A comparison of the swallowing function and quality of life by oral intake level in stroke patients with dysphagia

Improving Swallowing Function and Ability in Post Stroke Dysphagia: A Randomized Clinical Trial

Post-stroke dysphagia is a prevalent, life threatening condition. Scientists recommended implementing behavioral therapies with new technologies such as transcranial direct current of stimulation (TDCS). Studies showed promising TDCS effects, and scientists suggested the investigation of the effectiveness of different montages. Supramarginal gyrus (SMG) is important in swallowing function. Our study aimed to investigate the effectiveness of stimulating SMG in improving post-stroke dysphagia. Forty-four patients finished the study (a randomized, double-blind one). All of them received behavioral therapy. The real group received anodal (2 mA, 20 min) stimulation on the intact SMG, and the sham group received the same for 30 s (5 sessions). Patients were assessed with Functional Oral Intake Scale (FOIS) and Mann Assessment of Swallowing Ability (MASA) after treatment and at one-month follow-up. The results showed that the difference between groups at baseline was not significant. According to MASA both groups improved significantly during the time (p-value < 0.001). The improvement in the real group was significantly higher than in the sham group after treatment (p-value = 0.002) and after one-month follow-up (p-value < 0.001). According to FOIS, most of the patients in the real group (72.70%) reached level 6 or 7 after one-month follow-up which was significantly higher than the sham group (31.80%, p-value = 0.007). In conclusion, TDCS applied to the scalp's surface associated with SMG localization may improve swallowing function in the stroke patients with dysphagia.

Impact of Swallowing Impairment on Quality of Life of Individuals with Dysphagia

To explore oral intake and quality of life measures among individuals with dysphagia. This cross-sectional study with purposive sampling included 15 individuals with dysphagia. Functional oral intake scale (FOIS) and Dysphagia Quality of Life questionnaire in Marathi (DQOL-QM) were administered on individuals with dysphagia to evaluate oral intake levels and swallow related quality of life respectively. Data was collected using the interview method via tele-mode. Statistical analysis using Spearman's rank correlation revealed significant negative correlation (ρ = - 0.87) between oral intake and overall quality of life of the individuals with dysphagia. This negative impact was observed across all the domains of their quality of life. A considerable negative impact on quality of life was observed with declining oral intake of the individual with dysphagia. As oral intake plays an important role in the quality of life, decisions regarding the mode of feeding must be guided by the preferences of the individual and their family. strategies that enhance oral intake improves quality of life of dysphagic individual.

Quality of life in stroke patients with dysphagia: a systematic review

INTRODUCTION

Dysphagia is a common disorder among stroke patients. Dysphagia can lead to consequences that can negatively impact the quality of life (QoL) in stroke patients.

AIM

To investigate the impact of dysphagia on the QoL in stroke patients.

METHODS

Relevant types of literature were searched from PubMed, Scopus, ProQuest, and Google Scholar databases from inception to July 2022. Peerreviewed studies that aimed to determine the impact of dysphagia on the QoL in stroke patients were included regardless of the year of publication. The National Institutes of Health tool for observational cohort and cross-sectional studies was used to assess the methodological quality of the selected studies. In addition, data analysis was conducted using qualitative methodology with narrative synthesis.

RESULTS

A total of 6 studies met the inclusion criteria with a total number of 381 participants. Only one study has good methodological quality while other studies have fair methodological quality. Dysphagia negatively impacts the QoL in stroke patients, especially those with severe dysphagia. However, after treatment, changes were evident through improved QoL and decreased severity of dysphagia. Moreover, the research found that patients with a higher educational level have a better QoL.

CONCLUSION

Dysphagia has a negative impact on the QoL in stroke patients, so dysphagia in stroke patients should be diagnosed and treated as soon as possible to avoid poor QoL.

