory assessment approaches, treatment recommendations, and identifies optimal patient-centered outcome measures for future clinical investigations.
Collapse
Affiliation(s)
- Andrea Perren
- Department of Physiotherapy, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Patrick Zürcher
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| |
Collapse
|
26
|
Kurosu A, Coyle JL, Dudik JM, Sejdic E. Detection of Swallow Kinematic Events From Acoustic High-Resolution Cervical Auscultation Signals in Patients With Stroke. Arch Phys Med Rehabil 2018; 100:501-508. [PMID: 30071198 DOI: 10.1016/j.apmr.2018.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether there were any associations between high-resolution cervical auscultation (HRCA) acoustic signals recorded by a contact microphone and swallowing kinematic events during pharyngeal swallow as assessed by a videofluoroscopic (VF) examination. DESIGN Prospective pilot study. SETTING University teaching hospital, university research laboratories. PARTICIPANTS Patients (N=35) with stroke who have suspected dysphagia (26 men + 9 women; age = 65.8±11.2). METHODS VF recordings of 100 liquid swallows from 35 stroke patients were analyzed, and a variety of HRCA signal features to characterize each swallow were calculated. MAIN OUTCOME MEASURES Percent of signal feature maxima (peak) occurring within 0.1 seconds of swallow kinematic event identified from VF recording. RESULTS Maxima of HRCA signal features, such as standard deviation, skewness, kurtosis, centroid frequency, bandwidth, and wave entropy, were associated with hyoid elevation, laryngeal vestibule closure, and upper esophageal sphincter opening, and the contact of the base of the tongue and posterior pharyngeal wall. CONCLUSIONS Although the kinematic source of HRCA acoustic signals has yet to be fully elucidated, these results indicate a strong relationship between these HRCA signals and several swallow kinematic events. There is a potential for HRCA to be developed for diagnostic and rehabilitative clinical management of dysphagia.
Collapse
Affiliation(s)
- Atsuko Kurosu
- Department of Communication Science and Disorders, School of Health and Rehabilitation and Sciences, University of Pittsburgh, Pittsburgh, PA
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation and Sciences, University of Pittsburgh, Pittsburgh, PA; Department of Otolaryngology, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Joshua M Dudik
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA.
| |
Collapse
|
27
|
Nozue S, Ihara Y, Takahashi K, Harada Y, Takei Y, Yuasa K, Yokoyama K. Accuracy of cervical auscultation in detecting the presence of material in the airway. Clin Exp Dent Res 2017; 3:209-214. [PMID: 29744203 PMCID: PMC5839180 DOI: 10.1002/cre2.89] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/27/2022] Open
Abstract
Several studies have investigated the accuracy of cervical auscultation (CA). However, both the sensitivities and the specificities of CA in detecting dysphagic conditions varied widely among these studies. These wide variations of the accuracy of CA might be caused by differences of the targeted sounds, such as the expiratory sound (ES) and/or swallowing sound (SS). Forty-six dysphagic patients were served as subjects. Patients who had unoccluded tracheostoma and patients who could not follow the instructions were excluded. During the videofluorographic swallowing study (VFSS), the subjects swallowed 3 ml of yogurt containing barium sulfate. The VFSS images were recorded with acoustic signals including both the swallowing and respiratory sounds detected by our method. Classification of the VFSS images was decided by consensus of the three dentists using a penetration-aspiration scale (PAS). Recorded VFSS images were classified into the following 2 groups based on PAS: "no or minimum risk group": PAS1-2; and "possible risk group": PAS3-8. As a result of the classification of VFSS findings, 30 samples were evaluated as no or minimum risk group and 16 as possible risk group. Twelve observers including 10 dentists other than 3 dentists who evaluated VFSS images and 2 speech pathologists auditorily diagnosed "negative" and "positive." Sensitivity, specificity, and intra-rater reliability was calculated for the 3 types of acoustic samples. The sensitivity of the intra-rater reliability was 60.3% for ES, 76.6% for SS, and 89.9% for ES + SS. The sensitivity of intra-rater reliability of ES + SS samples was significantly higher than that of ES (p < .01) and SS (p < .05). The sensitivity of intra-rater reliability of SS was significantly higher than that of ES (p < .01). The specificity of the intra-rater reliability was 53.7% for ES, 50.3% for SS, and 44.5% for ES + SS. ES + SS might be most useful for detecting the presence of material in the airway.
