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Eimoto K, Nagai K, Nakao Y, Uchiyama Y, Domen K. Swallowing Rehabilitation With Neuromuscular Electrical Stimulation for Sarcopenic Dysphagia: A Case Report. Cureus 2024; 16:e59256. [PMID: 38813342 PMCID: PMC11136547 DOI: 10.7759/cureus.59256] [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] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing-related muscles. We present a case of sarcopenic dysphagia with improved swallowing function after strength training of swallowing-related muscles using neuromuscular electrical stimulation (NMES). A 78-year-old man was admitted to our hospital with an intraductal papillary mucinous tumor of the pancreatic duct. After admission, the patient developed aspiration pneumonia and was placed on strict bed rest without oral intake, which resulted in progressive malnutrition. At the start of swallowing rehabilitation, he had whole-body sarcopenia, nutritional impairment, and weakness in swallowing-related muscles, with a maximum tongue pressure of 21.4 kPa and an opening force of 5.1 kg. In the videofluoroscopic swallowing study, he aspirated 3 cc of a moderately thick liquid. Consequently, as part of swallowing rehabilitation, strengthening training of swallowing-related muscles with NMES was undertaken for about three weeks. As a result, the maximum tongue pressure and opening force improved to 28.4 kPa and 6.8 kg, respectively. A subsequent videofluoroscopic swallowing study showed no obvious aspiration during any procedure. The patient was discharged on the 86th day on a regular diet. As a component of swallowing rehabilitation, NMES may offer therapeutic benefits for patients with sarcopenic dysphagia.
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Affiliation(s)
- Kazuki Eimoto
- Department of Rehabilitation, Hyogo Medical University Hospital, Nishinomiya, JPN
| | - Koutatsu Nagai
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, JPN
| | - Yuta Nakao
- Department of Rehabilitation, Yamato University, Suita, JPN
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, School of Medicine, Hyogo Medical University, Nishinomiya, JPN
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Wang K, Cheng Z, Qiao D, Xie F, Zhao S, Zhang B. Polysaccharide-dextrin thickened fluids for individuals with dysphagia: recent advances in flow behaviors and swallowing assessment methods. Crit Rev Food Sci Nutr 2024:1-25. [PMID: 38556920 DOI: 10.1080/10408398.2024.2330711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The global aging population has brought about a pressing health concern: dysphagia. To effectively address this issue, we must develop specialized diets, such as thickened fluids made with polysaccharide-dextrin (e.g., water, milk, juices, and soups), which are crucial for managing swallowing-related problems like aspiration and choking for people with dysphagia. Understanding the flow behaviors of these thickened fluids is paramount, and it enables us to establish methods for evaluating their suitability for individuals with dysphagia. This review focuses on the shear and extensional flow properties (e.g., viscosity, yield stress, and viscoelasticity) and tribology (e.g., coefficient of friction) of polysaccharide-dextrin-based thickened fluids and highlights how dextrin inclusion influences fluid flow behaviors considering molecular interactions and chain dynamics. The flow behaviors can be integrated into the development of diverse evaluation methods that assess aspects such as flow velocity, risk of aspiration, and remaining fluid volume. In this context, the key in-vivo (e.g., clinical examination and animal model), in-vitro (e.g., the Cambridge Throat), and in-silico (e.g., Hamiltonian moving particles semi-implicit) evaluation methods are summarized. In addition, we explore the potential for establishing realistic assessment methods to evaluate the swallowing performance of thickened fluids, offering promising prospects for the future.
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Affiliation(s)
- Kedu Wang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Zihang Cheng
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Dongling Qiao
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Fengwei Xie
- Department of Chemical Engineering, University of Bath, Bath, UK
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Siming Zhao
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Binjia Zhang
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
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Kongjaroen A, Methacanon P, Gamonpilas C. Effects of barium sulfate on rheological properties and IDDSI flow consistency of liquid stimuli prepared using commercial thickening powders. J Texture Stud 2023; 54:835-844. [PMID: 37340614 DOI: 10.1111/jtxs.12784] [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: 04/05/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/22/2023]
Abstract
During videofluoroscopic swallowing study (VFSS), barium sulfate (BaSO4 ) is commonly added into food samples as a radiopaque contrast media for bolus visualization and examination. Accordingly, the consistency and flow behavior of barium stimuli can differ significantly from their non-barium counterparts. Such differences may have a subsequent impact on the validity of VFSS. Therefore, in this study, effects of barium sulfate on the shear and extensional rheological properties and IDDSI (International Dysphagia Diet Standardization Initiative) flow consistency of liquids prepared using various commercial thickening powders were investigated. Results showed that all barium stimuli exhibited shear thinning behavior but with significantly higher shear viscosity compared to the non-barium counterparts. A shift factor of viscosity at shear rate 50 s-1 with values in range of 1.21-1.73 could be used to describe the increase in the viscosity for samples thickened with gum-based thickeners. However, the change in the viscosity was not invariant for the stimuli prepared starch-based thickener. The addition of BaSO4 had a negative impact on extensional properties of samples by demonstrating a faster filament rupture. The extent of impact on the decrease in filament breakup time was more pronounced in xanthan > guar gum ≈ tara gum-based thickeners. Based on the IDDSI flow test, no significant effect of BaSO4 was found on the gum-based thickeners, whereas there was a marked effect in the starch-based sample. These results can be used beneficially to assist clinicians in the dysphagia diagnosis for matching rheological properties of the barium stimuli to enhance effectiveness dysphagia interventions.
