Dysphagia最新文献

To investigate the efficacy of Action Observation Therapy (AOT) which is conducted by observing and imitating swallowing videos for post-stroke dysphagia. 36 patients with post-stroke dysphagia were randomly assigned to an observation group or a control group equally. Both groups received routine dysphagia rehabilitation. AOT, was conducted for observation group while control group watched a same-duration landscape video before lunch and dinner．Before and after treatment, Watian Swallowing Test (WST), Eating Assessment Tool (EAT-10), Standard Swallowing Assessment (SSA), Functional Oral Intake Scale (FOIS), surface electromyogram (sEMG) and functional near-infrared spectroscopy (fNIRS) were conducted. After 3 weeks of treatment, WST, EAT-10, SSA, and duration of swallowing muscle groups of both groups significantly decreased (P ＜ 0.05). FOIS and amplitude of swallowing muscle groups of both groups significantly increased (P ＜ 0.05). Except for duration of subhyoid muscles and FOIS, other parameters in observation group were significantly improved compared to those in control group ( P ＜ 0.05). fNIRS showed that overall brain function connection was not significantly enhanced, but significant differences in bilateral primary motor cortex/supplementary motor cortex (PMC/SMC), left dorsolateral prefrontal cortex (DLPFC) and right Broca area were observed. Correlation analysis revealed that changes in amplitude of suprahyoid group muscle had a negative correlation with EAT-10 and SSA scores ( r = -0.332, -0.421, P ＜0.05). AOT based on observation and imitation of swallowing videos can enhance the strength of swallowing related muscles (such as the suprahyoid muscle group), shorten swallowing time, optimize the swallowing process, and ultimately promote the recovery of post-stroke swallowing function. Its mechanism may be related to the activation of brain regions such as PMC/SMC, DLPFC, and Broca area.

The clinical application of acoustic swallowing sound parameters collected from digital cervical auscultation is limited because of the time-consuming manual segmentation required by trained experts. The automated identification of swallowing sounds in children and adults from swallowing sound audio wavefiles using machine learning have accuracies between 76-95%. No data exists in preterm neonates. To determine if applying automated machine learning using a transfer learning approach could accurately identify and segment swallows from swallowing sounds collected in preterm neonates. Thin fluid swallow sounds were collected from 78 preterm neonates, median birth age 34 weeks gestation (range 25-36 weeks, 52.6% males) across 3 Australian special care nurseries. For the base machine learning model, a deep convolutional neural network (DCNN) pre-trained for audio event classification was used. With raw swallow audio data as input, embedding vectors from the base DCNN were generated and used to train a feedforward neural network to determine the presence of a swallow within an audio segment. The model showed high overall accuracy (94%) in identifying preterm swallows. Better model performance on bottle feeding swallows (Sensitivity, 95%; and specificity, 96%) was seen compared with breastfeeding swallows (sensitivity, 95%, specificity 92%). Interpretation: Our novel study demonstrates the successful use of transfer learning to accurately identify and segment digital swallowing sounds in preterm neonates. Application of this model could support the development of a digital CA app to automatically classify swallow sounds and improve objectivity for CA use in clinical practice within special care nurseries.

