Dysphagia最新文献

In age-related swallowing decline, low tongue pressure (LTP) represents a localized functional decline, and sarcopenia represents a systemic functional decline. However, their combined relationship with swallowing function is not fully understood. We examined whether the coexistence of LTP and sarcopenia is associated with pharyngeal residue, an indicator of swallowing efficiency, among older patients with dysphagia. A cross-sectional study was conducted in 102 outpatients aged 65 years or older with dysphagia and no clear underlying pathology. LTP and sarcopenia were assessed, and their coexistence was quantified using an original Tongue-Sarcopenia Composite Score (TSCS; 0-2 points). The primary outcome was pharyngeal residue (Bolus Residue Scale ≥ 2) after ingestion of semisolid food, as evaluated via videofluoroscopic swallowing studies. The association was analyzed using multiple logistic regression. LTP was observed in 69.6% of patients, sarcopenia in 49.0%, and their coexistence in 38.2%. The prevalence of pharyngeal residue increased stepwise across TSCS groups: 30.0% in the 0-point group, 60.5% in the 1-point group, and 82.1% in the 2-point group (p < 0.001). Multivariable analysis showed an association between TSCS and pharyngeal residue (adjusted odds ratio, 3.53; 95% confidence interval, 1.86 to 7.22). This association remained consistent across sensitivity analyses. In older patients with dysphagia who had no clear underlying pathology, the coexistence of LTP and sarcopenia was associated with pharyngeal residue. Combined assessment of both factors revealed stepwise differences in prevalence.

Prophylactic swallowing exercises (PSE) can mitigate (the consequences of) radiation associated dysphagia (RAD) in head and neck cancer (HNC) patients, provided patients adhere to a high-intensity program. However, patient adherence, a multifactorial concept influenced by several confounders, has been found to vary considerably between studies and individuals. PSE-related adherence confounders such as gender, smoking at baseline, baseline depression and high baseline fatigue levels have already been postulated. The influence of personality on adherence to PSE has not yet been investigated. Therefore, the aim of this secondary analysis of the Presto-trial is to examine the influence of personality traits on overall adherence rates to a PSE-program. One hundred fifty patients with a stage III or IVA-B (TNM7) newly diagnosed squamous cell carcinoma of the oropharynx -treated with (chemo)radiotherapy (C)RT - were included in the PRESTO-trial. One hundred sixteen out of the 150 participants completed the NEO Five Factor Inventory (NEO-FFI) personality questionnaire prior to starting RT. The NEO-FFI is a validated 60 item self-report questionnaire with 12 items per personality trait (neuroticism, extraversion, altruïsm, conscientiousness and openness). Statistical analysis was performed using simple and multiple regression models for the 5 personality traits. This study shows that the personality trait openness significantly influences overall adherence rates to PSE in HNC (p = 0.047). Higher scores on the personality trait openness increase overall adherence rates (β = 0.058, SE = 0.0290). Although, this singular statistical result has a very small effect size (OR 1.06), meaning that it is not likely a meaningful difference to consider any practice change. The personality traits extraversion, neuroticism, conscientiousness and altruism are not significantly related to overall adherence during PSE. This study is the first to explore the relationship between personality traits and adherence to PSE in HNC. While openness showed a statistically significant association with overall adherence, the effect size was very small and is unlikely to be of clinical relevance. No other personality traits demonstrated a significant relationship with adherence.

This systematic review and meta-analysis critically examine the efficacy of combined rehabilitation strategies, specifically the integration of swallowing exercises, neuromuscular electrical stimulation (NMES), and neuromuscular taping (NMT), in the management of post-stroke dysphagia. Four databases (Scopus, ScienceDirect, Cochrane Library, and PubMed) were searched for studies published from January 1990 to December 2024. Reference lists from relevant articles were also reviewed. A total of 372 studies were identified. After screening titles, abstracts, and full texts, 18 studies met the inclusion criteria.

Population: Adults (≥ 18 years) with post-stroke dysphagia in the acute or subacute phases.

Intervention: Swallowing exercises, NMES, NMT, or a combination.

Comparator: Control groups with single interventions, usual care, or traditional therapies.

Outcomes: Primary outcomes included swallowing function, aspiration pneumonia reduction, and quality of life. Secondary outcomes examined the timing, intensity, and type of interventions. Data were extracted using a standardized form in Microsoft Excel, focusing on study characteristics, participant demographics, intervention details, and outcome measurements. This systematic review supports the effectiveness of combined intervention approaches for post-stroke dysphagia. The meta-analysis revealed a significant improvement in swallowing function, with a pooled effect size of -1.27, indicating reduced Penetration-Aspiration Scale (PAS) scores. The random-effects pooled effect size was - 1.49 (95% CI: -1.92 to -1.06). Substantial heterogeneity (I² = 67.37%) was observed, likely attributable to differences in study methodologies, intervention protocols, and participant characteristics. The findings support the efficacy of combined rehabilitation strategies for post-stroke dysphagia. Certain combined interventions, particularly those incorporating NMES, show promise of effectiveness. However, the effectiveness of other modalities, such as kinesiology taping and chin tuck against resistance, remains less consistent and requires further investigation.

Registration number: PROSPERO Registration ID: CRD42025645917.

