Dysphagia最新文献

Objective: This randomized, sham-controlled, double-blind study investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on both bilateral and unilateral brain regions in patients with poststroke dysphagia.

Methods: Seventy poststroke dysphagia patients were randomly divided into four intervention groups: the ipsilesional stimulation group (ISG), the contralesional stimulation group (CSG), the bilateral stimulation group (BSG), and the sham stimulation group (SSG) with 3 Hz rTMS administered for 4 weeks, five days per week. Outcomes were assessed using a videofluoroscopic swallowing study (VFSS) at three time points: at baseline before the intervention (T0), immediately after the intervention (T1), and four weeks after intervention cessation (T2). These assessments included the latency of wave V in brainstem auditory evoked potentials (BAEP), Dysphagia Outcome and Severity Scale (DOSS), Penetration and Aspiration Scale (PAS), and Videofluoroscopic Dysphagia Scale (VDS).

Results: The swallowing improvement of BSG and CSG were showed significantly greater than SSG (p < 0.05), while the ISG exhibited no significant differences in the DOSS and total VDS scores (p > 0.05). Furthermore, some sub-items of the VDS were lower than those in the SSG (p < 0.05). The latency of wave V in BAEP of ipsilesional and contralesional was synchronized and shortened in the BSG at T1 and T2; similar results were observed in the CSG at T2. In contrast, in the ISG, only the latency of ipsilesional V was shortened at T1 and T2 (p < 0.05).

Conclusions: The results of the present study provide evidence that 3 Hz rTMS is more effective than traditional dysphagia therapies when applied to the bilateral and contralesional motor cortices, especially bilaterally over the cortical areas projecting to the mylohyoid muscles. Functional recovery was observed after real rTMS compared to the SSG, with the effects persisting at T2.

Trial registration: Study on the imaging of swallowing function and multimodal brain function in stroke patients with dysphagia based on different lateral repetitive transcranial magnetic stimulation: a randomized controlled trial. ( http://www.chictr.org.cn/ , ChiCTR2100044993, April 3, 2021).

Understanding the effects of reduced frame rates on the reliability of Modified Barium Swallow (MBS) ratings for swallowing safety and efficiency is essential for clinical practice. While previous research has examined frame rate (simulated pulse rates) implications concerning penetration, aspiration, and residue ratings, the impact on summary grading systems like the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) remains unclear. This study analyzed a total of 315 full MBS videos collected from 278 patients, and 76.25% of patients were diagnosed with head and neck cancer (mean age 62.51 years, SD 8.53; 12.23% female). We performed pairwise comparisons of DIGEST grades and DIGEST grade components (Safety and Efficiency) derived independently across studies with 30, 15, and 7.5 frames per second (FPS). Weighted Cohen's kappa values consistently exceeded 0.84 across all assessments, indicating "almost perfect" agreement among the different simulated pulse rates. Exact agreement for all comparisons surpassed 85%. These findings suggest that the DIGEST grading system is robust to variations in frame rate, allowing for reliable assessments even under reduced pulse rate conditions.

Head lifting strength can be easily measured without special equipment. The relationship between head lifting strength and dysphagia is well-established. However, its association with Pharyngeal residuals-a risk factor for aspiration-has not yet been explored. This study aimed to determine the association between head lifting strength and Pharyngeal residuals, as assessed through a Videofluoroscopic swallowing study (VFSS), in older inpatients with suspected dysphagia. A total of 50 patients who underwent VFSS for suspected dysphagia were included. Head lifting strength was measured as the number of repetitions of maximum head lifting and the time to maintain maximum head lifting. The Normalized Residue Ratio Scale (NRRS) was scored at the valleculae (NRRSv) and piriform sinus (NRRSp) while swallowing 3 ml of a moderately thick liquid during the VFSS. Univariate and multiple regression analyses examined the relationship between head lifting strength and NRRSv and NRRSp. The time to maintain maximum head lifting and the number of repetitions of maximum head lifting were significantly negatively correlated with the NRRSv and NRRSp. However, in the adjusted multiple regression analysis model, only the number of repetitions of maximum head lifting was related to NRRSv and NRRSp. This study implies that a simple head lifting strength test can be implemented in the clinic to determine the risk of pharyngeal residuals after swallowing and, consequently, the possibility of aspiration.

To compare swallowing exercise adherence, swallowing function, and media satisfaction between stroke patients with dysphagia using a video-guided exercise program on mobile electronic devices versus those using a handbook. Randomized controlled trial. Forty-four stroke patients with dysphagia were randomized to either a video-guided intervention group (n = 23) or a handbook-based control group (n = 21). The prescribed exercises included lip exercises, tongue range of motion and strengthening, chin tuck against resistance (CTAR), and Masako exercises, performed as three sets of ten repetitions daily. Baseline swallowing function was assessed using the Functional Oral Intake Scale (FOIS), and adherence was self-reported via logbooks. Outcomes were reassessed at 1-month follow-up. Forty participants completed the study (21 intervention, 19 control). Baseline characteristics were comparable, except for a higher prevalence of left hemiparesis and a longer time since stroke onset in the intervention group. Exercise adherence was significantly higher in the intervention group (median 42.9% [IQR 24.6, 78.4]) compared to the control group (19.4% [IQR 0, 38.7]; p = 0.009). Both groups showed FOIS score improvements, with no significant between-group difference. Media satisfaction did not differ significantly. A video-guided swallowing exercise program delivered via mobile devices significantly improved adherence compared to handbook-based instruction. This approach may offer a feasible and accessible strategy for post-stroke dysphagia rehabilitation.