The effect of pyridostigmine on post-stroke dysphagia: A randomized clinical trial

Background: Swallowing is one of the most complex functions of the central nervous system (CNS), which is controlled by different parts of the brain. Oropharyngeal dysphagia (OD) is one of the most common complications after stroke. Despite a variety of behavioral, compensatory, and rehabilitative methods, many stroke patients still suffer from swallowing disorders that adversely affect their quality of life (QOL). The aim of this study was to evaluate the effect of pyridostigmine on patients with post-stroke dysphagia. Methods: A randomized, double-blind, placebo-controlled clinical trial was carried out on 40 patients suffering from post-stroke dysphagia. Patients were assigned randomly into two groups: intervention and control groups (20 in each group). The intervention group was treated with pyridostigmine (60 mg, three times a day, 30 minutes before each meal for three weeks), and the control group received placebo treatment in the same way. All patients (intervention and control) were evaluated according to National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Functional Communication Measures (FCM)/American Speech-Language-Hearing Association (ASHA) criteria at baseline and after three weeks of intervention. Values of P < 0.05 were considered statistically significant. Results: In the intervention group, the mean values of NIHSS, mRS, and ASHA/FCM were significantly reduced following three weeks of treatment with pyridostigmine (P = 0.002, P = 0.003, and P < 0.001, respectively), but no significant differences were found in the mean NIHSS, mRS, and ASHA/FCM in the placebo group. Conclusion: Although pyridogestamine is somewhat effective in post-stroke dysphagia, it has not been shown to be more important in preventing aspiration pneumonia and length of hospital stay.

Blenderized formulations in home enteral nutrition: a narrative review about challenges in nutritional security and food safety

Blenderized formulations (BFs) are prepared by homogenization of food that is normally used in oral nutrition. BFs are mainly used in home enteral nutrition (HEN), although their use has also been reported by hospitals when commercial enteral formulas are not available. HEN is applied when the patient has been discharged from the hospital. This nutritional therapy promotes the patient's reintegration into the family nucleus and promotes humanized care, and decreases treatment costs. However, the patient should continue to receive health and nutritional care, ranging from periodic nutritional re-evaluation to adaptation of the dietary plan. HEN provides the patient a greater contact with the family, whereas BFs promote the adaptation of the diet with food, respecting the food diversity and culture, lower cost, and easier access to food. Disadvantages of BFs include more time spent by the professional to calculate the dietary plan, greater difficulty in adjusting daily needs, and less microbiological and chemical stability. In this review, the nutritional, food security, and safety aspects of BF used in HEN are discussed. Technological quality aspects that are essential knowledge in the preparation of the patient's dietary plan also are presented.

Effectiveness of fibreoptic endoscopic evaluation of swallowing and dietary intervention during home-visit dental care in older individuals

BACKGROUND

Currently, patients with dysphagia are receiving dietary management that deviates from their original swallowing function.

OBJECTIVE

To evaluate the clinical significance of fibreoptic endoscopic evaluation of swallowing (FEES) and dietary intervention (DI) by multi-professional collaboration during visit care for determining the actual oral intake status in patients with dysphagia.

METHODS

Five hundred and eighteen patients with dysphagia underwent FEES, focusing on the penetration-aspiration scale, and DI. Oral intake status was categorised using the functional oral intake scale (FOIS). FOIS scores at the first visit, after FEES, and at the reassessment were compared.

RESULTS

At the first visit, 34.7% of the patients had an FOIS score of level 1 (no oral intake) and 65.3% had a score of level 2 or higher (capable of oral intake). Following FEES, 7.1% of patients had an FOIS score of level 1, and 44.4% had a score of level 2 with resumption of oral intake. At the reassessment, 489 patients (94.4%) were capable of oral ingestion (FOIS level 2 or higher). There were significant differences between the distributions of FOIS scores at the first visit and following FEES (P < .01) and between those at the first visit and at the reassessment (P < .01). Regarding tube feeding, 17 (5.9%) of 289 patients, who had received tube feeding at the first visit, were completely capable of oral intake following FEES and at the reassessment.

CONCLUSION

Appropriate evaluation of swallowing function using FEES and DI helps to understand the definite swallowing function in patients with dysphagia.