This investigation assessed the impact of videofluoroscopic resolution on measures of swallow safety. Thirty adult and twenty infant swallow studies, all acquired at 30 frames and 30 pulses per second (fps, pps), were obtained from a publicly available repository of swallow studies. All swallow studies were altered to simulate 15 and 5 pulses per second. Safety was assessed using the penetration-aspiration score and a modified DIGEST safety score. Analysis of outcome measures was performed and compared across the three temporal resolutions (30, 15, and 5 pps). Significant differences in measures of safety occurred when lower pulse rates were employed. All 20 infant participants were classified as having safe swallows at 5 pps, despite 11 demonstrating unsafe swallows (PAS > 2) at 30 pps. This pattern was also observed in adult participants to a lesser extent. Reducing pulse rates below 30 pps significantly compromises the accuracy of swallow safety assessment for all age groups. The systematic underestimation of safety violations has direct implications for clinical decision-making and patient risk assessment. These findings support maintaining 30 fps/pps as the standard for videofluoroscopic swallow studies (VFSS) when swallow safety evaluation is paramount and suggest that alternative radiation reduction strategies should be prioritized over pulse rate reduction.

The purpose of this study was to develop and validate a clinical risk score (CRISPED) for predicting post-extubation dysphagia (PED) in critically ill children. We conducted a prospective cohort study in a pediatric intensive care unit of a tertiary hospital (2021-2025). Consecutive children aged 1 month to 15 years requiring invasive mechanical ventilation ≥ 24 h were eligible. PED was defined as Functional Oral Intake Scale < 6 at first post-extubation speech-language pathology (SLP) assessment. The candidate predictors were evaluated using LASSO logistic regression. The cohort was split into development (n = 300) and validation (n = 132) samples for model assessment. Overall, the PED incidence was 65% among 432 patients included in the study. Three independent predictors were retained: iatrogenic withdrawal syndrome, number of intubations, and intubation duration. The CRISPED score demonstrated strong discrimination in the development cohort (C-statistic 0.85, 95% CI 0.80-0.89; accuracy 75%; Brier score 0.14) with good calibration (Hosmer-Lemeshow p = 0.44). Bootstrap internal validation confirmed minimal optimism with corrected C-statistic 0.84. Performance remained robust in the validation cohort (C-statistic 0.86, 95% CI 0.79-0.92; accuracy 80%; Brier score 0.15). Risk stratification into low (≤ 13 points), intermediate (14-17), and high (≥ 18) categories showed progressive PED prevalence: 21.8%, 61.5%, and 87.5% (p < 0.001). For severe PED (tube dependent patients), discrimination remained good (C-statistic 0.80; accuracy 75.8%). The CRISPED score provides accurate risk stratification for PED using three readily available clinical variables. It enables early identification of high-risk patients for prioritized SLP interventions, potentially improving clinical outcomes. External multicenter validation is essential before widespread clinical implementation.

Oropharyngeal dysphagia is a prevalent and clinically significant toxicity in patients with head and neck cancer undergoing concurrent chemotherapy and radiotherapy (CCRT). Preventive swallowing interventions, including exercise-based programs initiated during CCRT, are increasingly adopted in clinical practice to minimize CCRT-induced dysphagia. However, maintaining consistent therapeutic adherence remains a major clinical challenge, potentially limiting the effectiveness of these interventions. This study aimed to examine the impacts of a group-based prophylactic swallowing intervention in patients with head and neck cancer (HNC) treated with concurrent chemotherapy and radiotherapy (CCRT). We conducted a retrospective cohort study examining (a) swallowing-related outcomes, (b) therapy attendance and (c) health-related quality of life (HRQOL) outcomes in patients who participated in either (1) an individual prophylactic swallowing intervention (I-PSI), or (2) a group-based prophylactic swallowing intervention (GB-PSI) using Bayesian regression models. Data from 188 medical charts (I-PSI: n = 101; GB-PSI = 87) were included for analysis. Patients in the GB-PSI cohort had a significantly lower probability of reactive nasogastric tube placement compared to the I-PSI cohort (-0.14 [-0.27, -0.06]). They presented with significantly lower dysphagia toxicity grades during CCRT (-0.48 [-0.32, -0.71]) and at treatment completion (-0.44 [-0.27, -0.63]), along with a lower probability of experiencing grade dysphagia at the end of CCRT (-0.2 [-0.07, -0.32]). The GB-PSI cohort attended more therapy sessions during CCRT (1.76 [1.18, 2.1]) but needed fewer swallowing therapy sessions following treatment completion (-0.52 [-0.92, -0.09]). The small sample size for HRQOL did not allow for statistical analysis. Results suggest that a group-based prophylactic swallowing intervention may be a valuable option for patients undergoing CCRT for HNC. Prospective studies are needed to further explore its impact on therapeutic adherence and a broader range of swallowing-related outcomes.

Thickened liquid (TL) is commonly used to aid swallowing and prevent aspiration in dysphagia patients. We hypothesized that incorporating air bubbles into TL (TLB) could reduce viscosity and pharyngeal residue, improving swallowing dynamics. This study included 24 adults (17 males, 7 females; mean age: 75.8 ± 11.4 years) with Dysphagia Severity Scale scores of 3 or 4, excluding those with laryngeal penetration or aspiration when swallowing 4 mL of TL. Test samples consisted of TL with 3% wt/vol thickening agent and TLB. Type E viscosity and texture profile analysis were conducted. The subjects were administered 4 ml of thickened liquid and 4 ml of thickened liquid with bubbles three times each in a random order. Swallowing dynamics were evaluated using videofluoroscopy, measuring hyoid displacement, velocity, duration, pharyngeal transit time, upper esophageal sphincter (UES) opening width, and pharyngeal residue ratios. No significant differences were observed in adhesion or cohesion between TL and TLB, while viscosity and specific gravity tended to be lower for TLB. Compared to TL, TLB significantly increased hyoid anterior displacement and velocity (p = 0.03, p < 0.01, respectively), shortened movement duration (p < 0.01), and widened UES opening (p < 0.01). Additionally, pyriform sinus residue ratio significantly decreased (p = 0.02). These findings suggest that TLB positively influences swallowing dynamics and reduces pharyngeal residue.