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Oh JC, Shin MS, Son MA, Kim HJ. Effect of Rest Interval Length on Oral Swallowing Pressure During Effortful Swallowing Exercises in Healthy Adults: A Crossover Design. Dysphagia 2024:10.1007/s00455-024-10749-4. [PMID: 39320511 DOI: 10.1007/s00455-024-10749-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 08/08/2024] [Indexed: 09/26/2024]
Abstract
Evidence supporting the prescription of effortful swallowing (ES) as a rehabilitation exercise remains lacking. This study aimed to evaluate the effect of rest interval length between sets on oral swallowing pressure during ES exercises in healthy adults. This study was a randomized trial of participants using a crossover design. Forty-three healthy adults (25.0 ± 3.7 years; 32 women and 11 men) without swallowing difficulties were recruited and participated in all four conditions (rest intervals between sets: 0-, 1-, 3-, and 5-min intervals) in a random order. The exercise constituted five sets, each comprising 10 ES repetitions. ES was performed with saliva swallows. The rest interval between each repetition was fixed at 10 s, and the oral swallowing pressure during ES was measured using a tongue pressure measuring device. Oral swallowing pressures were significantly lower in the fifth set than in the first set at the 0-min rest condition. In the comparison by condition, oral swallowing pressures were significantly higher in the 5-min than in the 0-min rest conditions in the fourth set and in the 3- and 5-min rest conditions than in the 0-min rest condition in the fifth set. A rest interval of appropriate length between sets during ES exercises may consistently maintain the targeted high swallowing pressures during the exercises. Further studies using more diverse equipment and targeting older patients and those with dysphagia are required to determine the effect of the rest interval length between sets on the degree of exercise intensity to improve the swallowing-related muscle strength.
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Affiliation(s)
- Jong-Chi Oh
- Department of Occupational Therapy, Cheongju University, 298 Daesung-ro, Cheongwon-gu, Cheongju, Chungcheongbuk-do, 28503, Republic of Korea.
| | - Min-Sook Shin
- Department of Occupational Therapy, CNC Purun Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Mo-A Son
- Department of Occupational Therapy, CNC Purun Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Hyeon-Ji Kim
- Department of Occupational Therapy, CNC Purun Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
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Calvache C, Castillo-Triana N, Aguirre FD, Leguízamo P, Rojas S, Valenzuela P, Piedrahita MM, Ardila MDPR, Pérez DVB. Integration of Dysphagia Therapy Techniques into Voice Rehabilitation: Design and Content Validation of a Cross-Therapy Protocol. J Voice 2024:S0892-1997(24)00235-2. [PMID: 39244386 DOI: 10.1016/j.jvoice.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/06/2024] [Accepted: 07/22/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND The intricate relationship between swallowing and phonation, sharing anatomical and physiological substrates, underscores a clinical demand for integrated therapeutic approaches. Existing interventions often address these functions in isolation, overlooking their interconnected dynamics. OBJECTIVE To design and validate a cross-therapy protocol incorporating dysphagia therapy techniques (maneuvers/exercises) into voice rehabilitation. This protocol aims to exploit the shared biomechanical components of swallowing and phonation to improve both functions simultaneously in patients with underlying hypofunctional laryngeal pathology. METHODS A descriptive research design was employed, consisting of three phases: a comprehensive literature review and expert discussions in a German seminar format to conceptualize the protocol; detailed analysis and categorization of swallowing maneuvers/exercises; and content validation by a panel of seven experts through a structured evaluation instrument. The process integrated motor learning and exercise physiology principles to ensure the protocol's clinical applicability and theoretical coherence. RESULTS The developed cross-therapy protocol incorporates four core swallowing therapy techniques to voice therapy procedures. Selected swallowing therapy techniques target laryngeal excursion and vocal fold closure because they are critical components of swallowing and phonation. Expert validation yielded a Content Validity Coefficient exceeding 0.90 for most items, indicating high consensus on the protocol's relevance, clarity, and applicability. Adjustments were made based on feedback, enhancing the protocol's precision and user-friendliness. CONCLUSION We present a novel, evidence-based therapy protocol for voice and swallowing difficulties resulting from hypofunctional laryngeal pathology. Its development marks a significant step toward bridging the gap between swallowing and voice therapy. Future empirical studies are needed to assess its effectiveness in clinical settings.
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Affiliation(s)
- Carlos Calvache
- Corporación Universitaria Iberoamericana, Department Communication Sciences and Disorders, Bogotá, Colombia; Vocology Research, Vocology Center, Bogotá, Colombia.
| | - Nicolás Castillo-Triana
- Corporación Universitaria Iberoamericana, Department Communication Sciences and Disorders, Bogotá, Colombia
| | - Fernando Delprado Aguirre
- Vocology Research, Vocology Center, Bogotá, Colombia; Fundación Universitaria María Cano, Speech Therapy Program, Medellín, Colombia
| | - Paola Leguízamo
- Escuela Colombiana de Rehabilitación, Speech Therapy Program, Bogotá, Colombia
| | - Sandra Rojas
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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Gandhi P, Peladeau-Pigeon M, Simmons M, Steele CM. Exploring the Efficacy of the Effortful Swallow Maneuver for Improving Swallowing in People With Parkinson Disease-A Pilot Study. Arch Rehabil Res Clin Transl 2023; 5:100276. [PMID: 37744193 PMCID: PMC10517353 DOI: 10.1016/j.arrct.2023.100276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objectives To determine the immediate (compensatory) and longer term (rehabilitative) effect of the effortful swallow (ES) maneuver on physiological swallowing parameters in Parkinson disease. Design Virtual intervention protocol via Microsoft Teams with pre- and post-videofluoroscopic swallowing studies. Setting Outpatient hospital setting, with intervention performed virtually. Participants Eight participants (median age 74 years [63-82])with Parkinson disease (years post onset 3-20) with a Hoehn and Yahr scale score between 2 and 4 (N=8). Interventions ES maneuver, initiated using a maximum effort isometric tongue-to-palate press, with biofeedback provided using the Iowa Oral Performance Instrument. The protocol included 30 minute sessions twice daily, 5 days/week for 4 weeks. Main Outcome Measures Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, total pharyngeal residue, and pharyngeal area at maximum constriction as seen on lateral view videofluoroscopy. Results No consistent, systematic trends were identified in the direction of improvement or deterioration across Penetration-Aspiration Scale scores, time-to-laryngeal-vestibule-closure, pharyngeal area at maximum constriction, or total pharyngeal residue. Conclusions Heterogeneous response to the ES as both a compensatory and rehabilitative technique. Positive response on the compensatory probe was predictive of positive response after rehabilitation.
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Affiliation(s)
- Pooja Gandhi
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Melanie Peladeau-Pigeon
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
| | - Michelle Simmons
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
| | - Catriona M. Steele
- Swallowing Rehabilitation Research Laboratory, KITE Research Institute—University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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Yan Y, Shimoga D, Sharma A. Parkinson's Disease and Diabetes Mellitus: Synergistic Effects on Pathophysiology and GI Motility. Curr Gastroenterol Rep 2023; 25:106-113. [PMID: 37067721 DOI: 10.1007/s11894-023-00868-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Parkinson's disease and diabetes affect an increasing proportion of the aging global population. Both conditions extensively affect gastrointestinal (GI) motility with similar and differing clinical symptoms. Nonetheless, GI symptoms in Parkinson's disease and diabetes pose significant morbidity and impairment of quality of life. Their pathophysiology is poorly understood, and therefore, effective treatment options are lacking. RECENT FINDINGS Parkinson's disease patients have oropharyngeal dysphagia and constipation. They also have mild or absent upper GI symptoms associated with delayed gastric emptying, which is prevalent in 70% of patients. Delayed gastric emptying in Parkinson's disease leads to erratic medication absorption and fluctuating motor symptoms. Half of diabetics have upper GI symptoms, which correlate to gastric emptying and changes in brain activity of the insular cortex. The majority of diabetics also have constipation. Diabetics have an increased risk for developing Parkinson's disease and anti-diabetic medications are associated with risk reduction of developing Parkinson's disease. Hyperglycemia is associated with advanced glycated end products formation and acceleration of α-synuclein aggregation. GLP-1 receptor agonists have also demonstrated efficacy in improving motor symptoms and cognition in Parkinson's disease patients with diabetes. Parkinson's disease and diabetes are pan-enteric disorders with significant GI symptoms and impairment of gut motility. Both conditions have synergistic pathophysiologies that propagate neurodegenerative changes. Treatment options for GI symptoms in diabetic and Parkinson's disease patients are lacking. Anti-diabetic treatment improves motor symptoms in Parkinson's disease, however, its effect on GI symptoms is unclear.