This study aimed to establish reference values for quantitative measurements of pharyngeal volume and residue during swallowing in healthy individuals and to examine how these measurements are influenced by age, sex, height, and bolus properties. We performed a retrospective analysis of 288 swallows from 135 healthy Japanese adults (median age, 43 years; height, 163 cm) who underwent Swallowing CT. Test boluses included thin or extremely thick liquids in either 3 mL, 10 mL, or 20 mL amounts. Pharyngeal cavity volume at bolus hold (PVHOLD), unobliterated air and bolus volume at maximum pharyngeal constriction (PVMAX), and pharyngeal volume constriction ratio (PVCR), and post-swallow pharyngeal residue were measured on dynamic 3D-CT images using a semi-automated software. We determined the 2.5th, 50th, 97.5th percentile values to obtain normative reference values for each parameter and made generalized linear regression models to determine how these volume measurements are associated with demographic factors and bolus properties. Normative values (median [97.5th percentile]) across all swallows were PVHOLD 20.9 cm³ [38.6 cm³], PVMAX 0.3 cm³ [2.1 cm³], PVCR 98.8% [2.5th percentile 89.1%], and residue 0 cm³ [0.4 cm³]. Males exhibited larger values than females. PVHOLD significantly increased with height (β = 0.465, p < 0.001) and age (β = 0.068, p = 0.001), while PVMAX and PVCR increased with larger bolus volumes (β = 0.293, p = 0.005) and in thicker consistencies (β = 0.376, p = 0.017). Pharyngeal residue was present in 98/288 (34.0%) of swallows and was significantly associated with increasing bolus volume (adjusted odds ratio [aOR] = 1.865 [95% confidence interval: 1.275-2.727]), age (aOR = 1.025 [1.010-1.040]), thicker bolus (aOR = 1.806 [1.275-2.727]). Each 1 cm² increase in PVMAX was associated with nearly double the odds of residue (aOR = 1.86 [1.202-2.862]). Similarly, each 1% decrease in PVCR corresponded to a 10.6% increase in the odds of residue (aOR = 1.106 [1.015-1.295]). These normative data provide a bases for comparing individuals with or without pharyngeal impairments.

Pill swallowing and medication administration can be problematic in patients with difficulty swallowing and can lead to poor medication compliance. The extent to which speech-language pathologists (SLPs) consider pill swallowing during videofluorographic assessments, however, is not known. A survey focusing on SLP practices, knowledge, and opinions about assessment of pill swallowing and subsequent medication administration decisions in patients with dysphagia was distributed to SLPs via American Speech-Language-Hearing Association (ASHA) special interest divisions and an online forum. Results from the survey revealed that while 53% of respondents agreed that pill swallowing should be included during dysphagia assessment, only 28% routinely do so. However, 58% of the SLPs reported making recommendations regarding medication administration based on the results of the videofluorographic exam. Further research should focus on best practices for pill swallowing assessment as well as exploring interventions for pill swallowing difficulty within the dysphagic population so that adverse events can be minimized, and patient outcome maximized.

Ultrasound (US), a technology extensively utilized and deemed safe for medical purposes, represents an innovative approach that has recently been applied in the evaluation of swallowing functions as well as in the rehabilitation processes. Therapeutic interventions often prioritize swallowing maneuvers as preferred options. Nevertheless, the current body of literature indicates that the application of ultrasound in the assessment and treatment of swallowing disorders remains limited, with a scarcity of studies investigating muscle activation and laryngeal elevation during these swallowing maneuvers. This research seeks to compare the movements and timing of the floor of the mouth muscles across various age and gender demographics, while also aiming to procure quantitative data on hyoid-laryngeal convergence during the maneuvers, thereby substantiating the implementation of US in conjunction with three commonly employed swallowing maneuvers for the intervention of disorders affiliated with the oropharyngeal phase of swallowing. The results indicate that the duration of swallowing maneuvers tends to increase with advancing age, with the Mendelsohn maneuver emerging as the most efficacious technique for hyoid-larynx convergence. Conversely, it was also observed that the Mendelsohn maneuver posed the greatest challenge for subjects in terms of cooperation. Consequently, this study demonstrates that ultrasound can be effectively utilized during the execution of swallowing maneuvers, while also providing valuable insights into muscle activation associated with these interventions.