Collapse
Affiliation(s)
- Shinji Nozue
- Division of Oral Rehabilitation Medicine, Department of Special Needs DentistrySchool of Dentistry, Showa UniversityTokyoJapan
| | - Yoshiaki Ihara
- Division of Oral Rehabilitation Medicine, Department of Special Needs DentistrySchool of Dentistry, Showa UniversityTokyoJapan
| | - Koji Takahashi
- Division of Oral Rehabilitation Medicine, Department of Special Needs DentistrySchool of Dentistry, Showa UniversityTokyoJapan
| | - Yuka Harada
- Division of Oral Rehabilitation Medicine, Department of Special Needs DentistrySchool of Dentistry, Showa UniversityTokyoJapan
| | - Yoshiko Takei
- Division of Oral Rehabilitation Medicine, Department of Special Needs DentistrySchool of Dentistry, Showa UniversityTokyoJapan
| | - Ken Yuasa
- Division of Oral Rehabilitation Medicine, Department of Special Needs DentistrySchool of Dentistry, Showa UniversityTokyoJapan
| | - Kaoru Yokoyama
- Division of Oral Rehabilitation Medicine, Department of Special Needs DentistrySchool of Dentistry, Showa UniversityTokyoJapan
| |
Collapse
|
28
|
Frakking TT, Chang AB, O'Grady KAF, David M, Weir KA. Reliability for detecting oropharyngeal aspiration in children using cervical auscultation. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 19:569-577. [PMID: 27686754 DOI: 10.1080/17549507.2016.1222452] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 08/05/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Limited data exist that support the reproducibility of cervical auscultation (CA) use in children. This study aimed to determine the reliability of CA in detecting oropharyngeal aspiration (OPA) in children within a controlled environment. METHOD This observational study included eight speech-language pathologists who rated clips of 40 normal and 40 OPA swallowing sounds on two separate occasions (i.e.160 sound clips rated by each speech-language pathologist) to comprise a total of 1280 swallow clips rated. Swallowing sound clips were collected from (1) a volunteer sample of 20 healthy children from the general community (mean 16.2 ± 10.7 months; 65% female); (2) a referred sample of 19 children with demonstrated OPA (mean 22.8 ± 25.5 months; 36.8% female), as determined on videofluoroscopic swallow studies (VFSS) using the Penetration-Aspiration Scale (PAS) (≥6 score). RESULT Inter-rater reliability was very good (kappa =0.81, 95%CI 0.79-0.84). Intra-rater reliability for each rater was good to very good (kappa range 0.72-0.98). Overall sensitivity was 93.9% (95%CI 91.8-95.6) and specificity was 94.5% (95%CI 92.5-96.2). High reliability values were found for the detection of OPA versus normal swallows using CA alone. CONCLUSION Future research should investigate the use of CA in a variety of clinical settings with less environmental control before CA can be advocated for use in routine clinical practice.
Collapse
Affiliation(s)
- Thuy T Frakking
- a Centre for Children's Health Research, The University of Queensland , Brisbane , Australia
- b Speech Pathology Department , Caboolture Hospital , Brisbane , Australia
| | - Anne B Chang
- c Queensland Children's Respiratory Centre, Royal Children's Hospital , Brisbane , Australia
- d Child Health Division, Menzies School of Health Research , Charles Darwin University , Darwin , Australia
- e Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology , Brisbane , Australia
| | - Kerry-Ann F O'Grady
- e Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology , Brisbane , Australia
| | - Michael David
- a Centre for Children's Health Research, The University of Queensland , Brisbane , Australia
- f School of Public Health , The University of Queensland , Brisbane , Australia , and
| | - Kelly A Weir
- a Centre for Children's Health Research, The University of Queensland , Brisbane , Australia
- b Speech Pathology Department , Caboolture Hospital , Brisbane , Australia
- g Menzies Health Institute Queensland , Griffith University , Gold Coast , Australia
| |
Collapse
|
29
|
Effect of Modified Shaker Exercise on the Amplitude and Duration of Swallowing Sounds: Evidence from Cervical Auscultation. Rehabil Res Pract 2017; 2017:6526214. [PMID: 29082044 PMCID: PMC5610851 DOI: 10.1155/2017/6526214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/12/2017] [Accepted: 07/31/2017] [Indexed: 12/04/2022] Open
Abstract
Objective Anecdotal evidence shows that the Shaker exercise and its modifications improve pharyngeal muscle contraction. However, there is no experimental evidence for the same. Thus, the present study examined the effect of modified Shaker exercise on the amplitude and duration of pharyngeal muscle contraction using cervical auscultation. Design The study follows a cross-sectional study design, where 50 healthy individuals (23 males and 27 females) performed modified Shaker exercise and noneffortful swallow during 10 ml water swallowing. Swallow sound characteristics were analyzed with and without modified Shaker exercise using cervical auscultation. Results The results of mixed ANOVA revealed significant differences for the amplitude of swallow sound with modified Shaker exercise (mean = 47.24, SD = 20.64) when compared to noneffortful swallow (mean = 28.19, SD = 10.26) at p < 0.05. However, no significant difference was obtained for the swallow sound duration with (mean = 0.19, SD = 0.07) and without (mean = 0.18, SD = 0.07) modified Shaker exercise at p > 0.05. No significant difference across the genders was also noted at p > 0.05. Conclusion The outcomes of the study suggest that modified Shaker exercise improves the amplitude of pharyngeal muscle contraction. Further studies are needed to confirm this finding using gold standard tools like videofluoroscopy.