This study aimed to characterize the abnormal swallowing features observed during Videofluoroscopic Swallowing Studies (VFSS) in moderate to severe COVID-19 patients. From the JH CROWN cohort database (January 2020 to March 2022), a total of 3,660 patients with moderate to severe COVID - 19 disease requiring oxygen supplementation were identified. The study abstracted and reported VFSS referral rates and swallowing characteristics using Modified Barium Swallow Impairment Profile (MBSImP). 16% (n = 588) of patients exhibited dysphagia; only half underwent VFSS. Among those referred, 39.3% had COVID-19 severity level 7, 39% exhibited aspiration, and 30% had silent aspiration. Abnormal MBSImP scores were reported in the following components: tongue control during bolus hold (score 2/3, 40%), bolus transport and lingual motion (score 3/4, 34%), oral residue (score 2/4, 57.7%), initiation of pharyngeal swallow (score 3/4, 65.2%), laryngeal vestibular closure (score 1/2, 64.5%), and pharyngeal residue (score 2/4, 50.5%). In conclusion, this large cohort of COVID-19 patients exhibited a myriad of swallowing abnormalities in the oral and pharyngeal phases, with a notably high rate of silent aspiration. Moreover, differentiating COVID-19-induced dysphagia from post-extubation dysphagia is challenging.

The feeding swallowing impact survey (FS-IS) is an 18-question, 3 subscale, validated tool measuring parent/caregiver impact of children's eating, drinking and swallowing difficulties. This study aimed to establish reference values from parents of children without known or suspected paediatric feeding disorder for the FS-IS. Parents of children aged 6 months-11 years were invited to complete an anonymous, online questionnaire. The Pedi-EAT-10 was used to screen for pediatric feeding disorder. For the FS-IS average and cumulative scores were calculated for the whole scale and subscales. Percentile rankings were calculated for the cumulative whole scale score. The relationship between variables was explored using Spearman's correlation and 75th centile quantile regression. The final sample consisted of 904 parents. Median (IQR) whole scale score was 1.11 (1.06, 1.22), from a possible range of 1-5.. Percentile rank scores were: 5th = 18, 25th = 19, 50th percentile = 20, 75th = 22 and 95th = 29, from a possible range of 18-70. Parent perception of a feeding difficulty was the factor associated with greatest score increase. These data provide UK reference data for the FS-IS, facilitating its use in the evaluation of parental impact of feeding difficulties, a key component of holistic, family-centred care. Feeding-related QOL is largely unaffected in caregivers of children without a diagnosed or suspected pediatric feeding disorder.

This study investigated telemedicine as an alternative to home-visit medical care (HMC) when HMC for patients with dysphagia was suspended. This retrospective study assessed whether telemedicine reduced adverse events compared to suspending care during the initial 3 months of the coronavirus pandemic. Seventy-six HMC patients were enrolled. Those who received telemedicine formed the telemedicine group (TG), and those who declined comprised the suspended group (SG). Baseline data and adverse events, including whole-body and dysphagia-related adverse events, were analyzed using the Mann-Whitney U-test, Fisher's exact test, and binomial logistic regression. Of the 76 patients, 20 were in TG and 56 in SG. Telemedicine consultations' frequency was 1-3. Significant baseline differences occurred in the Charlson Comorbidity Index (CCI) and caregiver type. In the TG and SG, 0% and 12.5% of patients experienced whole-body adverse events and 10.0% and 33.9% had dysphagia-related adverse events, respectively. Dysphagia-related adverse events were significantly lower in TG (p = 0.046). Telemedicine was significantly associated with fewer dysphagia-related adverse events after adjusting for age, CCI, and Dysphagia Severity Scale (p = 0.040). Telemedicine effectively supplemented in-person dysphagia rehabilitation, enabling continued monitoring and reducing complications, although patient self-selection and caregiver support may have influenced outcomes.

The author identified three main operational definitions of presbyphagia in the specialized literature: (1) changes in healthy older people's swallowing, (2) a swallowing disorder compensated by physiological reserves, and (3) a synonym of dysphagia. As the author stated in the conclusion, presbyphagia should be considered an etiology of oropharyngeal dysphagia (OD). However, significant methodological flaws were found, including selecting only one person to screen and analyze articles in the systematic review, not using any keywords or MeSH terms in the search, not presenting a search strategy, limiting the search term to "presbyphagia", and omitting details about screening, inclusion, and exclusion criteria. The operational definitions describe that aging inherently causes swallowing impairment. However, they disregard age-related changes without significant functional impact, as found by a previous study, reviewed in the current research, but analyzed inconsistently by the author. This recent study showed that presbyphagia is the opposite of OD, framing both the "negative" aspects of swallowing and the "compensatory positives" as natural consequences of aging, consistent with the World Health Organization's concept of intrinsic capacity. This perspective positions aging as an adaptive process-not a disease or cause of disease-, although it may increase vulnerability due to cumulative factors. Since OD is a symptom, attributing it to aging frames aging itself as a disease, contradicting current geriatrics and gerontology paradigms.