Reassessment of Poststroke Dysphagia in Rehabilitation Facility Results in Reduction in Diet Restrictions

Background: Dysphagia assessment in postacute stroke patients can decrease the incidence of complications like malnutrition, dehydration, and aspiration pneumonia. It also helps to avoid unnecessary diet restrictions. The aim of this study is to verify if regular reassessment of dysphagia would change the diet management of postacute stroke patients in rehabilitation settings. Methods: This single-center retrospective study included 63 patients referred to an inpatient neurological rehabilitation center between 2018–2019. A standardized clinical swallowing evaluation and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) were performed. Diet level according to Functional Oral Intake Scale (FOIS) was evaluated. As the primary endpoint, the FOIS values based on diagnostic procedures were assessed at hospital discharge, rehabilitation admission, and after FEES. Results: 19 women (30%) and 44 men (70%), with a mean age of 75 y (SD ± 10.08), were enrolled. The intergroup ANOVA revealed significant differences (p < 0.001) between dietary prescriptions in an acute care setting and following clinical and endoscopic reassessment in the rehabilitation center. Diet recommendations changed in 41 of 63 (65%) enrolled patients (p < 0.001). Conclusion: Instrumental diagnostic by FEES during the early convalescence period of stroke patients leads to clinically relevant changes to diet restrictions and lower rates of pneumonia. Our findings underline the need for regular and qualitative dysphagia diagnostics in stroke patients participating in neurological rehabilitation.

Nutritional Status and Feeding Practice among Dysphagic Older Adult Inpatients in Vietnam

The Vietnamese older adult population has increased rapidly on an annual basis and dysphagia has become a common issue. The nutritional status of older adults in general and of dysphagic older adults in particular has not received adequate attention. The automatic solution for cases of serious choking/aspiration is still a prescription for tube feeding. In developed countries, oral intake is a priority alternative for dysphagia and has positive consequences. This study aimed to investigate the nutritional status of and feeding practices for dysphagic older adult inpatients in some Vietnamese hospitals. The study was designed as a cross-sectional study and was conducted in three large hospitals in northern Vietnam. The data for 1007 older inpatients (58.3% were females, mean age was 75.5±7.3 y) about their dysphagic status, nutritional status and feeding practices were collected by dietitians. About 29% of the older adult inpatients suffered from malnutrition and 54% had a risk of malnutrition. Half of the dysphagia group had malnutrition and 42% were at risk of malnutrition. About 78% of the dysphagic older adults had oral intake of soft foods/regular foods and the remainder had tube feeding. Almost all dysphagic patients had reduced food intake over the prior 3 mo. The rate of pneumonia was quite high among dysphagic patients. The nutritional status of Vietnamese older adult inpatients in general and of dysphagic older adults specifically was poor. Oral intake of a texture-modified diet should be a method with priority over tube feeding or soft foods/regular foods for dysphagic patients.

Understanding Quality of Life for Palliative Patients With Dysphagia Using the Swallowing Quality of Life (SWAL-QOL) Questionnaire

OBJECTIVE

There are few studies concerning the differences in quality-of-life (QOL) between palliative care patients with and without dysphagia to date. We aimed to compare the QOL and symptoms in palliative patients with and without dysphagia using Swallowing Quality of Life (SWAL-QOL).

METHODS

Eighty-one palliative patients with and without dysphagia underwent the SWAL-QOL questionnaire. A series of Mann Whitney U tests were performed between non-dysphagic and dysphagic groups for the total SWAL-QOL score and the 11 SWAL-QOL domains.

RESULTS

Dysphagia significantly impacted patients' QOL in the dysphagic group (mean, 69.5; SD 21.9) than non-dysphagic group (mean, 83.2; SD 14.8) (P = 0.006). Significant differences were observed between both groups for the domains of burden, eating desire, eating duration, symptoms, food selection, communication and mental health. The results also showed that the dysphagic group had lower symptom score across all symptoms, suggesting higher symptom burdens.

CONCLUSIONS

This study is the first to examine QOL and swallow symptoms in palliative care patients with and without dysphagia. Dysphagia causes significantly worse QOL in palliative care patients. Screening for dysphagia and managing its impact on symptoms and QOL domains is important in palliative care.