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Affiliation(s)
- Yun Yan
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA
| | - Dhanush Shimoga
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA
| | - Amol Sharma
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA.
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Kim JY, Kim H. Effects of behavioural swallowing therapy in patients with Parkinson's disease: A systematic review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:269-280. [PMID: 35282718 DOI: 10.1080/17549507.2022.2045356] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE A previous 2014 systematic review outlining the treatment effects of swallowing therapies in Parkinson's disease (PD) demonstrated a lack of well-designed randomised controlled studies. This current review presents and evaluates the latest evidence for behaviour swallowing therapies for PD-related dysphagia to enhance speech-language pathologists' evidence-based decision-making around treatment choices. METHOD A systematic review of articles published in English and Korean was conducted from January 2014 through June 2020 using the electronic databases PubMed, Embase, and Cochrane Library. Two authors independently searched the literature and differences after the search were settled following discussion and consensus. Identified studies were evaluated for quality with the ABC rating scale and critical appraisal criteria. RESULT Eight studies after initial search and three additional studies which met our original criteria but were not freely available, or published after the initial search period were also included. Eleven studies included the following treatments: biofeedback therapy (N = 1), respiratory-swallow coordination training (N = 2), neuromuscular electrical stimulation (NMES) (N = 1), expiratory muscle strength training (EMST) (N = 2), intensive exercise-based swallowing program (ISP) (N = 1), chin-down strategy (N = 2), Lee Silverman Voice Treatment (N = 1), and therapeutic singing (N = 1). CONCLUSION Most of the behavioural therapies improved swallowing function in PD. Treatments that enhanced airway function globally demonstrated positive effects on swallow function as did intensive, targeted swallowing treatment. However, the chin-down strategy did not show a significant effect on swallowing measured by flexible endoscopic evaluations of swallowing. EMST detraining effects implied a need to design maintenance training in PD. In the future, well-designed randomised controlled trials are needed to consolidate the effects of these therapies.
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Affiliation(s)
- Ja Young Kim
- Graduate Program in Speech-Language Pathology, Yonsei University, Seoul, Korea
| | - HyangHee Kim
- Graduate Program in Speech-Language Pathology, Yonsei University, Seoul, Korea
- Graduate Program of Speech-Language Pathology; Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
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Winiker K, Kertscher B. Behavioural interventions for swallowing in subjects with Parkinson's disease: A mixed methods systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023. [PMID: 36951546 DOI: 10.1111/1460-6984.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Dysphagia is prevalent in subjects with Parkinson's disease (PD). Swallowing intervention to improve or maintain swallowing function is of major importance as dysphagia may considerably impact physical and psycho-social health. AIMS A mixed methods systematic review was conducted to summarize and appraise literature reporting (1) effects of behavioural interventions for swallowing in individuals with PD; and (2) participants' perspectives of swallowing interventions. METHODS & PROCEDURES Electronic databases were searched systematically in July 2020 for articles published between 2014 and 2020. In addition, studies published between 2000 and 2014 were identified non-systematically through previous reviews. Peer-reviewed quantitative and qualitative research in English or German documenting behavioural interventions for swallowing in individuals with a diagnosis of PD was eligible for inclusion. Participants at all disease stages were included. Behavioural interventions included rehabilitative and compensatory strategies. Studies reporting swallowing outcomes with and without a comparative group were included. For each study, the National Health and Medical Research Council level of evidence was defined. Included studies were critically appraised using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. An integrated synthesis was performed after separate analysis of effect data and data reflecting participants' experiences. This review was conducted based on published JBI methodology and the guideline from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis system was followed. MAIN CONTRIBUTION A total of 33 studies published in English met the inclusion criteria. Thirty-one studies reported quantitative data, one was qualitative and one was mixed methods. Intervention effects on swallowing function, swallowing safety and swallowing-related quality of life were reported for various treatment approaches. Three studies explored how participants perceived the intervention. Overriding themes including subjects' views regarding treatment schedules and levels of effort or comfort associated with the intervention were identified across these studies. Combining evidence of intervention effects and subjects' experiences was possible for one rehabilitative and one compensatory intervention. CONCLUSIONS & IMPLICATIONS Beneficial effects of swallowing interventions have been reported; however, most experiments were case studies of variable methodological quality. Randomized-controlled trials with robust methodology to explore treatment effects in larger samples is needed to guide clinical practice. Research reporting subjects' views is scarce. More studies exploring how individuals perceive behavioural interventions for swallowing are necessary to inform clinical decision-making. WHAT THIS PAPER ADDS What is already known on the subject Dysphagia is common in individuals with PD. Swallowing intervention is of major importance as dysphagia may negatively affect physical and psycho-social health of subjects with PD. What this study adds Beneficial effects of behavioural interventions for swallowing, including rehabilitative and compensatory strategies, have been reported; however, available data are mostly based on case studies of variable quality. Data on how participants perceive specific behavioural interventions are lacking. Based on the available data, integration of efficacy data and individuals' experiences is limited. What are the clinical implications of this work? Given the current evidence of intervention effects and individuals' views on behavioural treatment strategies, interventions implemented into clinical practice require careful evaluation on a case-by-case basis. More high-quality research is needed to examine interventions' short- and long-term effects in larger samples to guide clinical practice. In addition to studies evaluating intervention effects, research exploring participants' experiences with interventions is required as a foundation for clinical decision-making.
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Affiliation(s)
- Katharina Winiker
- Department of Research and Development, Swiss University of Speech and Language Sciences SHLR, Rorschach, Switzerland
| | - Berit Kertscher
- Institute for Therapy & Rehabilitation, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Heslin N, Regan J. Effect of effortful swallow on pharyngeal pressures during swallowing in adults with dysphagia: A pharyngeal high-resolution manometry study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:190-199. [PMID: 34607470 DOI: 10.1080/17549507.2021.1975817] [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: Evidence base to support the use of the effortful swallow in clinical populations with dysphagia is currently lacking. This study aims to quantify the effects of effortful swallowing on pharyngeal swallowing biomechanics in adults with dysphagia using pharyngeal high-resolution manometry (PHRM).Method: ManoScan HRM equipment with a 4.2 mm pressure catheter was used. Participants completed duplicate 10ml baseline and 10ml effortful liquid (IDDSI Level 0) swallows in randomised order. PHRM data were analysed using a semi-automated online platform (www.swallowgateway.com).Result: Fifteen adults (8 males; range 45-86 years) with mixed aetiology dysphagia (Functional Oral Intake Scale Level 2-5) were included. Median pharyngeal contractile (156.81 mmHg cm s; IQR 80.62) increased significantly (213.50 mmHg cm s; IQR 117.2) during effortful swallowing. Significant increases were also observed in velopharyngeal pressure, mesopharyngeal pressure, hypopharyngeal pressure and upper oesophageal sphincter (UOS) relaxation duration. UOS integrated relaxation pressure (IRP) was not significantly altered with effortful swallowing.Conclusion: Effortful swallowing induced significant biomechanical changes to swallow in adults with dysphagia. Increases in global pharyngeal rigour, tongue base pressure and UOS opening duration were captured by PHRM during effortful swallowing. Further investigation in larger homogeneous clinical populations is needed to verify the physiological effects of this frequently employed intervention.