Slow gait speed and subjective cognitive decline in older adults are characteristics of motoric cognitive risk syndrome (MCRS). Dysphagia and oral health may be connected to MCRS because they are linked to both motor function and cognitive performance. This study aimed to investigate dysphagia and oral health among older adults with MCRS. Community-dwelling adults over 65 years of age who visited the geriatric outpatient clinic for regular check-ups were included (N = 152). Socio-demographic and clinical data were collected, and the Eating Assessment Tool (EAT-10) and Geriatric Oral Health Assessment Index (GOHAI) were implemented. Participants were divided into two groups as MCRS (N = 36) and non-MCRS (N = 116). Poorer GOHAI and EAT-10 scores were observed in the MCRS group (p < 0.05 for all). After adjusting for potential confounding factors, higher EAT-10 scores were found to be independently associated with MCRS (OR = 1.13, 95% CI: 1.04-1.23, p = 0.005), but not GOHAI scores. Our findings indicated an association between dysphagia and MCRS in older adults. This is the first study in the literature to examine the association between dysphagia and oral health among older adults with MCRS. MCRS is a very recent topic in the literature and the parameters associated with MCRS are not clear. This study will contribute to the literature filling an important gap because a better understanding of the mechanisms linking these two comorbidities is vital for the development of targeted interventions aimed at reducing swallowing difficulties in patients with MCRS.

Dysphagia is a common concern. In an outpatient phoniatric and otorhinolaryngology clinic, approximately one fourth of dysphagia patients are classified as having non-organic, or functional dysphagia. This study aimed to evaluate symptom severity, health-related quality of life (HRQoL) and disability among dysphagia patients. Additionally, it focused on assessing the impact of flexible endoscopic evaluation of swallowing (FEES) and swallowing guidance particularly for patients with functional dysphagia. We recruited 60 consecutive dysphagia patients from our phoniatrics clinic. They completed the Eating Assessment Tool (EAT-10), the 15D Health-related Quality of Life Instrument and the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaires before their appointments. We performed FEES and gave swallowing guidance. One month later, the patients repeated the EAT-10, 15D, and WHODAS 2.0. At one-month follow-up, the EAT-10 scores of all 60 dysphagia patients (median age 65, range 18-89 years, 70% female), and the functional dysphagia patients (n = 15, 25%) had decreased significantly (p = 0.020, p = 0.029, respectively). Although the changes in the 15D and WHODAS 2.0 scores were insignificant, the score of WHODAS 2.0 item D3.3 concerning eating had decreased significantly in the functional dysphagia group (p = 0.020). Comparison of the whole dysphagia patient cohort to an age- and gender-standardized sample of the general population revealed significant differences in 15D total scores (p < 0.001) and 12 of the 15 dimensions. Dysphagia seems to significantly diminish patients' HRQoL in comparison to that of the general population. A short FEES intervention with swallowing guidance may alleviate symptoms, especially in functional dysphagia.

Swallowing disorders are a common clinical issue that significantly impacts patients' quality of life and nutritional intake. Recent years have seen a growing interest in capsaicin, a natural compound, due to its potential neuroprotective effects and its ability to stimulate the swallowing reflex. This review summarizes the research progress on the application of capsaicin in the treatment of swallowing disorders, detailing its mechanisms of action, clinical applications, and future research directions. By doing so, this paper aims to provide insights into the potential of capsaicin as a therapeutic agent in the management of swallowing difficulties, highlighting the need for further exploration in this promising area of study.

This study aimed to determine the impact of bolus volume on UES opening. Twenty-two healthy subjects (10 males and 12 females, 23-45 years) underwent a CT scan while swallowing 3-, 10-, and 20 ml of thin liquid. Upper esophageal sphincter (UES) cross-sectional area and hyoid and laryngeal displacement were measured at every frame across three conditions. The timing of UES opening onset, UES maximum opening, and duration of UES opening were also measured. With increasing bolus volume, the UES maximum opening area increased, at the UES opening onset, at the UES maximum opening was earlier, and the duration of the UES opening prolonged. The maximum displacement of the hyoid and larynx was significantly more anteriorly and higher with a large bolus volume. However, the hyoid displacement at the timing of UES maximum opening did not change across three bolus volumes. This result suggests that the increase in the UES maximum opening area with increasing bolus volume was modulated by the bolus itself rather than by the hyoid movement.