Submandibular Push Exercise Using Visual Feedback from a Pressure Sensor in Patients with Swallowing Difficulties: A Pilot Study

Quality of Life and Aesthetic Satisfaction in Patients Who Underwent the “Commando Operation” with Pectoralis Major Myocutaneus Flap Reconstruction—A Case Series Study

The “commando operation” is an extensive surgical procedure used to treat patients with oral squamous carcinoma and metastasis in the cervical lymph nodes. While the procedure can be curative, it is also very mutilating, which consequently has a major impact on the patient’s quality of life. Several studies showed that the procedure is associated with loss of certain functions, such as impairments in speech, chewing, swallowing, and loss of taste and appetite. Furthermore, some of these impairments and their degree depend on the reconstruction method. However, the data regarding the functional impairments and aesthetic results in patients who underwent the “commando operation” along with the pectoralis major myocutaneus flap reconstruction are still inconclusive. This study included 34 patients that underwent partial glossectomy, ipsilateral modified radical neck dissection, pectoralis major myocutaneus flap reconstruction, and adjuvant radiotherapy. A structured questionnaire was used to evaluate aesthetical results and functional impairments as well as to grade the level of satisfaction with the functional and aesthetic outcomes both by the patients and by the operator. Most of the patients stated that their speech (N = 33; 97%) and salivation (N = 32; 94.2%) severely changed after the operation and that they cannot chew (N = 33; 97%) and swallow (N = 33; 97%) the same as before the operation. Moreover, almost half of the patients (N = 16; 47%) reported that they have severe sleep impairments. However, only few of the included patients stated that they sought professional help regarding the speech (N = 4; 11.7%), eating (N = 5; 14.7%), and sleeping (N = 4; 11.7%) disturbances. Additionally, there was a statistically significant difference between the operator and the patients in the subjective assessment of the aesthetic results (p = 0.047), as operators gave significantly better grades. Our results imply that this procedure and reconstructive method possibly cause impairments that have an impact on the patients’ wellbeing. Moreover, our outcomes also suggest that patients should be educated and rehabilitated after the “commando operation” since most of them were reluctant to seek professional help regarding their impairments. Lastly, sleep deficiency, which was observed after the procedure, should be further explored.

YouTube as a Source of Patient Information Regarding Exercises and Compensated Maneuvers for Dysphagia

OBJECTIVE

Acquiring online health-related information has become increasingly widespread. In this study, we aimed to evaluate the quality of the most-viewed YouTube videos on dysphagia regarding exercises and compensated maneuvers.

METHOD

We searched for the keywords "dysphagia exercise", "dysphagia rehabilitation", "dysphagia maneuver", "dysphagia therapy", and "dysphagia compensation" on YouTube on 5 February 2021. The educational quality of videos on YouTube was investigated based on the Global Quality Scale (GQS) and categorized into three groups: high-, intermediate-, and low-quality. The modified DISCERN tool was used to evaluate the reliability of the YouTube videos. Video parameters were compared between the groups according to the quality of the videos.

RESULTS

Of the 51 videos evaluated, according to the GQS, 54.9% (n = 28) were of high-quality, 35.3% (n = 18) were of intermediate-quality, and 9.8% (n = 5) were of low-quality, respectively. When the video parameters were compared among the groups, there were no significant differences in the number of views, likes, dislikes, or comments per day (p > 0.05). However, there was a significant difference in the DISCERN scores between the groups (p < 0.001).

CONCLUSION

YouTube can be deemed as a predominant source for high-quality videos on dysphagia exercise and compensated maneuvers. However, YouTube should be accepted as a mixed pool, with high-, intermediate-, and low-quality videos. Therefore, healthcare professionals, such as physicians and therapists, should verify the suitability and quality of the video, and suggest it to the patient, to ensure that the patient obtains the appropriate information.

Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Choosing the Feeding Method for Stroke Patients with Dysphagia

INTRODUCTION

The Videofluoroscopic Dysphagia Scale (VDS) is used to predict the long-term prognosis of dysphagia in patients with strokes. However, the inter-rater reliability of the VDS was low in a previous study. To overcome the mentioned limitations of the VDS, the modified version of the VDS (mVDS) was created and clinically applied to evaluate its usefulness in choosing the feeding method for stroke patients with dysphagia.

METHODS

The videofluoroscopic swallowing study (VFSS) data of 56 stroke patients with dysphagia were collected retrospectively. We investigated the presence of aspiration pneumonia and the selected feeding method. We also evaluated the correlations between the mVDS and the selected feeding method, and between the mVDS and the presence of aspiration pneumonia after stroke. Univariate logistic regression and receiver operating characteristic analyses were used in the data analysis.

RESULTS

The inter-rater reliability (Cronbach α value) of the total score of the mVDS was 0.886, which was consistent with very good inter-rater reliability. In all patients with dysphagia, the supratentorial stroke subgroup, and the infratentorial stroke subgroup, the mVDS scores were statistically correlated with the feeding method selected (p < 0.05) and the presence of aspiration pneumonia (p < 0.05).

CONCLUSIONS

The mVDS can be a useful scale for quantifying the severity of dysphagia, and it can be a useful tool in the clinical setting and in studies for interpreting the VFSS findings in stroke patients with dysphagia. Further studies with a greater number of patients and various stroke etiologies are required for more generalized applications of the mVDS.