Dysphagia最新文献

The aim of the present study was to investigate the effects of game-based electromyography (EMG)-biofeedback therapy on swallowing functions and quality of life in patients with post-stroke dysphagia. The prospective, double-blind, randomized controlled trial included 33 patients with post-stroke dysphagia. The study group performed the Mendelsohn maneuver and effortful swallow using game-based EMG-biofeedback, while the control group performed the Mendelsohn maneuver and effortful swallow using only verbal feedback for 30 min in 15 sessions in total. Before and during the trial, patients were evaluated using clinical swallowing assessments such as the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS), Dysphagia Outcome and Severity Scale (DOSS), and Dysphagia Handicap Index (DHI). Statistically significant improvement was found in FOIS scores (p = 0.038), PAS-Liquid scores (p = 0.026), and DOSS scores (p = 0.003) in the study group, while there was no statistically significant change in the control group. While PAS-Semisolid scores improved in both groups (study group, p = 0.002; control group, p = 0.023), post-treatment scores were statistically significantly higher in the study group than in the control group (p = 0.031). Although statistically significant improvement was found in DHI total, physical, emotional, and functional scores in both groups at the end of treatment (p < 0.05 for all), the post-treatment DHI scores were statistically significantly higher in the study group compared to those in the control group (p < 0.05 for all). The addition of game-based EMG-biofeedback to conventional treatment improved clinical and radiological assessments demonstrated by FOIS, PAS-Liquid, and DOSS scores and resulted in a statistically significant improvement in PAS-Semisolid and DHI scores. In conclusion, we believe that the inclusion of game-based EMG-biofeedback therapy in swallowing rehabilitation programs may have a positive impact on treatment outcomes.

Oropharyngeal dysphagia (OD) is a prevalent issue in hospitalized COVID-19 patients. This study aimed to determine swallowing abnormalities in post-COVID-19 patients with OD and to determine the potential risk factors of aspiration in patients who have recovered from COVID-19. Screening for OD was done for 310 patients who were discharged from the main university isolation hospital during the study period. A longitudinal descriptive study was carried out on 127 adult post-COVID-19 patients between the ages of 24 and 65 years who failed OD screening at the time of discharge. Instrumental swallowing assessment was done using fiberoptic endoscopic evaluation of swallowing (FEES) at one of two different time points: one-week post-discharge (Group 1) and 3-4 weeks post-discharge (group 2). The prominent swallowing abnormalities were delayed triggering of swallowing reflex, laryngeal penetration, tracheal aspiration, as well as vallecular and pyriform sinuses residue with lower frequencies and milder degrees in group 2 than in group 1 patients. Statistically significant associations were found between the presence of ageusia and anosmia in post-COVID-19 patients and both impaired laryngeal sensation and delayed triggering of the swallowing reflex. Significant associations were detected between aspiration in post-COVID-19 patients and the following factors: higher Eating Assessment Tool (EAT-10) scores, presence of dysphonia, higher respiratory rate, and the longer duration of the use of noninvasive ventilation (NIV) and/or invasive mechanical ventilation (IMV). The combined higher EAT-10 scores and higher respiratory rate predicted aspiration in post-COVID-19 patients by an overall percentage of 87.1.

Multiple Sclerosis (MS) is a common chronic disease among young adults. It affects various aspects of Quality of Life (QOL). Dysphagia is a problem associated with neurological damage in MS patients. This study aimed to compare MS patients' QOL with and without dysphagia. This is a cross-sectional study performed on 40 patients with MS (20 with and 20 without dysphagia) selected from the MS Society members of Ahvaz, Iran. Research tools included the Persian version of Dysphagia in Multiple Sclerosis (DYMUS), Mini-Mental State Examination (MMSE), and Multiple Sclerosis Quality of Life-54 (MSQOL-54). The data were analyzed by SPSS software version 22 and the Mann-Whitney test. The results showed a significant difference in QOL score amongst patients with and without dysphagia. The QOL score of patients with dysphagia was significantly lower than patients without dysphagia. The main differences in the subscale of the QOL Index were mental component and physical activity. MS patients with dysphagia had lower QOL than patients without it. The results show that the quality of life of MS patients with dysphagia is lower than the quality of life of MS patients without dysphagia, and this issue includes different physical and mental aspects of the quality of life of these patients. According to the findings of this study, it seems that early referral of patients with MS to speech and language pathologists for the management of swallowing disorders in the early stages of the disease can be very important and help improve the wellbeing of these patients and their families.