Collapse
|
30
|
Abstract
Changes to swallowing affect most people with Parkinson's disease (PD). Changes may not initially exercise a decisive impact, but can later pose significant threats to nutritional, hydration and respiratory health and psychosocial quality of life. This review, from a largely clinical viewpoint, outlines the nature of changes in PD and considers the issue of how many people are affected and in what ways. It outlines main approaches to assessment and management, with an emphasis on aspects relevant to PD. Dysphagia contributes to drooling in PD. The review therefore also touches on the nature and management of this condition that has its own set of health and psychosocial quality-of-life issues.
Collapse
Affiliation(s)
- Nick Miller
- Newcastle University Institute for Ageing, Speech & Language Sciences, George VI Building, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| |
Collapse
|
31
|
Hennessey NW, Fisher G, Ciccone N. Developmental changes in pharyngeal swallowing acoustics: a comparison of adults and children. LOGOP PHONIATR VOCO 2017; 43:63-72. [DOI: 10.1080/14015439.2017.1326526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Gemma Fisher
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
- Department of Health, Government of Western Australia, Perth, Australia
| | - Natalie Ciccone
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
- School of Psychology and Social Science, Edith Cowan University, Joondalup, Australia
| |
Collapse
|
32
|
Andrews M, Pillay M. Poor consistency in evaluating South African adults with neurogenic dysphagia. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2017; 64:e1-e14. [PMID: 28155280 PMCID: PMC5842977 DOI: 10.4102/sajcd.v64i1.158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/21/2016] [Accepted: 09/11/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Speech-language therapists are specifically trained in clinically evaluating swallowing in adults with acute stroke. Incidence of dysphagia following acute stroke is high in South Africa, and health implications can be fatal, making optimal management of this patient population crucial. However, despite training and guidelines for best practice in clinically evaluating swallowing in adults with acute stroke, there are low levels of consistency in these practice patterns. OBJECTIVE The aim was to explore the clinical practice activities of speech-language therapists in the clinical evaluation of swallowing in adults with acute stroke. Practice activities reviewed included the use and consistency of clinical components and resources utilised. Clinical components were the individual elements evaluated in the clinical evaluation of swallowing (e.g. lip seal, vocal quality, etc.)Methods: The questionnaire used in the study was replicated and adapted from a study increasing content- and criterion-related validity. A narrative literature review determined what practice patterns existed in the clinical evaluation of swallowing in adults. A pilot study was conducted to increase validity and reliability. Purposive sampling was used by sending a self-administered, electronic questionnaire to members of the South African Speech-Language-Hearing Association. Thirty-eight participants took part in the study. Descriptive statistics were used to analyse the data and the small qualitative component was subjected to textual analysis. RESULTS There was high frequency of use of 41% of the clinical components in more than 90% of participants (n = 38). Less than 50% of participants frequently assessed sensory function and gag reflex and used pulse oximetry, cervical auscultation and indirect laryngoscopy. Approximately a third of participants showed high (30.8%), moderate (35.9%) and poor (33.3%) consistency of practice each. Nurses, food and liquids and medical consumables were used usually and always by more than 90% of participants. CONCLUSION Infrequent use of clinical components and high variability in clinical practice among speech-language therapists calls for uniform curricula in the clinical evaluation of swallowing at South African universities and for continued professional development post-graduation. Different contexts and patient symptoms contribute towards varied practice; however, there is still a need to improve consistency of practice for quality health care delivery. A research-based policy for the clinical swallowing evaluation for a resource-limited context is also needed.