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Affiliation(s)
- Niall Heslin
- Department of Clinical Speech & Language Studies, Trinity College, Dublin, Ireland
| | - Julie Regan
- Department of Clinical Speech & Language Studies, Trinity College, Dublin, Ireland
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Characterizing Effortful Swallows from Healthy Community Dwelling Adults Across the Lifespan Using High-Resolution Cervical Auscultation Signals and MBSImP Scores: A Preliminary Study. Dysphagia 2021; 37:1103-1111. [PMID: 34537905 PMCID: PMC8449695 DOI: 10.1007/s00455-021-10368-3] [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: 11/10/2020] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
There is growing enthusiasm to develop inexpensive, non-invasive, and portable methods that accurately assess swallowing and provide biofeedback during dysphagia treatment. High-resolution cervical auscultation (HRCA), which uses acoustic and vibratory signals from non-invasive sensors attached to the anterior laryngeal framework during swallowing, is a novel method for quantifying swallowing physiology via advanced signal processing and machine learning techniques. HRCA has demonstrated potential as a dysphagia screening method and diagnostic adjunct to VFSSs by determining swallowing safety, annotating swallow kinematic events, and classifying swallows between healthy participants and patients with a high degree of accuracy. However, its feasibility as a non-invasive biofeedback system has not been explored. This study investigated 1. Whether HRCA can accurately differentiate between non-effortful and effortful swallows; 2. Whether differences exist in Modified Barium Swallow Impairment Profile (MBSImP) scores (#9, #11, #14) between non-effortful and effortful swallows. We hypothesized that HRCA would accurately classify non-effortful and effortful swallows and that differences in MBSImP scores would exist between the types of swallows. We analyzed 247 thin liquid 3 mL command swallows (71 effortful) to minimize variation from 36 healthy adults who underwent standardized VFSSs with concurrent HRCA. Results revealed differences (p < 0.05) in 9 HRCA signal features between non-effortful and effortful swallows. Using HRCA signal features as input, decision trees classified swallows with 76% accuracy, 76% sensitivity, and 77% specificity. There were no differences in MBSImP component scores between non-effortful and effortful swallows. While preliminary in nature, this study demonstrates the feasibility/promise of HRCA as a biofeedback method for dysphagia treatment.
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Oommen ER, Cuellar ME, Scholten A, Rylander B, David M. Objective measures of lingual and jaw function in healthy adults and persons with Parkinson's disease: Implications for swallowing. Physiol Behav 2021; 232:113349. [PMID: 33545210 DOI: 10.1016/j.physbeh.2021.113349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/13/2022]
Abstract
The study examines the effects of age and Parkinson's disease on lingual and jaw function in neurotypical adults, as well as persons with Parkinson's Disease. Preliminary results provide reference measures in these populations and support the systematic collection of objective data regarding lingual strength, lingual range of motion, and jaw range of motion in clinical populations. The application of this clinically meaningful protocol also provides a means to track physiological changes over time in order to maximize the results of rehabilitative efforts to restore swallow function.
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Affiliation(s)
- Elizabeth R Oommen
- Calvin University, Speech Pathology and Audiology Department, 1810 E. Beltline Ave SE, Grand Rapids, MI 49546, United States
| | - Megan E Cuellar
- San José State University, Communicative Disorders & Sciences, One Washington Square, San Jose, CA 95192-0046, United States.
| | - Alyssa Scholten
- Helen DeVos Children's Hospital, 100 Michigan St NE, Grand Rapids, MI 49503, United States
| | - Bethany Rylander
- Colt Early Childhood Center, 4344 W. Michigan Ave, Lansing, MI 48917, United States
| | - Mallika David
- Metro Health, Univ of Michigan, 5900 Byron Center Ave, Wyoming, MI 49519, United States
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Crary MA. Adult Neurologic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Battel I, Calvo I, Walshe M. Interventions Involving Biofeedback to Improve Swallowing in People With Parkinson Disease and Dysphagia: A Systematic Review. Arch Phys Med Rehabil 2020; 102:314-322. [PMID: 32861667 DOI: 10.1016/j.apmr.2020.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 06/01/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the effectiveness of biofeedback used in the treatment of adults with Parkinson disease (PD) and dysphagia, define the factors associated with biofeedback treatment outcomes, and inform a theory to guide the implementation of biofeedback in future dysphagia interventions. DATA SOURCES A systematic review using a narrative synthesis approach of all published and unpublished studies were sought with no date or language restrictions. Ten electronic databases (EMBASE, PubMed, CINAHL, Web of Science, Scopus, Science Direct, AMED, The Cochrane Database of Systematic Reviews, ProQuest Dissertations and Theses A & I, Google Scholar) were searched from inception to April 2019. This search was updated in January 2020. The methodological quality of included studies was assessed using Downs and Black checklist. STUDY SELECTION Four studies were included. The methodological quality of the included studies was low with a high risk of bias. Data were analyzed narratively and descriptively. Despite the heterogeneity of the included studies, the findings suggest that interventions incorporating visual biofeedback may have positive effects on swallowing-related quality of life. CONCLUSIONS Based on these preliminary findings, we provide directions for further research and clinical interventions that incorporate an augmentative biofeedback component of swallowing interventions in people with PD. Future studies should be rigorously designed and set appropriate biofeedback treatment in terms of types, schedules, and timing.
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Affiliation(s)
- Irene Battel
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland.
| | - Irene Calvo
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech & Language Studies, University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland
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Bahia MM, Lowell SY. A Systematic Review of the Physiological Effects of the Effortful Swallow Maneuver in Adults With Normal and Disordered Swallowing. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1655-1673. [PMID: 32463714 DOI: 10.1044/2020_ajslp-19-00132] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose This systematic review summarizes the biomechanical and functional effects of the effortful swallow in adults with and without dysphagia, highlighting clinical implications and future research needs. Specifically, the effects of the effortful swallow on swallowing physiology, safety, and efficiency were identified, as well as the strengths and limitations of current research. Method Recommendations specified by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. A literature search of three databases and relevant articles cited in the searched studies was performed. Two evaluators independently analyzed the studies for eligibility criteria, and final inclusion of studies was decided by consensus. Evaluators also assessed each study for quality of evidence. Results Twenty-three studies were included in this systematic review. Main findings indicated that the effortful swallow generated greater pressures in the tongue-to-palate, pharynx, upper esophageal sphincter, and esophageal regions. Inconsistent results for hyolaryngeal excursion were reported, as well as for swallowing function. Instructions of the effortful swallow varied greatly across studies. Two of the 23 studies were judged to be of high quality, and the remaining studies were of medium quality based on the quality indicators of this review. Conclusions Biomechanical effects of the effortful swallow included increased pressures in the oral, pharyngeal, and esophageal regions. Future investigations should address the effects of the effortful swallow in individuals with dysphagia and its potential role as a rehabilitative maneuver. Moreover, standardization of the effortful swallow instructions based on its physiological and functional effects is essential.
