Dysphagia最新文献

To identify oral health variables associated with laryngotracheal aspiration-related outcomes as determined by swallowing during videofluoroscopy in adults and older adults. This cross-sectional study included 225 persons aged 18 years or older who were referred for clinical evaluation and videofluoroscopy examination due to suspected dysphagia. Oral health status assessment comprised self-reported the number of teeth, use and fit of dentures, xerostomia and satisfaction with chewing. The number of teeth and fit of dentures were also assessed clinically by a speech therapist. Videofluoroscopy followed a standardized protocol. The presence and severity of dysphagia was assessed using the O'Neill Swallowing Scale. The Dysphagia Severity and Outcome Scale defined the occurrence of laryngotracheal penetration or aspiration of food. Results were presented as prevalence ratios and 95% confidence intervals. Poisson regressions with robust variance ran on R version 4.2.1. were used to estimate associations with dysphagia and aspiration. In the multivariate models for aspiration, the following factors were associated with the upper arch: Partial dentition with poorly fitted implants, fixed prostheses (single or multiple), or removable partial dentures (PR, 3.45; 95% CI, 1.15-10.41), partial dentition without rehabilitation with prosthesis (PR, 4.05; 95% CI, 1.46-11.22), edentulism with well-fitted conventional total prosthesis (PR, 4.82; 95% CI, 1.29-17.92), and edentulism without complete dentures (PR, 7.22; 95% CI, 2.25-23.10). For the lower arch, associated factors included: Edentulism with poorly fitted conventional total prosthesis (PR, 8.99; 95% CI, 1.85-43.44), partial dentition without prosthesis (PR, 6.76; 95% CI, 1.67-27.84), and edentulism without prosthesis (PR, 8.69; 95% CI, 1.86-40.63). This study highlights the significant association between poor oral health, dysphagia, and aspiration laryngotracheal, underscoring the need for integrated care between speech-language pathology and dentistry. Our findings provide a foundation for future research that incorporates more robust research designs and oral examinations to explore underlying mechanisms explaining the relation between oral health, dysphagia, and aspiration.

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.

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.

To investigate the association between tongue pressure (TP) and phase angle (PhA) in patients with connective tissue diseases (CTDs) aged 65 years or older. This retrospective cross-sectional study was conducted on 189 patients with CTDs who underwent hospital rehabilitation. TP was measured using a tongue pressure measuring device, and PhA was calculated from the bioimpedance analysis readings. Statistical analyses included multivariate linear regression with TP and receiver operating characteristic curves to determine PhA cutoff values indicative of low TP, defined as < 24.3 kPa for men and < 23.7 kPa for women. A total of 189 patients with CTDs (mean age 75 years; 49 men and 140 women; mean PhA 4.0°; mean TP 27.7 kPa) were included in the analysis. Fifty-five patients had low TP. Patients with low TP had lower PhA values than those with normal TP (mean PhA values 3.5° versus 4.3°). After adjusting for confounding factors, PhA (β = 0.387, p < 0.001) was significantly associated with TP. Cutoff values for PhA predicting low TP were identified as 3.9° for men and 3.5° for women. PhA is associated with TP, independent of other factors, in older inpatients with CTDs. The identified PhA cutoff values could enable the early detection of declining TP.