The impact of oropharyngeal dysphagia (OD) on older adults is recognized in Western countries but has not received sufficient attention in China. The dysphagia handicap index (DHI) scale is an OD quality-of-life evaluation instrument. This study evaluated the psychometric properties of the Chinese version of DHI scale in older Chinese adults. A total of 600 older adults were recruited from five nursing homes in one city to complete the 25-item scale. The reliability and validity of the scale were evaluated: internal consistency was investigated using Cronbach's alpha; test-retest reliability was evaluated using the intraclass correlation coefficient; the content validity of the scale was evaluated using content validity ratio; and the factor structure was examined using an exploratory factor analysis, principal component analysis, and confirmatory factor analysis. The scale was divided into three subscales: physical, functional, and emotional. Cronbach's alpha was 0.97 for the entire scale and between 0.89 and 0.94 for the three subscales. The item-to-total correlation coefficients for the three subscales were between 0.63 and 0.92, and the test-retest correlation coefficient was 0.87. The content validity was 0.93. In the factor analysis, these three factors accounted for 75.3% variance of 25 items. The confirmatory factor analysis was significant (p < 0.0001). The Chinese version of dysphagia index scale had good reliability and validity. Thus, it can provide a subjective evaluation of older adults with OD and can be used by clinicians to improve the outcomes of older adults with OD.

The MDADI is a validated tool for assessing quality of life in several languages, often used for patients with head and neck cancer (HNC). It has never been translated and validated in Canadian French, which bears significantly different linguistic characteristics compared to European French. Our objective was to validate a Canadian French version of the MDADI (MDADI-CF) for HNC patients suffering from dysphagia. The MDADI-CF was developed using the translation-back-translation method. Participants were recruited from an outpatient clinic: those suffering from dysphagia secondary to HNC comprised the experimental group, while those without dysphagia comprised the control group. They were asked to complete the MDADI-CF and the SWAL-QoL, another similar questionnaire on dysphagia which has been validated in French. A subgroup of patients also received a second MDADI-CF to complete one week later. Feasibility, internal consistency, construct validity, and test-retest reliability were all assessed. 93% of patients completed the questionnaire without leaving any questions blank. Internal consistency analyses demonstrated a Cronbach's alpha > 0.7 for all subscales of the questionnaire. Convergent validity was confirmed with a high correlation between the MDADI-CF scores and French SWAL-QOL (0.91, p < 0.0001). Discriminant validity was also demonstrated by the significant difference between MDADI-CF scores of patient vs control group (93.3 vs 62.4, p < 0.0001). Test-retest reliability was demonstrated with an intraclass correlation coefficient of 0.918 on the total score between the first and second questionnaire completion. Our results demonstrate that the MDADI-CF I is valid and should be used in evaluating dysphagia in the Canadian Francophone population.

Motor imagery practice (MP), or visualizing performing a task without executing it, is an effective intervention for the limbs and tongue. However, MP of expiratory muscle strength training (EMST) and voluntary cough (VC) has not been explored. We examined the feasibility and impact of MP of VC and EMST on pulmonary and cough function in twenty community-dwelling adults. Participants underwent two baseline research evaluations of maximum expiratory and inspiratory pressure (MEP, MIP), forced vital capacity (FVC), voluntary peak expiratory flow rate (PEF), and cough spirometry. After the second research evaluation, participants underwent five weeks of MP of VC or EMST (alternating assignment, 25 repetitions, 70% training load, daily) at home with weekly telehealth sessions. Participants underwent post-treatment research evaluations of MEP, MIP, FVC, PEF, cough spirometry, and the Exercise Therapy Burden Questionnaire (ETBQ). Treatment adherence and telehealth attendance were tracked. Descriptives and Wilcoxon signed rank tests were performed. MP adherence was 95% and telehealth attendance was 91%. Median (IQR) ETBQ scores were 8 (1, 15), indicating minimal burden. Across both MP groups, increases in PEF from a handheld device (+ 13.7, 95% CI: 1.8, 25.6, p = 0.03) and from cough spirometry (+ 0.71, 95% CI: 0.05, 1.4, p = 0.04) were observed. Increases in PEF from cough spirometry (+ 1.00, 95% CI: 0.12, 1.9, p = 0.04) were observed for the MP VC group. Preliminary data demonstrate MP of VC and EMST is feasible and improves voluntary cough in community-dwelling adults. Future research is needed in larger sample sizes and patient populations with pulmonary, cough, and swallowing impairments.