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Affiliation(s)
- Mariana M Bahia
- Department of Communication Sciences and Disorders, Syracuse University, NY
| | - Soren Y Lowell
- Department of Communication Sciences and Disorders, Syracuse University, NY
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López-Liria R, Parra-Egeda J, Vega-Ramírez FA, Aguilar-Parra JM, Trigueros-Ramos R, Morales-Gázquez MJ, Rocamora-Pérez P. Treatment of Dysphagia in Parkinson's Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114104. [PMID: 32526840 PMCID: PMC7312221 DOI: 10.3390/ijerph17114104] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022]
Abstract
The incidence of oropharyngeal dysphagia in Parkinson’s disease (PD) is very high. It is necessary to search for effective therapies that could prevent pneumonia. Previous results should be interpreted cautiously as there is a lack of evidence to support the use of compensatory or rehabilitative approaches to dysphagia. We reviewed the scientific literature to describe the treatments of dysphagia in PD. A systematic review was performed in PubMed, Scopus, Elsevier, and Medline according to PRISMA standards in 2018. The articles that did not mention dysphagia secondary to PD or used surgical treatment were excluded. Eleven articles met the criteria with information from 402 patients. The review relates to different protocols, such as training in expiratory muscle strength, postural techniques, oral motor exercises, video-assisted swallowing therapy, surface electrical stimulation, thermal stimulation, touch, compensatory interventions, training regime for swallowing, neuromuscular electrical stimulation, Lee Silverman voice treatment, swallow maneuver, airway protection, and postural compensation maneuvers. This review identifies the rationing interventions in each trial, if they are efficient and equitable. Several rehabilitative therapies have been successful. An improvement was seen in the degenerative function (coordination, speed, and volume), quality of life, and social relationships of people with PD. Further investigations concerning the clinical applicability of these therapies based on well-designed randomized controlled studies are needed. Larger patient populations need to be recruited to evaluate the effectiveness, long-term effects, and new treatment techniques.
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Affiliation(s)
- Remedios López-Liria
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain;
- Correspondence: (R.L.-L.); (J.M.A.-P.); (R.T.-R.); Tel.: +34-950-214-573 (R.L.-L.)
| | | | | | - José Manuel Aguilar-Parra
- Department of Psychology, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain
- Correspondence: (R.L.-L.); (J.M.A.-P.); (R.T.-R.); Tel.: +34-950-214-573 (R.L.-L.)
| | - Rubén Trigueros-Ramos
- Department of Psychology, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain
- Correspondence: (R.L.-L.); (J.M.A.-P.); (R.T.-R.); Tel.: +34-950-214-573 (R.L.-L.)
| | - María José Morales-Gázquez
- Department of Nursing, University of Las Palmas de Gran Canaria (ULPGC), Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria, Spain;
| | - Patricia Rocamora-Pérez
- Health Research Centre, Department of Nursing, Physiotherapy and Medicine, University of Almería, Carretera del Sacramento s/n, La Cañada de San Urbano, 04120 Almería, Spain;
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Ardenghi LG, Signorini AV, Maahs GS, Selaimen F, Deutsch KM, Dornelles S, Rieder CRDM. Deglutition Impairment during Dual Task in Parkinson Disease Is Associated with Cognitive Status. Int Arch Otorhinolaryngol 2020; 25:e41-e47. [PMID: 33542750 PMCID: PMC7850888 DOI: 10.1055/s-0039-3402440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/26/2019] [Indexed: 11/06/2022] Open
Abstract
Introduction
Dysphagia is a relevant symptom in Parkinson disease (PD), and its pathophysiology is poorly understood. To date, researchers have not investigated the effects of combined motor tasks on swallowing. Such an assessment is of particular interest in PD, in which patients have specific difficulties while performing two movements simultaneously.
Objective
The present study tested the hypothesis that performing concurrent tasks could decrease the safety of swallowing in PD patients as visualized using fiberoptic endoscopic evaluation of swallowing (FEES).
Methods
A total of 19 patients and 19 controls matched by age, gender, and level of schooling were compared by FEES under two conditions: isolated swallowing and dual task (swallowing during non-sequential opposition of the thumb against the other fingers). The two tasks involved volumes of food of 3 mL and 5 mL. The PD subjects were classified according to the Hoehn & Yahr (H&Y) Scale, the Mini Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). The FEES assessment was performed according to the Boston Residue and Clearance Scale (BRACS).
Results
The data showed a significant worsening of swallowing in the dual task assessment for both volumes (3 mL:
p
≤ 0.001; 5 mL:
p
≤ 0.001) in the PD group. A correlation between the MoCA and dual-task swallowing of 3 mL was also found.
Conclusion
These findings suggest that additional tasks involving manual motor movements result in swallowing impairment in patients with PD. Moreover, these data highlight the need to further evaluate such conditions during treatment and assessment of PD patients.
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Affiliation(s)
| | - Alana Verza Signorini
- Program of Graduate Studies in Medical Sciences, Universidade Federal do Rio Grande do Sul, Cesar Lombroso, Porto Alegre, Brazil
| | - Gerson Schulz Maahs
- Departament of Health and Human Communication, Speech-Language Pathology Course, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fabio Selaimen
- Program of Graduate Studies in Medical Sciences, Universidade Federal do Rio Grande do Sul, Cesar Lombroso, Porto Alegre, Brazil
| | - Konrado Massing Deutsch
- Departament of Health and Human Communication, Speech-Language Pathology Course, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Silvia Dornelles
- Department of Developmental Psychology and Personality Ramiro Barcelos, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Carlos Roberto de Mello Rieder
- Department of Neurology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Department of Neurology, Distúrbios do Movimento, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Rodrigues EHDS, Coriolano MDGWDS, Lins CCDSA. Use of biofeedback combined with conventional therapy in the swallowing rehabilitation of older adults: an integrative literature review. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/20202256919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to identify biofeedback methods combined with conventional therapy in the swallowing rehabilitation of older adults. Methods :an integrative literature review that searched the LILACS, MEDLINE/PubMed, BIREME, SciELO, and Scopus databases, with no restrictions of time or language. The search items used were deglutition, biofeedback, elderly, rehabilitation, and their corresponding terms in Portuguese. The articles were evaluated with the adapted Newcastle-Ottawa Scale (NOS). Results: out of the 73 articles found in the databases, four, with a longitudinal design, were considered eligible. The biofeedback methods described were accelerometry, pressure balloon, and surface electromyography. The swallowing disorders observed were hypofunctioning of articulatory organs, increased oral transit, decreased laryngeal elevation, residues in pyriform sinuses and vallecula, reduced cough reflex, and change in voice quality. Regarding the effectiveness assessment of the recommended technique, a study used the clinical assessment combined with videofluoroscopy, before and after the treatment, two studies used the videofluoroscopy before the treatment and clinical assessment after it, and one study used clinical assessment prior to the treatment and swallowing videoendoscopy after it. As for the assessment of bias risk, one article was classified as low, two as intermediate, and one as high, in terms of risk. Conclusion: the biofeedback methods combined with conventional therapy to treat dysphagia in older adults were accelerometry, pressure balloon, and surface electromyography, whose use had positive effects.