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Affiliation(s)
- Akapong Kongjaroen
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Khlong Luang, Pathumthani, Thailand
| | - Pawadee Methacanon
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Khlong Luang, Pathumthani, Thailand
| | - Chaiwut Gamonpilas
- Advanced Polymer Technology Research Group, National Metal and Materials Technology Center (MTEC), NSTDA, Khlong Luang, Pathumthani, Thailand
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Dhar SI, Nativ-Zeltzer N, Starmer H, Morimoto LN, Evangelista L, O'Rourke A, Fritz M, Rameau A, Randall DR, Cates D, Allen J, Postma G, Kuhn M, Belafsky P. The American Broncho-Esophagological Association Position Statement on Swallowing Fluoroscopy. Laryngoscope 2023; 133:255-268. [PMID: 35543231 DOI: 10.1002/lary.30177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/14/2022] [Accepted: 04/24/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop an expert consensus statement on the clinical use of swallowing fluoroscopy in adults that reduces practice variation and identifies opportunities for quality improvement in the care of patients suffering from swallowing impairment. METHODOLOGY A search strategist reviewed data sources (PubMed, Embase, Cochrane, Web of Science, Scopus) to use as evidence for an expert development group to compose statements focusing on areas of controversy regarding swallowing fluoroscopy. Candidate statements underwent two iterations of a modified Delphi protocol to reach consensus. RESULTS A total of 2184 publications were identified for title and abstract review with 211 publications meeting the criteria for full text review. Of these, 148 articles were included for review. An additional 116 publications were also included after reviewing the references of the full text publications from the initial search. These 264 references guided the authors to develop 41 candidate statements in various categories. Forty statements encompassing patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study and esophagram techniques, and interpretation of swallowing fluoroscopy met criteria for consensus. One statement on esophagram technique reached near-consensus. CONCLUSIONS These 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults can guide the development of best practices, improve quality and safety of care, and influence policy in both the outpatient and inpatient settings. The lack of consensus on some aspects of esophagram technique likely reflects gaps in knowledge and clinical practice variation and should be a target for future research. Laryngoscope, 133:255-268, 2023.
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Affiliation(s)
- Shumon Ian Dhar
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Nogah Nativ-Zeltzer
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Heather Starmer
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | | | - Lisa Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Ashli O'Rourke
- Department of Otolaryngology-Head and Neck Surgery, Evelyn Trammell Institute for Voice and Swallowing, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Mark Fritz
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Anaïs Rameau
- The Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, U.S.A
| | - Derrick R Randall
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Cates
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Jacqueline Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Gregory Postma
- Department of Otolaryngology-Head & Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, U.S.A
| | - Maggie Kuhn
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
| | - Peter Belafsky
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, Sacramento, California, U.S.A
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Park J, Yoo B. Rheological properties of thickened barium liquids prepared with xanthan gum‐based thickener and barium powder used in the diagnosis of dysphagia: Effect of thickener concentration and serving temperature. J FOOD PROCESS PRES 2021. [DOI: 10.1111/jfpp.15234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jaechun Park
- Department of Food Science and Biotechnology Dongguk University‐Seoul Goyang Korea
| | - Byoungseung Yoo
- Department of Food Science and Biotechnology Dongguk University‐Seoul Goyang Korea
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Impact of Thickened Liquids on Laryngeal Movement Velocity in Patients with Dysphagia. Dysphagia 2021; 37:207-215. [PMID: 33709290 DOI: 10.1007/s00455-021-10267-7] [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: 04/25/2020] [Accepted: 02/13/2021] [Indexed: 10/21/2022]
Abstract
Considering that thickened liquids are frequently used for patients with dysphagia, elucidating their impact on laryngeal dynamics is important. Although studies have investigated the impact of thickened liquids on laryngeal movement velocity among healthy young adults, no study has examined the same among patients with dysphagia. We aimed to elucidate the influence of bolus consistency on laryngeal movement velocity and surface electromyographic activity of the suprahyoid muscles in patients with dysphagia. Participants included 18 male, poststroke patients with dysphagia, whereas patients with true bulbar paralysis, head and neck cancer, neuromuscular disease, or recurrent nerve paralysis were excluded. A video fluoroscopic swallowing study (VFSS) was performed while swallowing 3 mL of moderately thick and thin liquids. Quantitative VFSS analysis, including factors such as laryngeal peak velocity, laryngeal mean velocity, laryngeal movement distance, duration of the laryngeal elevation movement, and the temporal location of laryngeal vestibule closure within the laryngeal elevation movement was performed. Muscle activity was evaluated using integrated muscles activity values obtained from electromyography (iEMG) of the suprahyoid muscle during swallowing. VFSS analysis showed that laryngeal peak velocity and laryngeal mean velocity were significantly faster while swallowing moderately thick than while swallowing thin liquids. Laryngeal movement distance was significantly greater while swallowing moderately thick than while swallowing thin liquids. iEMG was significantly higher while swallowing moderately thick liquids than while swallowing thin liquids. Compared to thin liquids, moderately thick induced an increase in laryngeal movement velocity and in suprahyoid muscle activity among patients with dysphagia, a finding consistent with that of a previous study among healthy adults.