To evaluate the impact of the elevation training mask (ETM) on swallowing safety and swallowing efficiency in patients with Parkinson's disease (PWP) when used as a respiratory muscle strengthening tool. Study Design. Prospective cohort study. Setting. Tertiary university-affiliated medical center. Thirteen PWP underwent Fiberoptic Endoscopic Evaluation of Swallowing and spirometry assessments both before and after a 4-week ETM use, which included incrementally increasing resistance each week. Measurements taken included EAT-10, swallowing disturbances questionnaire (SDQ), Penetration Aspiration Score (PAS), Yale Pharyngeal Residue Severity Rating Scale, and Peak Expiratory Flow (PEF). Disease severity was assessed using the Unified Parkinson's Disease Rating Scale (UPDRS). Eleven out of 13 male participants (median age 70 years, UPDRS 33, disease duration 8.5 years) completed the 4-week protocol (84.6% completion rate). Vallecular residue significantly decreased for solids (median from 3.0 [IQR: 2.0-3.0] to 2.0 [IQR: 1.0-2.0], p = 0.028) and semi-solids (from 3.0 [IQR: 2.0-4.0] to 2.0 [IQR: 1.0-3.0], p = 0.025), with a non-significant improvement for liquids (from 2.0 [IQR: 2.0-2.0] to 2.0 [IQR: 1.0-2.0], p = 0.19). Patient-reported outcomes (EAT-10, SDQ, VHI-10, RSI) and PEF showed non-significant trends toward improvement. A 4-week use of ETM, serving as a form of respiratory muscle strengthening, demonstrated specific improvements in vallecular residue for semi-solid and solid consistencies in PWP with dysphagia. While other swallowing and respiratory measures showed positive trends, these changes did not reach statistical significance. Further research with a larger cohort is needed to evaluate ETM's role in swallowing rehabilitation.

Videofluoroscopic Swallowing Study (VFSS) is considered the gold standard for diagnosing swallowing disorders, or dysphagia. However, the interpretation of VFSS is susceptible to human bias and subjectivity, resulting in significant inter- and intra-patient variability. In this context, artificial intelligence (AI) has emerged as a potentially valuable tool for physicians. This study reviews state-of-the-art research utilizing AI to analyze VFSS for the assessment of swallowing disorders and to support clinical decision-making. Our comprehensive analysis highlights substantial progress in areas such as pharyngeal phase detection, segmentation and identification of the bolus and hyoid bone, and penetration-aspiration detection. Despite these advancements, an end-to-end automated AI tool for VFSS analysis has yet to be developed. However, there is considerable potential for AI applications in areas like exploring the clinical relevance of segmented or tracked components and expanding the scope to include more upper aerodigestive components in the analysis. Additionally, we discuss the limitations of current research, including the lack of publicly available datasets, the need to address the generalizability of AI models, the integration of cutting-edge AI techniques, and the clinical implications for speech-language pathologists.

Pharyngolaryngeal secretions, penetration, and aspiration belong to the cardinal symptoms of swallowing disorders in head and neck cancer patients. In order to provide safe swallowing diagnostics, it is of interest whether pharyngolaryngeal secretion accumulations can be used as a predictor for penetration and aspiration of food and liquids. This study analyzed the predictive power of pharyngolaryngeal secretion accumulations for the penetration and aspiration in head and neck cancer patients. Between 2016 - 2024, 403 head and neck cancer patients underwent swallowing diagnostics via Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Pharyngolaryngeal secretions were graded with the secretion severity rating scale (SSRS) by Murray et al., penetration and aspiration with the penetration-aspiration scale (PAS) by Rosenbek et al. Both scales were cross-tabulated and correlated with each other. Possible influencing factors on PAS were analyzed by Spearman's correlations and Kruskal-Wallis-H-tests: patients' age, tumor stage and site, type of the oncological therapy, and time of examination. A linear regression and a Categorical Principal Components Analysis were utilized for the same purpose. Higher SSRS and PAS values tended to co-occur. In univariate calculations, the tumor stage and time of examination showed significant correlations with PAS. In multivariate analyses, the tumor stage, patients' age, but above all the SSRS were shown to be significant influencing factors on PAS. Pharyngolaryngeal secretion accumulations can be used for the prediction of aspiration of food and liquids and thus for the improvement of safety of the swallowing diagnostics via FEES.

Cervical auscultation, commonly used by speech-language pathologists in some countries as an adjuvant to the clinical feeding evaluation, requires data on acoustic and perceptual profiles of swallowing sounds. Whilst these exists in adults and children, none currently exist for preterm neonates. Our study aims to establish the acoustic and perceptual parameters of swallowing sounds in preterm neonates. Swallowing sounds were recorded on a digital microphone during oral feeding observations. Acoustic parameters of duration, peak frequency, peak power and peak intensity were determined. Perceptual parameters heard pre, during and post-swallows were rated as 'present', 'absent', or 'cannot be determined'. Eighty preterm neonates (43 males; mean age = 33.4 weeks [SD 2.6]) from three Australian special care nurseries demonstrated mean swallow durations of < 1 s. The peak amplitude correlated with the number of medical co-morbidities (r = 0.24; 95%CI 0.03-0.45). Most preterm neonates have coordinated swallows that are loud, quick and completed in < 1 s. The perceptual parameters of a bolus transit sound was consistently present in all preterm neonates. One in five pre-term neonates have an uncoordinated swallow where wheeze, stridor or wet breath sounds were present post-swallow. Our study provides clinicians with acoustic and perceptual parameters to guide use of cervical auscultation in special care nurseries. Future studies should consider simultaneous instrumental assessment to ensure validity when using cervical auscultation to support diagnostic decision-making on swallowing coordination.