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Kober SE, Grössinger D, Wood G. Effects of Motor Imagery and Visual Neurofeedback on Activation in the Swallowing Network: A Real-Time fMRI Study. Dysphagia 2019; 34:879-895. [PMID: 30771088 PMCID: PMC6825652 DOI: 10.1007/s00455-019-09985-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/25/2019] [Indexed: 12/01/2022]
Abstract
Motor imagery of movements is used as mental strategy in neurofeedback applications to gain voluntary control over activity in motor areas of the brain. In the present functional magnetic resonance imaging (fMRI) study, we first addressed the question whether motor imagery and execution of swallowing activate comparable brain areas, which has been already proven for hand and foot movements. Prior near-infrared spectroscopy (NIRS) studies provide evidence that this is the case in the outer layer of the cortex. With the present fMRI study, we want to expand these prior NIRS findings to the whole brain. Second, we used motor imagery of swallowing as mental strategy during visual neurofeedback to investigate whether one can learn to modulate voluntarily activity in brain regions, which are associated with active swallowing, using real-time fMRI. Eleven healthy adults performed one offline session, in which they executed swallowing movements and imagined swallowing on command during fMRI scanning. Based on this functional localizer task, we identified brain areas active during both tasks and defined individually regions for feedback. During the second session, participants performed two real-time fMRI neurofeedback runs (each run comprised 10 motor imagery trials), in which they should increase voluntarily the activity in the left precentral gyrus by means of motor imagery of swallowing while receiving visual feedback (the visual feedback depicted one's own fMRI signal changes in real-time). Motor execution and imagery of swallowing activated a comparable network of brain areas including the bilateral pre- and postcentral gyrus, inferior frontal gyrus, basal ganglia, insula, SMA, and the cerebellum compared to a resting condition. During neurofeedback training, participants were able to increase the activity in the feedback region (left lateral precentral gyrus) but also in other brain regions, which are generally active during swallowing, compared to the motor imagery offline task. Our results indicate that motor imagery of swallowing is an adequate mental strategy to activate the swallowing network of the whole brain, which might be useful for future treatments of swallowing disorders.
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Affiliation(s)
- Silvia Erika Kober
- Institute of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Doris Grössinger
- Institute of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Universitaetsplatz 2/III, 8010 Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Therapeutic Approaches to Dysphagia Treatment in Parkinson Disease: A Review. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.64921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Does Therapy With Biofeedback Improve Swallowing in Adults With Dysphagia? A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 100:551-561. [PMID: 29859178 DOI: 10.1016/j.apmr.2018.04.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/19/2018] [Accepted: 04/21/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe and systematically review the current evidence on the effects of swallow therapy augmented by biofeedback in adults with dysphagia (PROSPERO 2016:CRD42016052942). DATA SOURCES Two independent reviewers conducted searches that included MEDLINE, EMBASE, trial registries, and gray literature up to December 2016. STUDY SELECTION Randomized controlled trials (RCTs) and non-RCTs were assessed, including for risk of bias and quality. DATA EXTRACTION Data were extracted by 1 reviewer and verified by another on biofeedback type, measures of swallow function, physiology and clinical outcome, and analysed using Cochrane Review Manager (random effects models). Results are expressed as weighted mean difference (WMD) and odds ratio (OR). DATA SYNTHESIS Of 675 articles, we included 23 studies (N=448 participants). Three main types of biofeedback were used: accelerometry, surface electromyography (sEMG), and tongue manometry. Exercises included saliva swallows, maneuvers, and strength exercises. Dose varied between 6 and 72 sessions for 20-60 minutes. Five controlled studies (stroke n=95; head and neck cancer n=33; mixed etiology n=10) were included in meta-analyses. Compared to control, biofeedback augmented dysphagia therapy significantly enhanced hyoid displacement (3 studies, WMD=0.22cm; 95% confidence interval [CI] [0.04, 0.40], P=.02) but there was no significant difference in functional oral intake (WMD=1.10; 95% CI [-1.69, 3.89], P=.44) or dependency on tube feeding (OR =3.19; 95% CI [0.16, 62.72], P=.45). Risk of bias was high and there was significant statistical heterogeneity between trials in measures of swallow function and number tube fed (I2 70%-94%). Several nonvalidated outcome measures were used. Subgroup analyses were not possible due to a paucity of studies. CONCLUSIONS Dysphagia therapy augmented by biofeedback using sEMG and accelerometry enhances hyoid displacement but functional improvements in swallowing are not evident. However, data are extremely limited and further larger well-designed RCTs are warranted.
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Presotto M, Olchik MR, Kalf JG, Rieder CR. Translation, linguistic and cultural adaptation, reliability and validity of the Radboud Oral Motor Inventory for Parkinson's Disease – ROMP questionnaire. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:316-323. [DOI: 10.1590/0004-282x20180033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/08/2018] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To translate and linguistically and culturally adapt to Brazilian Portuguese, and verify the reliability and validity of the Radboud Oral Motor Inventory for Parkinson's Disease (ROMP). Methods: The ROMP was translated and retranslated, and the instrument reliability was verified by analyzing the internal consistency and the reproducibility of the intra-examiner retest. The final version was applied to 27 participants with Parkinson's disease. Results: Internal consistency was 0.99 for the total ROMP and 0.96 to 0.99 for the three domains. Intraclass correlation coefficients for reproducibility were 0.99 for the total ROMP and 0.93 to 0.99 for the subscales. The ROMP and its subscales correlated substantially with the Likert-type scale, as well as with the unified Parkinson's disease rating scale II and III items. Conclusion: The linguistic and cultural equivalence of the ROMP in Brazilian Portuguese is now available, with excellent reliability and validity.
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Affiliation(s)
| | | | | | - Carlos R.M. Rieder
- Universidade Federal Ciências da Saúde de Porto Alegre, Brasil; Hospital de Clínicas de Porto Alegre, Brasil
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Jones O, Cartwright J, Whitworth A, Cocks N. Dysphagia therapy post stroke: An exploration of the practices and clinical decision-making of speech-language pathologists in Australia. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 20:226-237. [PMID: 28079400 DOI: 10.1080/17549507.2016.1265588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE A variety of dysphagia management options are available for the treatment of dysphagia following a stroke, however, it is unknown which of these approaches are most commonly utilised by Australian speech-language pathologists (SLPs) and whether particular factors influence decision-making. METHOD The aim of this study was to investigate, through an online survey, the treatment practices of SLPs in Australia for the treatment of dysphagia post-stroke and identify the factors influencing treatment decisions. RESULT A total of 118 SLPs completed the online survey. Descriptive statistics identified large variability in the dysphagia treatments utilised, with all 24 therapies listed in the online survey reported as being routinely used. Compensatory therapies were ranked as being utilised more frequently than rehabilitative approaches, with six of the seven highly utilised therapies being compensatory in nature. A client's cognitive capacity was the most prominent factor influencing SLPs' treatment decisions. CONCLUSION This study provides insight into the practices of SLPs in Australia for the treatment of dysphagia following stroke and discusses potential for shifts in practice. It highlights the complexity involved in the decision-making process and that clinicians consider evidence, as well as client, clinician and service factors, when selecting between the range of options available.
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Affiliation(s)
- Olivia Jones
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia and
| | - Jade Cartwright
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia and
- b Department of Audiology and Speech Pathology , School of Health Sciences, The University of Melbourne , Melbourne , Australia
| | - Anne Whitworth
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia and
| | - Naomi Cocks
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia and
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ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37:354-396. [DOI: 10.1016/j.clnu.2017.09.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
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Ayres A, Jotz GP, Rieder CRM, Olchik MR. Benefit from the Chin-Down Maneuver in the Swallowing Performance and Self-Perception of Parkinson's Disease Patients. PARKINSON'S DISEASE 2017; 2017:7460343. [PMID: 28203475 PMCID: PMC5288524 DOI: 10.1155/2017/7460343] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/27/2016] [Indexed: 11/22/2022]
Abstract
Aims. To verify the effectiveness of the maneuver application in swallowing therapy with PD. Materials and Method. We performed an open-label trial, with three groups compounds by PD individuals: the experimental group, control group, and orientation group. The study included PD patients with dysphagia. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Swallowing assessment was performed through (1) fiberoptic endoscopic evaluation of swallowing (FEES); (2) clinical evaluation and Functional Oral Intake Scale (FOIS); and (3) assessment of the quality life related to swallowing (SWALQOL). A therapeutic program, which consisted of chin-down postural maneuver and orientations on feeding, was applied. Both groups (EG and OG) received on-month therapeutic program. Results. A significant improvement in swallowing, evaluated by clinical assessment, was observed in solid (p < 0.001) and liquid (p = 0.022) consistencies in EG when compared to OG and CG. Patients in EG presented improvement in QoL, with the significant difference in comparison with the other groups, about domain frequency of symptoms (p = 0.029) in SWALQOL questionnaire. Conclusion. The postural maneuver chin-down improved swallowing performance and self-perception, but not the laryngeal signs. This trial is registered with registration number NCT02973698.
