Dysphagia最新文献

To investigate the effect of oxygen airflow administered through a subglottic suction tube on the swallowing function of stroke patients with tracheotomies. This study used randomized self-controlled cross-over design. A total of 20 patients with dysphagia following tracheotomy related to stroke were enrolled. Patients were assessed using fiberoptic endoscopic evaluation of swallowing (FEES) as they swallowed 5 ml of thickness liquid under five different conditions: continuous oxygen airflow through the subglottic suction tube at three varying flow rates (3 L/min, 5 L/min, and 7 L/min) with the tube cuff inflated, the tube cuff deflated, and the tracheal tube capped. The Rosenbek penetration aspiration scale (PAS) and Yale Pharyngeal Residue Scale(YPR-SRS) were employed to evaluate swallowing residue and aspiration. When continuous subglottic oxygen airflow was administered at 5 L/min and 7 L/min, the PAS scores were significantly lower compared to the conditions of cuff deflation and tracheal tube capping. Additionally, the PAS scores at a subglottic oxygen airflow rate of 3 L/min were significantly lower than the condition with the tube cuff deflated (P < 0.01). Furthermore, the YPR-SRS scores during continuous subglottic oxygen airflow at 5 L/min were significantly lower than those observed with the tube cuff deflated and the tracheal tube capped (P < 0.01). The continuous administration of oxygen airflow through the subglottic suction tube significantly enhanced the safety and efficiency of swallowing in stroke patients with tracheotomy and dysphagia, which expected to be widely used in clinical practice.

Unlike what is observed in the adult population, in paediatric rehabilitation, no reliable and validated observational tools are available in the Italian language to evaluate subjects considered to be at risk for swallowing disorders, regardless of the pathology. The aim of this study was to adapt the Mealtime Assessment Scale (MAS) to a paediatric population. Additionally, internal consistency, intra-rater and inter-rater agreement, concurrent validity and discriminative ability were investigated to assess validity and reliability of the scale. The first part of the study consisted in an adaptation of the original version of the MAS to the paediatric population (MAS-p) by a multidisciplinary team. A pilot study, involving 40 subjects, was conducted to assess psychometric properties as validity and reliability in terms of internal consistency, intra- and inter-rater reliability, and discrimination index. Retaining MAS original structure and scoring system, items were maintained, modified, or removed through a revision by the multidisciplinary team to guarantee a correct evaluation in children. None of the patients were lost or had withdrawn. MAS-p showed good internal consistency, both in safety (Cronbach's alpha 0.857) and efficacy scale (Cronbach's alpha 0.885). No improvement was noticed removing items one at a time and an optimal item to total correlation was observed (Cronbach's alpha ≥ 0.80). No items were found to be not assessable. Intra-rater and inter-rater agreement were good for all items (ICC > 0.8 for intra-rater agreement and AD index < 0.66 for inter-rater agreement). A second revision of the scale was carried out by the multidisciplinary team after the pilot study to further modify items to fully adapt to the paediatric population. MAS-p was developed to introduce an objective dysphagia assessment in paediatric rehabilitation. It showed good validity and reliability. The validation process should be completed through further studies.

The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) rating method was developed in head and neck cancer populations to describe severity of aspiration and residue. The purpose of this study was to assess criterion validity of DIGEST in a post-stroke cohort. In this retrospective analysis, two raters (using version two criteria) performed DIGEST_V2 rating on recordings of modified barium swallow studies (MBSS) from 88 post-stroke patients that were extracted from a larger de-identified database. Modified Barium Swallow Study Impairment Profile (MBSImP) scores and Functional Oral Intake Scale (FOIS) scores were used to determine criterion validity. Inter-rater and intra-rater reliability for overall DIGEST_V2 grade were substantial (ƙ = 0.69 and 0.73, respectively), however inter-rater reliability for efficiency were only moderately reliable (ƙ = 0.52). Reliability for MBSImP scoring was excellent for Pharyngeal Total (PT) scores (ICC = 0.81-0.93). Overall DIGEST_V2 grades were significantly associated with PT scores in the expected direction (τ = 0.51, p < 0.0001), and there was no association between Oral Total (OT) and DIGEST grade (τ = -0.01, p = 0.889). Pairwise comparisons using PT scores indicated significant differentiation between DIGEST_V2 grades 0 from all other grades (p < 0.0001), with overlap in intermediate grades (p = 0.102-0.711). Functional Oral Intake Scale (FOIS) scores were significantly associated with DIGEST_V2 grade in the anticipated direction (τ = -0.43, p < 0.0001). Expected psychometrics and acceptable reliability for DIGEST_V2 grading were shown in this post-stroke cohort. A larger dataset would clarify mid-grade differentiation and potential influence of oral phase impairments in this sub-population.

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.