Aspiration pneumonia is a serious condition resulting from swallowing dysfunction. However, predicting high risk patients remains challenging. This study aimed to assess the incidence and risk factors for pneumonia in oropharyngeal dysphagia patients exhibiting episodes of penetration or aspiration during fiberoptic endoscopic swallowing evaluation (FEES). A retrospective analysis was performed on patients who visited a dysphagia clinic between 2016 and 2022, and demonstrated at least one episode of penetration or aspiration during the FEES (Penetration Aspiration Scale [PAS] score ≥ 3). Data collected included demographics, comorbidities and FEES findings. Outcomes included mortality, hospital admissions to treat pneumonia events, and incidents of pneumonia managed by primary care providers or outpatient medical facilities. Statistical analyses included descriptive statistics, chi-squared tests, t-tests, logistic regression and Kaplan-Meier survival analysis. Among 73 patients (mean follow-up: 3.87 ± 1.5 years), 33 (45.2%) exhibited penetration, and 40 (54.8%) aspiration. Pneumonia developed in 41 patients (56%), with 33 (45%) hospitalized. A total of 28 patients (38.4%) died during follow-up. A history of prior pneumonia (OR: 1.374, p = 0.02) and Murray Secretion Scale score (OR: 1.121, p = 0.022) were associated with subsequent pneumonia events. Reduced laryngeal sensation showed a near-significant trend toward association with pneumonia-related hospitalizations in the penetration group (58.3% vs. 19%, P = 0.052). No significant association was found between PAS and pneumonia or mortality. Prior pneumonia and secretions accumulation during FEES significantly predict pneumonia in patients presenting with penetration-aspiration during FEES. Reduced laryngeal sensation showed a nearly-significant trend toward pneumonia-related hospitalizations.

Oropharyngeal dysphagia is an independent predictor of poor outcomes in many health conditions and can be targeted directly through swallowing therapy. This study aims to explore the outcomes of outpatient swallowing therapy in clinical practice across a diverse cohort of patients. This was a retrospective, single-site longitudinal cohort study. Patients 18 years or older with dysphagia who completed 7-8 weeks of outpatient swallowing therapy with a pre- and post-treatment videofluoroscopy were included. Therapy employed a progressive swallowing exercise regimen based on the Systematic Exercise for Treatment of Swallowing (SETS) protocol. Outcome measures included the pharyngeal components of the Modified Barium Swallow Impairment Profile, penetration-aspiration scale scores, and diet recommendations using the International Dysphagia Diet Standardization Initiative. 152 patients were included. Swallowing therapy improved all MBSImP component scores except 1, 7, and 13. Therapy improved total pharyngeal impairment scores by 2.66 points (p < .001) and total oral impairment score by 1.41 points (p < .001). Odds of elevated aspiration risk were reduced by 49% (p < .001). Patients were more likely to be on an unmodified food consistency after completion of therapy (OR 26, p = .004), but liquid consistency was not altered (OR 2.0, p = .57). Overall, 44% of patients in the cohort with an efficiency issue improved, and 50% of patients at risk for aspiration pre-therapy improved. Completing a 7-8 week course of exercise-based outpatient swallowing therapy is effective at improving multiple measures of swallowing physiology, safety and efficiency. It can also enable relaxation of diet consistency restrictions based on the IDDSI framework.

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.

Free water protocols (FWP) give patients at risk of aspiration the option to drink water between meals. Evidence is lacking about their use in acute stroke care. This systematic review evaluated the literature about barriers and facilitators to FWP implementation in acute stroke unit settings. Electronic databases and grey literature sources were systematically searched, eligible studies were critically appraised, and data extracted and mapped onto the Consolidated Framework for Implementation Research (CFIR). The results are presented in a narrative synthesis. Five studies were identified for inclusion: Two qualitative studies, 1 mixed method study, 1 randomised controlled trial and 1 pilot cohort study. Barriers and facilitators to implementation were identified across the 5 CFIR domains. Key barriers were a lack of evidence base and a standard protocol, trying to adapt and deliver a protocol designed for a different setting, complexity of patient selection and FWP design, culture of risk aversion, nursing staff availability and skills to deliver the FWP, and a greater use of agency nurses and transient workforce. Key facilitators were the existence of national guidance for research into its use, implementation of oral care protocols prior to FWP implementation, the unique characteristics of the acute stroke setting, leadership and modelling by senior clinicians, interdisciplinary working and accountability for roles and responsibilities for each discipline, regular communication and ongoing education, and involving patients in decision making and implementation. The findings of this review will guide the data collection of a feasibility study of the FWP in acute stroke.

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.