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Affiliation(s)
- Annelise Ayres
- Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Geraldo Pereira Jotz
- Postgraduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carlos R. M. Rieder
- Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Department of Neurology and Postgraduate Program in Rehabilitation, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Maira Rozenfeld Olchik
- Department of Surgery and Orthopaedics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Abstract
Oropharyngeal dysphagia is a frequent consequence of several medical aetiologies, and even considered part of the normal ageing process. Early and accurate identification provides the opportunity for early implementation of dysphagia treatments. This Review describes the current state of the evidence related to dysphagia therapies - focusing on treatments most clinically utilized and of current interest to researchers. Despite successes in select studies, the level of evidence to support the efficacy of these treatments remains limited. Heterogeneity exists across studies in both how interventions are administered and how their therapeutic value is assessed, thereby making it difficult to establish external validation. Future work needs to address these caveats. Also, to be most efficacious, dysphagia therapies need to account for influences from pre-morbid patient characteristics as these factors have potential to increase the risk of dysphagia and the resulting complications of aspiration, malnutrition and psychological burden. Dysphagia therapies therefore need to incorporate the medical aetiology that is at its root, the resulting swallow physiology captured from comprehensive clinical and/or instrumental assessments, and the existing needs and supports of patients.
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Affiliation(s)
- Rosemary Martino
- Departments of Speech Language Pathology, Rehabilitation Sciences Institute, and Otolaryngology-Head and Neck Surgery, University of Toronto, 160-500 University Avenue, Ontario M5G 1V7, Canada.,Krembil Research Institute, University Health Network, 399 Bathurst Street (MP 11-331), Toronto, Ontario M5T 2S8, Canada
| | - Timothy McCulloch
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, 600 Highland Avenue, Madison, Wisconsin 53792, USA
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Ayres A, Ghisi M, Rieder CRDM, Manor Y, Olchik MR. Tradução e adaptação cultural do swallowing disturbance questionnaire para o português-brasileiro. REVISTA CEFAC 2016. [DOI: 10.1590/1982-021620161844016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: traduzir e adaptar culturalmente para o português brasileiro o Swallowing disturbance questionnaire (SDQ) para detecção de risco de disfagia em indivíduos com Doença de Parkinson (DP). Métodos: realizou-se tradução para o português, retradução para o inglês, análise de confiabilidade do instrumento, sendo a versão final aplicada aos participantes e realizado o reteste após duas semanas. Selecionou-se os participantes em um ambulatório de distúrbios do movimento de um hospital de referência no Rio Grande do Sul. Incluiu-se indivíduos com diagnóstico de DP. Excluiu-se indivíduos com alteração de linguagem ou audição que impossibilitasse a compreensão do questionário e com diagnóstico de outras doenças neurológicas. Resultados: a amostra foi composta por 23 indivíduos. Os participantes responderam a todas as questões. Não houve eliminação de nenhuma questão. Na análise da confiabilidade teste-reteste o coeficiente de correlação intraclasse do escore final nos dois momentos foi de 0,912 com p<0,001 (95%IC=0,792-0,963), demonstrando que os dados são altamente homogêneos. Na análise por questão, não houve diferença significante entre os dois momentos de aplicação. O valor de α de Cronbach do instrumento foi de 0,63. Conclusão: houve equivalência cultural do SDQ para o português brasileiro, com boa confiabilidade interna do instrumento.
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Affiliation(s)
- Annelise Ayres
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Essa H, Hamdy S. Evaluating the Scope of Gastrointestinal Symptoms of Parkinson's Disease: A Review of the Evidence. ACTA ACUST UNITED AC 2016. [DOI: 10.4303/ne/235955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Crary MA. Adult Neurologic Disorders. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jang HJ, Leigh JH, Seo HG, Han TR, Oh BM. Effortful swallow enhances vertical hyolaryngeal movement and prolongs duration after maximal excursion. J Oral Rehabil 2015; 42:765-73. [PMID: 26013277 DOI: 10.1111/joor.12312] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/30/2022]
Abstract
Effortful swallowing (EFS) is a common compensatory swallowing manoeuver for dysphagia patients. We investigated the influence of EFS on temporal and spatial characteristics of the movements of the hyoid bone, larynx and epiglottis in healthy subjects. A total of 41 volunteers swallowed 10 mL of diluted barium solution using two swallowing strategies: usual and effortful swallowing (USS and EFS). The motions of the hyoid bone, larynx and epiglottis were tracked using frame-by-frame kinematic motion analysis of videofluoroscopic images. Maximal velocities and maximal displacements of hyoid and larynx, the maximal angle of the epiglottic tilt, and the durations of hyoid excursion, laryngeal elevation and epiglottic tilt were measured. Compared to USS, EFS was associated with significantly greater vertical displacement of the hyoid (P < 0.001), vertical and horizontal displacement of the larynx (P = 0.003, P = 0.019), and maximal angle of the epiglottic tilt (P = 0.001). In addition, the durations of the vertical and horizontal excursions of the hyoid, vertical excursion of the larynx and the epiglottic tilt were greater in EFS, compared with USS. Effortful swallowing was also associated with significantly greater maximum velocities of the hyoid and larynx during swallowing. In conclusion, the EFS manoeuver facilitates vertical speed and distance of hyolaryngeal excursion and epiglottic tilt and extends the duration of excursion and the epiglottic tilt, especially after reaching maximal excursion in healthy subjects. These results confirm the temporal and kinematic benefits of airway protection induced by the EFS manoeuver.
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Affiliation(s)
- H J Jang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - J H Leigh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - H G Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - T R Han
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - B M Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Luchesi KF, Kitamura S, Mourão LF. Dysphagia progression and swallowing management in Parkinson's disease: an observational study. Braz J Otorhinolaryngol 2014; 81:24-30. [PMID: 25450106 PMCID: PMC9452192 DOI: 10.1016/j.bjorl.2014.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 03/03/2014] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Dysphagia is relatively common in individuals with neurological disorders. OBJECTIVE To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. METHODS It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. RESULTS During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. CONCLUSION The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.
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Affiliation(s)
| | - Satoshi Kitamura
- Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Luchesi KF, Kitamura S, Mourão LF. Management of dysphagia in Parkinson's disease and amyotrophic lateral sclerosis. Codas 2014; 25:358-64. [PMID: 24408486 DOI: 10.1590/s2317-17822013000400010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 09/05/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To describe swallowing management in patients with amyotrophic lateral sclerosis (ALS) and Parkinson' disease (PD), to investigate whether physiopathology determines the choice of therapeutic approaches, and to investigate whether the disease duration modifies the therapeutic approaches. METHODS This is a long-term study comprising 24 patients with idiopathic PD and 27 patients with ALS. The patients were followed-up in a dysphagia outpatient clinic between 2006 and 2011. The patients underwent clinic evaluation and Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale, and therapeutic intervention every 3 months. The swallowing management was based on orientation about the adequate food consistency and volume, besides the necessary maneuvers or exercises to improve swallowing functionality. An exploratory analysis of data was used to investigate associations between the groups of disease (PD or ALS) and clinic aspects and to know about the association between the groups of diseases and the application of maneuver or exercises over the follow-up. RESULTS The most frequent recommended maneuvers in PD were bolus effect (83.3%), bolus consistency (79.2%), and swallowing frequency (79%). To patients with ALS, the bolus consistency (92%) and the bolus effect (74.1%) were more recommended. Strengthening-tongue (p=0.01), tongue control (p=0.05), and vocal exercises (p<0.001) were significantly more recommended in PD than in ALS. CONCLUSION Compensatory and sensorial maneuvers are more recommended to rehabilitee program in both diseases. The physiopathology of the diseases determined the choice of therapeutic approaches. The disease duration of the patients did not interfere directly in the therapeutic approaches.