Collapse
Affiliation(s)
- Mckinley Andrews
- Discipline of Speech-Language Pathology, University of KwaZulu-Natal.
| | | |
Collapse
|
33
|
Frakking T, Chang A, O’Grady K, David M, Weir K. Aspirating and Nonaspirating Swallow Sounds in Children. Ann Otol Rhinol Laryngol 2016; 125:1001-1009. [DOI: 10.1177/0003489416669953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Cervical auscultation (CA) may be used to complement feeding/swallowing evaluations when assessing for aspiration. There are no published pediatric studies that compare the properties of sounds between aspirating and nonaspirating swallows. Aim: To establish acoustic and perceptual profiles of aspirating and nonaspirating swallow sounds and determine if a difference exists between these 2 swallowing types. Methods: Aspiration sound clips were obtained from recordings using CA simultaneously undertaken with videofluoroscopic swallow study. Aspiration was determined using the Penetration-Aspiration Scale. The presence of perceptual swallow/breath parameters was rated by 2 speech pathologists who were blinded to the type of swallow. Acoustic data between groups were compared using Mann Whitney U-tests, while perceptual differences were determined by a test of 2 proportions. Combinations of perceptual parameters of 50 swallows (27 aspiration, 23 no aspiration) from 47 children (57% male) were statistically analyzed using area under a receiver operating characteristic (aROC), sensitivity, specificity, and positive and negative predictive values to determine predictors of aspirating swallows. Results: The combination of post-swallow presence of wet breathing and wheeze and absence of GRS and normal breathing was the best predictor of aspiration (aROC = 0.82, 95% CI, 0.70-0.94). There were no significant differences between these 2 swallow types for peak frequency, duration, and peak amplitude. Conclusion: Our pilot study has shown that certain characteristics of swallow obtained using CA may be useful in the prediction of aspiration. However, further research comparing the acoustic swallowing sound profiles of normal children to children with dysphagia (who are aspirating) on a larger scale is required.
Collapse
Affiliation(s)
- Thuy Frakking
- Centre for Children’s Health Research, The University of Queensland, South Brisbane, Queensland, Australia
- Speech Pathology Department, Caboolture Hospital, Caboolture, Queensland, Australia
| | - Anne Chang
- Queensland Children’s Respiratory Centre, Lady Cilento Children’s Hospital, South Brisbane, Queensland, Australia
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia
- Institute of Health and Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Kerry O’Grady
- Institute of Health and Biomedical Innovation, Centre for Children’s Health Research, Queensland University of Technology, South Brisbane, Queensland, Australia
| | - Michael David
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Kelly Weir
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| |
Collapse
|
34
|
Pan Q, Maeda N, Manda Y, Kodama N, Minagi S. Validation of the optimal site in the neck region for detecting swallowing sounds. J Oral Rehabil 2016; 43:840-846. [PMID: 27627032 DOI: 10.1111/joor.12440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2016] [Indexed: 12/14/2022]
Abstract
Recently, the swallowing sound has been used to detect swallowing events non-invasively. A previous study, using an accelerometer, showed that the site over the lateral border of the trachea immediately inferior to the cricoid cartilage was the optimal site for detecting swallowing sounds. However, the optimal site for detection of the swallowing sound using a microphone remains undetermined. To validate the optimal site in the neck region for detecting swallowing sounds. Fourteen healthy subjects (mean age, 27·6 ± 2·2 years; seven male and seven female) participated in this study. Twenty condenser microphones were attached to 20 sites on the left neck surface to detect swallowing sounds. Participants were instructed to swallow five different stimuli three times as follows: Resting saliva, 1 and 5 mL of Japanese tea, and 1 and 5 mL of yoghurt. Mean relative peak intensity was used to indicate the magnitude of the swallowing sound. Sound spectrograms were used to illustrate differences in the properties of swallowing sounds. Mean relative peak intensity number was highest in sites at the inferior border of the mandible just above the sternocleidomastoid muscle (site 11) and sites over the lateral border of the trachea immediately inferior to the cricoid cartilage (site 8). Comparison of spectrograms showed a greater density distribution of higher frequency components at site 11 compared with site 8. These results indicate that the inferior border of the mandible just above the sternocleidomastoid muscle is the optimal site for the detection of swallowing sounds.
Collapse
Affiliation(s)
- Q Pan
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - N Maeda
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Y Manda
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - N Kodama
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - S Minagi
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| |
Collapse
|