Sarcopenic dysphagia is an emerging clinical concept defined as dysphagia resulting from generalized sarcopenia and sarcopenic changes in the muscles involved in swallowing. However, despite growing clinical interest, its diagnostic criteria, pathophysiological boundaries, and causal validity remain insufficiently established. This systematic review aimed to examine how sarcopenic dysphagia has been defined and assessed in the literature and to identify conceptual and methodological gaps. A comprehensive literature search was conducted across PubMed, EMBASE, the Cochrane Library, and CINAHL, covering all records from database inception through December 2024. Studies were included if they explicitly used and defined the term "sarcopenic dysphagia." A total of 31 studies were included, comprising 20 observational studies and 11 case reports. Definitions varied considerably across studies, from structured diagnostic frameworks to the co-occurrence of sarcopenia and dysphagia. Many studies included patients with comorbidities known to independently cause dysphagia, such as neurologic disease or head and neck cancer, thereby complicating causal inference. Given the numerous shared risk factors and known associations between sarcopenia and dysphagia, interpreting a direct causal relationship requires careful consideration. Moreover, swallowing function is influenced by factors beyond muscle mass and strength, including neuromuscular coordination and age-related physiological changes. This systematic review highlights that the current conceptualization of sarcopenic dysphagia is challenged by the complex influence of multifactorial etiologies, the association between sarcopenia and dysphagia, and methodological limitations in swallowing assessment. Future research may require prospective longitudinal studies using standardized, objective measures to clarify the complex interplay between sarcopenia and swallowing dysfunction.

Laryngeal elevation during swallowing is critical to airway protection, pharyngeal shortening, and upper esophageal sphincter opening. Currently, videofluoroscopy is the only way to quantify amplitude and timing of laryngeal elevation during swallowing. Although wearable devices exist, none are able to quantify amplitude of laryngeal elevation. This proof-of-concept study introduces a novel wearable fabric sensing device equipped with three knitted strain sensors, designed for real-time monitoring and precise classification of swallowing actions. Simultaneous recordings were made with our sensors and submental surface electromyography (sEMG) on 12 healthy adults who performed swallowing and non-swallowing tasks. K-nearest neighbors models were utilized to classify swallowing and non-swallowing tasks using data from knitted sensors and sEMG signals. Surveys were conducted to assess the comfort of wearing the device. The overall accuracy of KNN classifications to predict swallowing versus non-swallowing tasks was 0.97 for the knitted sensor, 0.82 for sEMG, and 0.98 for the combined dataset (knitted sensor + sEMG), while the accuracy to predict specific tasks was 0.75 for the knitted sensor, 0.32 for sEMG, and 0.77 for the combined dataset. Participants rated the knitted sensor's discomfort an average rating of 7.33/100, indicating a low level of discomfort. Our findings show that laryngeal movement during swallowing can be detected using knitted strain sensors worn on the outside of the neck, with the ability to distinguish between swallowing and non-swallowing tasks, as well as between types of swallows. The detection accuracy is significantly higher than that using the state-of-the-art sEMG method.

Primary sarcopenia, characterized by age-related decline in muscle mass and strength, is increasingly recognized as a contributor to oropharyngeal dysphagia in older adults. Understanding its mechanical and functional components is essential for early detection and intervention. This study aimed to investigate early oropharyngeal swallowing impairments in older adults with primary sarcopenia using a multimodal instrumental assessment and to evaluate the utility of combining different objective measures. In this cross-sectional study, swallowing safety and efficiency were assessed using the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale through fiberoptic endoscopic evaluation of swallowing (FEES) in 44 older individuals with primary sarcopenia. Additional assessments included tongue strength measurement, suprahyoid muscle activity using surface electromyography (sEMG), peak cough flow (PCF), and self-perceived swallowing symptoms evaluated using Eating Assessment Tool-10 (EAT-10). According to DIGEST overall score, 20.5% of participants showed no dysphagia (grade 0), while 56.8% had mild (grade 1), and 22.7% had moderate (grade 2) dysphagia. Participants with dysphagia (grades 1-2) showed decreased tongue strength, reduced sEMG amplitudes, longer swallowing durations, and decreased PCF compared to those with grade 0. Although these differences were not statistically significant, a trend toward early functional decline was noted. These findings suggest that in early-stage primary sarcopenia, swallowing safety may be preserved despite mild physiological deficits. This likely reflects the presence of a functional reserve within the swallowing mechanism. However, clinicians should not rely solely on this compensation, as subtle changes may precede clinically significant dysphagia. Early identification and monitoring remain crucial to prevent deterioration in this vulnerable population.

Accurate assessment of swallowing function is essential to prevent aspiration pneumonia and nutritional decline. However, in hospitalized patients, discrepancies are often observed between clinical assessments and the actual oral intake. We retrospectively analyzed 5,091 patients who underwent a videofluoroscopic swallowing study or videoendoscopic evaluation of swallowing (VE) at our hospital between 2018 and 2024. The Discrepancy Index (DI), as the difference between the Food Intake LEVEL Scale and Fujishima's swallowing ability grade, was calculated. Patients with DI ≤ - 2 were classified as the "underestimated group". Logistic regression analysis was conducted to identify the associated factors. The underestimated group accounted for 22.5% of the cases. Female sex (OR = 1.45, p < 0.001), VE use (OR = 1.68, p < 0.001), pulmonary disease (OR = 1.63, p = 0.001), and disuse-related physical decline (hereafter referred to as disuse syndrome) (OR = 1.71, p = 0.001) were significantly associated with underestimation. The subgroup analyses revealed that these associations were more prominent in men with pulmonary and disuse-related conditions. Overestimation though rare (< 3%) was clinically important. Over 20% of patients were likely to receive unnecessarily restrictive diets due to underestimation of their swallowing function. Such underestimation may be influenced by inaccurate assessments or clinicians' safety concerns, as reported in previous studies. Although sex showed a statistical effect on the DI, it did not indicate a consistent pattern of under- or over-estimation between sexes. Timely and accurate assessment of swallowing through an interdisciplinary collaboration is essential to avoid unnecessary fasting, prevent nutritional decline, and reduce the risk of developing sarcopenic dysphagia.