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Clark HM, Shelton N. Training Effects of the Effortful Swallow Under Three Exercise Conditions. Dysphagia 2014; 29:553-63. [DOI: 10.1007/s00455-014-9544-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/22/2014] [Indexed: 11/29/2022]
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Gerszt PP, Baltar CR, Santos AED, Oda AL. Interferência do tratamento medicamentoso imediato e tardio na doença de Parkinson no gerenciamento da disfagia. REVISTA CEFAC 2014. [DOI: 10.1590/1982-02162014141-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A Doença de Parkinson apresenta grande incidência na população idosa, gerando comprometimento motor progressivo, que afeta várias funções, dentre as quais se destaca a deglutição. Esse trabalho teve como objetivo relacionar a disfagia na Doença de Parkinson aos efeitos imediatos e/ou tardios do tratamento medicamentoso, que de forma direta ou indireta interferirá no gerenciamento fonoaudiológico. Fizemos uma revisão de literatura nas bases de dados eletrônicas Lilacs, Scielo, Medline e Pubmed no período de 2001 a 2011, utilizando os termos livres “Doença de Parkinson”; (Parkinson Disease), “deglutição”; (deglutition), “disfagia”; (dysphagia), “preparações farmacêuticas”; (pharmaceutical preparations), “levodopa”;, “videofluoroscopia”; (videofluoroscopy), além de um documento governamental (OPAS, 2002), artigos relevantes e exemplares da literatura americana e brasileira sobre o tema. A literatura aponta a Levodopa como o principal tratamento farmacológico da doença de Parkinson. Contudo, a melhora dos sintomas motores deve ser ponderada em função da ocorrência de efeitos colaterais importantes, sejam imediatos ou tardios. Até o momento não há respostas consistentes a favor da melhora da disfagia como resultado do tratamento farmacológico, cujos efeitos podem interferir direta ou indiretamente sobre as manifestações disfágicas e de várias formas. Assim, torna-se fundamental o registro das medicações como parte da anamnese, considerando que tais dados possam auxiliar na orientação/reorientação da conduta fonoaudiológica, especialmente em contexto interdisciplinar. A despeito da possibilidade do doente de Parkinson responder de forma inconsistente à terapia farmacológica, vale ressaltar que o profissional deve estar atento à presença de efeitos colaterais como fatores modificadores do quadro de disfagia orofaríngea na Doença de Parkinson idiopática.
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Ciucci MR, Grant LM, Rajamanickam ESP, Hilby BL, Blue KV, Jones CA, Kelm-Nelson CA. Early identification and treatment of communication and swallowing deficits in Parkinson disease. Semin Speech Lang 2013; 34:185-202. [PMID: 24166192 DOI: 10.1055/s-0033-1358367] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Parkinson disease (PD) is a complex, progressive, neurodegenerative disorder that leads to a wide range of deficits including fine and gross sensorimotor impairment, autonomic dysfunction, mood disorders, and cognitive decline. Traditionally, the focus for diagnosis and treatment has been on sensorimotor impairment related to dopamine depletion. It is now widely recognized, however, that PD-related pathology affects multiple central nervous system neurotransmitters and pathways. Communication and swallowing functions can be impaired even in the early stages, significantly affecting health and quality of life. The purpose of this article is to review the literature on early intervention for communication and swallowing impairment in PD. Overarching themes were that (1) studies and interpretation of data from studies in early PD are limited; (2) best therapy practices have not been established, in part due to the heterogeneous nature of PD; and (3) as communication and swallowing problems are pervasive in PD, further treatment research is essential.
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Affiliation(s)
- Michelle R Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin
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Manor Y, Mootanah R, Freud D, Giladi N, Cohen JT. Video-assisted swallowing therapy for patients with Parkinson's disease. Parkinsonism Relat Disord 2012; 19:207-11. [PMID: 23131836 DOI: 10.1016/j.parkreldis.2012.10.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/07/2012] [Accepted: 10/04/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conventional swallowing therapy for patients with Parkinson's disease (PD) and swallowing difficulties has poor carryover to everyday life. Herein, we test the effectiveness of visual information while treating swallowing disturbances in patients with PD. METHODS Forty two non-demented PD patients with swallowing disturbances were randomly divided into two groups. An experimental group received video-assisted swallowing therapy (VAST) and a control group (n = 21) was given conventional therapy. Both groups were given 6 interventional sessions by the same speech and swallowing therapist. Patients in the VAST group were exposed to video of the swallowing process in general as well as of their own, as part of all therapy sessions. Swallowing function was assessed before and post-intervention by fiberoptic endoscopic evaluation of swallowing (FEES). Quality of life, quality of care and the degree of pleasure from eating were also assessed by questioners pre and post-intervention. RESULTS There was a significant improvement in swallowing functions following both interventions. The FEESs demonstrated a significantly greater reduction in food residues in the pharynx in the VAST group compared to the conventional treatment group. There were significant group improvement in some parameters of the quality of life, quality of care and pleasure of eating scales. CONCLUSION In cognitively intact patients with PD with swallowing disturbances VAST was associated with improved swallowing related QOL and less food residues in the pharynx.
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Affiliation(s)
- Yael Manor
- Movement Disorders Unit, Dept of Neurology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Walterfang M, Chien YH, Imrie J, Rushton D, Schubiger D, Patterson MC. Dysphagia as a risk factor for mortality in Niemann-Pick disease type C: systematic literature review and evidence from studies with miglustat. Orphanet J Rare Dis 2012; 7:76. [PMID: 23039766 PMCID: PMC3552828 DOI: 10.1186/1750-1172-7-76] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 09/24/2012] [Indexed: 02/06/2023] Open
Abstract
Niemann-Pick disease type C (NP-C) is a rare neurovisceral disease characterised by progressive neurological deterioration and premature death, and has an estimated birth incidence of 1:120,000. Mutations in the NPC1 gene (in 95% of cases) and the NPC2 gene (in approximately 4% of cases) give rise to impaired intracellular lipid metabolism in a number of tissues, including the brain. Typical neurological manifestations include vertical supranuclear gaze palsy, saccadic eye movement abnormalities, cerebellar ataxia, dystonia, dysmetria, dysphagia and dysarthria. Oropharyngeal dysphagia can be particularly problematic as it can often lead to food or fluid aspiration and subsequent pneumonia. Epidemiological data suggest that bronchopneumonia subsequent to food or fluid aspiration is a major cause of mortality in NP-C and other neurodegenerative disorders. These findings indicate that a therapy capable of improving or stabilising swallowing function might reduce the risk of aspiration pneumonia, and could have a positive impact on patient survival. Miglustat, currently the only approved disease-specific therapy for NP-C in children and adults, has been shown to stabilise key neurological manifestations in NP-C, including dysphagia. In this article we present findings from a systematic literature review of published data on bronchopneumonia/aspiration pneumonia as a cause of death, and on the occurrence of dysphagia in NP-C and other neurodegenerative diseases. We then examine the potential links between dysphagia, aspiration, pneumonia and mortality with a view to assessing the possible effect of miglustat on patient lifespan.