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Moss M, White SD, Warner H, Dvorkin D, Fink D, Gomez-Taborda S, Higgins C, Krisciunas GP, Levitt JE, McKeehan J, McNally E, Rubio A, Scheel R, Siner JM, Vojnik R, Langmore SE. Development of an Accurate Bedside Swallowing Evaluation Decision Tree Algorithm for Detecting Aspiration in Acute Respiratory Failure Survivors. Chest 2020; 158:1923-1933. [PMID: 32721404 DOI: 10.1016/j.chest.2020.07.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The bedside swallowing evaluation (BSE) is an assessment of swallowing function and airway safety during swallowing. After extubation, the BSE often is used to identify the risk of aspiration in acute respiratory failure (ARF) survivors. RESEARCH QUESTION We conducted a multicenter prospective study of ARF survivors to determine the accuracy of the BSE and to develop a decision tree algorithm to identify aspiration risk. STUDY DESIGN AND METHODS Patients extubated after ≥ 48 hours of mechanical ventilation were eligible. Study procedures included the BSE followed by a gold standard evaluation, the flexible endoscopic evaluation of swallowing (FEES). RESULTS Overall, 213 patients were included in the final analysis. Median time from extubation to BSE was 25 hours (interquartile range, 21-45 hours). The FEES was completed 1 hour after the BSE (interquartile range, 0.5-2 hours). A total of 33% (70/213; 95% CI, 26.6%-39.2%) of patients aspirated on at least one FEES bolus consistency test. Thin liquids were the most commonly aspirated consistency: 27% (54/197; 95% CI, 21%-34%). The BSE detected any aspiration with an accuracy of 52% (95% CI, 45%-58%), a sensitivity of 83% (95% CI, 74%-92%), and negative predictive value (NPV) of 81% (95% CI, 72%-91%). Using recursive partitioning analyses, a five-variable BSE-based decision tree algorithm was developed that improved the detection of aspiration with an accuracy of 81% (95% CI, 75%-87%), sensitivity of 95% (95% CI, 90%-98%), and NPV of 97% (95% CI, 95%-99%). INTERPRETATION The BSE demonstrates variable accuracy to identify patients at high risk for aspiration. Our decision tree algorithm may enhance the BSE and may be used to identify patients at high risk for aspiration, yet requires further validation. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02363686; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO.
| | - S David White
- University of Colorado Denver Rehabilitation Therapy Services, University of Colorado Hospital, Aurora, CO
| | - Heather Warner
- Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Communication Disorders, Southern Connecticut State University, New Haven, CT
| | - Daniel Dvorkin
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO; The Bioinformatics CRO, Inc, Niceville, FL
| | - Daniel Fink
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
| | | | - Carrie Higgins
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Gintas P Krisciunas
- Department of Otolaryngology, Boston Medical Center, Boston, MA; Department of Otolaryngology, Boston University School of Medicine, Boston, MA
| | - Joseph E Levitt
- Division of Pulmonary and Critical Care, Stanford University, Stanford, CA
| | - Jeffrey McKeehan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Edel McNally
- Department of Otolaryngology, Boston Medical Center, Boston, MA; Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Alix Rubio
- Department of Otolaryngology, Boston Medical Center, Boston, MA
| | - Rebecca Scheel
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA; Division of Speech Language Pathology, Massachusetts General Hospital, Boston, MA
| | - Jonathan M Siner
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Rosemary Vojnik
- Division of Pulmonary and Critical Care, Stanford University, Stanford, CA
| | - Susan E Langmore
- Department of Otolaryngology, Boston Medical Center, Boston, MA; Department of Otolaryngology, Boston University School of Medicine, Boston, MA; Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
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