Factors related to physical and mental components of quality of life in the community-dwelling frail older persons

[Purpose] The aim of this study was to investigate factors associated with changes in both the physical and mental components of quality of life (QOL) in of community-dwelling frail older persons in long-term care and to clarify which aspects are important to maintaining physical and mental components of QOL. [Participants and Methods] In this 1 year follow-up cohort study, participants were older persons from a single day care rehabilitation center in Japan. The Medical Outcome Study 8-Item Short-Form Health Survey (MOS-SF8), which gives both physical component summary (PCS) and mental component summary (MCS) scores, was used as the main QOL assessment. Participants were divided according to their level of QOL maintenance according to changes in PCS and MCS scores over the study period, and the variables were compared between the groups. [Results] PCS domain was significantly associated with forced vital capacity and the MCS domain was significantly associated with the Geriatric Depression Scale and Dysphagia Risk Assessment for the Community-Dwelling Elderly Test. [Conclusion] Depression, reduced pulmonary function, and reduced deglutition ability were independently related to low QOL. Assessment of these factors could be beneficial for maintaining the physical and mental components of QOL in community-dwelling frail older persons in long-term care.

The impact of dysphagia on quality of life in stroke patients

The objective of this study was to investigate the quality of life in stroke patients using a swallowing quality of life (SWAL-QOL) questionnaire. The correlation between SWAL-QOL questionnaire outcome and videofluoroscopic dysphagia scale (VDS) scores in stroke patients was also determined.This cross-sectional study was retrospectively conducted with 75 stroke patients with dysphagia symptoms. Videofluoroscopic swallowing study (VFSS) and SWAL-QOL questionnaires were performed for all patients. These patients were divided into an oral feeding group and a tube feeding group. SWAL-QOL scores were compared between the 2 groups. The severity of dysphagia was estimated by VDS scores according to the videofluoroscopic swallowing study results. The relationships between SWAL-QOL scores and VDS scores were also investigated.The composite score was 48.82 ± 19.51 for the tube feeding group and 53.17 ± 25.42 for the oral feeding group. There were significant differences in burden and sleep subdomains of the SWAL-QOL between the 2 groups (P = .005 and P = .012, respectively). There was a significant negative correlation between the composite score of SWAL-QOL outcome and the total VDS score (r = -0.468, P = .012). The pharyngeal-phase score of the VDS had significant negative correlations with the SWAL-QOL subdomains of burden (r = -0.327, P = .013), mental health (r = -0.348, P = .008), and social functioning (r = -0.365, P = .029).To improve the quality of life of stroke patients, dysphagia rehabilitation should focus on the pharyngeal phase of dysphagia.

Effect of dysphagia rehabilitation in patients receiving enteral nutrition at home nursing care: A retrospective cohort study

Objective

We considered the effect of dysphagia rehabilitation and investigated parameters associated with the resumption of oral intake in the elderly patients receiving home nursing care who were not eating by mouth.

Methods

The participants were 116 patients aged ≥65 years (66 men and 50 women, mean age 79.7 ± 8.9 years) who were receiving home nursing care and not eating by mouth because of dysphagia. All patients underwent dysphagia rehabilitation for 6 months with the objective of resuming oral intake. After 6 months of dysphagia rehabilitation, the patients’ eating status was assessed using the Functional Oral Intake Scale (FOIS) and the associations of the post‐intervention FOIS score with age, history of pneumonia, duration of enteral nutrition, body mass index (BMI), alertness, physical function (ability to walk) and swallowing function at the initial examination.

Results

Functional Oral Intake Scale scores increased significantly after 6 months rather than those at the initial evaluation (P < .001). Eighty patients (69.0%) resumed oral intake (FOIS score ≥2), thirty patients (25.9%) of whom became capable of daily oral intake (FOIS score ≥3). Swallowing function was associated with the resumption of oral intake. In addition, physical function before dysphagia rehabilitation was an important factor to resume daily oral intake.

Conclusions

The results of the present study suggest that the resumption of oral intake by patients receiving enteral nutrition requires improvement in swallowing function. In addition, anyone who cannot walk may not recover daily oral intake.

Re-initiation of Oral Food Intake Following Enteral Nutrition Alters Oral and Gut Microbiota Communities