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Affiliation(s)
- Mark Walterfang
- Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, Melbourne 3050, Australia
| | - Yin-Hsiu Chien
- Departments of Paediatrics and Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Derren Rushton
- Actelion Pharmaceuticals Pty Ltd, New South Wales, Australia
| | - Danielle Schubiger
- Royal Melbourne Hospital and Melbourne Neuropsychiatry Centre, Melbourne 3050, Australia
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Smith SK, Roddam H, Sheldrick H. Rehabilitation or compensation: time for a fresh perspective on speech and language therapy for dysphagia and Parkinson's disease? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2012; 47:351-364. [PMID: 22788222 DOI: 10.1111/j.1460-6984.2011.00093.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Dysphagia is a common symptom of Parkinson's disease and can have negative consequences for physical health and quality of life. A variety of treatment options are available to clinicians working with people who have dysphagia and Parkinson's disease. These options can be broadly categorized as being compensatory or rehabilitative in nature. AIMS To explore the evidence behind treatment options available to clinicians working with dysphagia and Parkinson's disease and to draw conclusions about whether compensatory or rehabilitative approaches are likely to provide the best outcomes for our patients. METHODS & PROCEDURES A critical literature review of compensatory and rehabilitative interventions for dysphagia in Parkinson's disease was undertaken. Relevant studies were analysed for their robustness and potential clinical applications. General conclusions were drawn based on the evidence base identified in this review. MAIN CONTRIBUTION This review outlines the lack of evidence supporting both compensatory and rehabilitative methods of treating dysphagia in Parkinson's disease. It directs clinicians and researchers towards areas that require further investigation. CONCLUSIONS & IMPLICATIONS To date, compensatory methods of treating dysphagia in Parkinson's disease have received more research attention than rehabilitative methods and yet neither approach has a strong evidence base. This review argues that rehabilitative methods could possibly have greater potential to increase swallowing safety and improve quality of life in the long-term than compensatory methods alone. However, at present there is a lack of research in this area.
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Affiliation(s)
- Sarah K Smith
- Division of Physiotherapy and Sports Therapy, SSTO Greenbank Building 161, University of Central Lancashire, PRESTON PR1 2HE, UK
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NEKL CG, LINTZENICH CR, LENG X, LEVER T, BUTLER SG. Effects of effortful swallow on esophageal function in healthy adults. Neurogastroenterol Motil 2012; 24:252-6, e107-8. [PMID: 22316290 PMCID: PMC4842311 DOI: 10.1111/j.1365-2982.2011.01864.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Treatment for esophageal dysmotility is currently limited to primarily pharmacologic intervention, which has questionable utility and frequently associated negative side effects. A potential behavioral intervention for esophageal dysmotility is the effortful oropharyngeal swallow. A previous pilot study using water perfusion manometry found an increase in distal esophageal amplitudes during effortful vs non-effortful swallowing. The current study sought to duplicate the previous study with improvements in methodology. METHODS The effects of swallow condition (effortful vs non-effortful), sensor site, and gender on esophageal amplitude, duration, velocity, and bolus clearance were examined for 18 adults (nine males and nine females, mean age = 29.9 years) via combined solid-state manometry and intraluminal impedance. KEY RESULTS The effortful swallow condition yielded significantly higher esophageal amplitudes across all sensor locations (P < 0.05). Further, the effortful swallowing decreased the risk of incomplete bolus clearance when compared with non-effortful swallowing (OR: 0.51; 95% CI: 0.30-0.86). CONCLUSIONS & INFERENCES With improved manometric instrumentation, larger participant numbers, and methodology that controlled for potential confounding factors, this study confirms and advances the results of the previous pilot study: Volitional manipulation of the oropharyngeal phase of swallowing using the effortful swallow indeed affects esophageal physiology. Thus, the effortful swallow offers a behavioral manipulation of the esophageal phase of swallowing, and future studies will determine its clinical potential for treating esophageal dysmotility in patient populations.
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Affiliation(s)
- C. G. NEKL
- Department of Otolaryngology, Center for Voice and Swallowing Disorders, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - C. R. LINTZENICH
- Department of Otolaryngology, Center for Voice and Swallowing Disorders, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - X. LENG
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - T. LEVER
- Department of Communication Science and Disorders, University of Missouri, Columbia, MO, USA
| | - S. G. BUTLER
- Department of Otolaryngology, Center for Voice and Swallowing Disorders, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Humbert IA, Joel S. Tactile, gustatory, and visual biofeedback stimuli modulate neural substrates of deglutition. Neuroimage 2011; 59:1485-90. [PMID: 21872665 DOI: 10.1016/j.neuroimage.2011.08.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Revised: 08/08/2011] [Accepted: 08/09/2011] [Indexed: 10/17/2022] Open
Abstract
It has been well established that swallowing kinematics are modified with different forms of exogenous and endogenous input, however the underlying neural substrates associated with these effects are largely unknown. Our objective was to determine whether the swallowing BOLD response is modulated with heightened sensory modalities (taste, cutaneous electrical stimulation, and visual biofeedback) compared to water ingestion (control) in healthy adults across the age span. Habituation and sensitization were also examined for each sensory condition. Our principal findings are that each sensory swallowing condition activated components of the swallowing cortical network, plus regions associated with the particular sensory modality (i.e. primarily frontal motor planning and integration areas with visual condition). Overall, the insula was most commonly active among the sensory modalities. We also discuss gradual increases and decreases in BOLD signal with repeated exposures for each condition. We conclude that both stimulus- and intention-based inputs have unique cortical swallowing networks relative to their modality. This scientific contribution advances our understanding of the mechanisms of normal swallowing cortical control and has the potential to impact clinical uses of these modalities in treatments for neurogenic dysphagia.
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Affiliation(s)
- Ianessa A Humbert
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, 98 North Broadway, Suite 403, Baltimore, MD 21231, USA.
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van der Marck M, Kalf J, Sturkenboom I, Nijkrake M, Munneke M, Bloem B. Multidisciplinary care for patients with Parkinson's disease. Parkinsonism Relat Disord 2009; 15 Suppl 3:S219-23. [PMID: 20082995 DOI: 10.1016/s1353-8020(09)70819-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Belo LR, Lins SC, Cunha DAD, Lins O, Amorim CF. Eletromiografia de superfície da musculatura supra-hióidea durante a deglutição de idosos sem doenças neurológicas e idosos com Parkinson. REVISTA CEFAC 2009. [DOI: 10.1590/s1516-18462009000200012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: investigar as diferenças entre os achados eletromiográficos dos músculos supra-hióideos direito e esquerdo durante a deglutição de um líquido e um pastoso fino, em sujeitos idosos com doença de Parkinson e idosos sem doença neurológica. MÉTODOS: 30 sujeitos de ambos os sexos participaram deste estudo, 15 idosos sem doença neurológica e os demais com doença de Parkinson. Todos foram submetidos a um protocolo de avaliação clínica e avaliação eletromiográfica de superfície. RESULTADOS: foram constatadas diferenças significantes nos valores entre os sujeitos (f=14.4 e p= 0.000) e entre os lados (f=4.4 e p=0.0037). Em relação ao tempo de duração da contração muscular durante a deglutição as diferenças foram significantes apenas entre as consistências (f=8.2 e p=0.005). CONCLUSÃO: a amplitude eletromiográfica foi menor nos sujeitos com doença de Parkinson e maior nos músculos supra-hiódeos do lado direito em ambos os grupos. A duração da contração muscular não diferiu significativamente entre os sujeitos com doença de Parkinson e idosos sem doença neurológica e foi menor para a consistência líquida.
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