Stroke is associated with multiple forms of disability, including dysphagia. Post-stroke dysphagia increases the risks of pneumonia and mortality and often results in cessation of oral feeding. However, appropriate rehabilitation methods can eventually lead to resumption of oral food intake. This study tried to clarify that re-initiating oral food intake could modify the composition of oral/gut microbial communities in patients with dysphagia. From 78 patients with sub-acute stage of stroke, 11 complete tube feeding subjects without taking antibiotics were enrolled and received rehabilitation for re-initiation of oral food intake, and 8 subjects were brought back to complete oral feeding. Oral and gut microbiota community profiles were evaluated using 16S rRNA sequencing of the saliva and feces samples before and after re-initiation of oral food intake in patients recovering from enteral nutrition under the same nutrient condition. Standard nutrition in the hospital was 1,840 kcal, including protein = 75 g, fat = 45 g, and carbohydrates = 280 g both for tube and oral feeding subjects. Oral food intake increased oral and gut microbiome diversity and altered the composition of the microbiome. Oral and gut microbiome compositions were drastically different; however, the abundance of family Carnobacteriaceae and genus Granulicatella was increased in both the oral and gut microbiome after re-initiation of oral food intake. Although oral microbiota showed more significant changes than the gut microbiota, metagenome prediction revealed the presence of more differentially enriched pathways in the gut. In addition, simpler co-occurrence networks of oral and gut microbiomes, indicating improved dysbiosis of the microbiome, were observed during oral feeding as compared to that during tube feeding. Oral food intake affects oral and gut microbiomes in patients recovering from enteral nutrition. Rehabilitation for dysphagia can modify systemic health by increasing the diversity and altering the composition and co-occurrence network structure of oral and gut microbial communities.

Predicting the Swallow-Related Quality of Life of the Elderly Living in a Local Community Using Support Vector Machine

Background and Objectives: This study developed a support vector machine (SVM) algorithm-based prediction model with considering influence factors associated with the swallowing quality-of-life as the predictor variables and provided baseline information for enhancing the swallowing quality of elderly people’s lives in the future. Methods and Material: This study sampled 142 elderly people equal to or older than 65 years old who were using a senior welfare center. The swallowing problem associated quality of life was defined by the swallowing quality-of-life (SWAL-QOL). In order to verify the predictive power of the model, this study compared the predictive power of the Gaussian function with that of a linear algorithm, polynomial algorithm, and a sigmoid algorithm. Results: A total of 33.9% of the subjects decreased in swallowing quality-of-life. The swallowing quality-of-life prediction model for the elderly, based on the SVM, showed both preventive factors and risk factors. Risk factors were denture use, experience of using aspiration in the past one month, being economically inactive, having a mean monthly household income <2 million KRW, being an elementary school graduate or below, female, 75 years old or older, living alone, requiring time for finishing one meal on average ≤15 min or ≥40 min, having depression, stress, and cognitive impairment. Conclusions: It is necessary to monitor the high-risk group constantly in order to maintain the swallowing quality-of-life in the elderly based on the prevention and risk factors associated with the swallowing quality-of-life derived from this prediction model.

Cuidados paliativos, esclerose lateral amiotrófica e deglutição: estudo de caso

RESUMO Tem-se por objetivo discutir aspectos da atuação fonoaudiológica em disfagia, voltada para os cuidados paliativos e a qualidade de vida em deglutição. Trata-se de um estudo de quatro casos com esclerose lateral amiotrófica (ELA) em acompanhamento fonoaudiológico. Foi aplicado o questionário de qualidade de vida em disfagia (SWAL-QOL), realizada entrevista estruturada, classificação da funcionalidade da deglutição pela Funcional Oral Intake Scale (FOIS), aplicação da escala de gravidade da ELA (EGELA), realizada videofluoroscopia da deglutição e classificação da severidade da disfagia pela Dysphagia Outcome Severity Scale (DOSS). Observou-se que os casos apresentavam tempo de doença entre 12 e 35 meses e possuíam o desejo de manter uma via oral de alimentação, mesmo que mínima, em caso de aceitação da via alternativa de alimentação. Quanto à severidade da disfagia, observada por meio do exame de videofluoroscopia e classificada pela DOSS, apresentavam desde deglutição funcional até disfagia leve a moderada. O impacto na qualidade de vida em deglutição foi mensurado entre discreto e severo. Nem todos apresentavam correspondência entre a severidade da disfagia e a qualidade de vida em deglutição, sendo observado impacto na qualidade de vida, mesmo nos casos com menor grau de disfagia. Os participantes relataram que se sentiriam desconfortáveis em caso de alimentação exclusiva por via alternativa e que a ingestão de alimentos por via oral, mesmo que mínima, apenas pelo prazer da alimentação, refletiria em sua qualidade de vida.