1,936 results
Search Results
2. Effect of bolus property on swallowing dynamics in patients with dysphagia.
- Author
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Hino H, Suzuki T, Maekawa K, Ita R, Sasa A, Kulvanich S, Takei E, Magara J, Tsujimura T, and Inoue M
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- Humans, Female, Male, Aged, Middle Aged, Fluoroscopy, Mastication physiology, Aged, 80 and over, Video Recording, Hyoid Bone physiopathology, Hyoid Bone diagnostic imaging, Adult, Food, Deglutition Disorders physiopathology, Deglutition physiology
- Abstract
Background: Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture-modified food for patients with dysphagia., Objectives: The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy., Materials and Methods: A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide (Jelly) and jelly made of pectin (Reset gel). Outcome measures of videofluoroscopic images, bolus transit time and hyoid movements were compared., Results: The frequency of chewing movements was highest for Jelly, followed by Reset gel and Thick liquid. While the probability of oral residue was the highest for Reset gel, pharyngeal residue after swallowing was high for Thick liquid as compared to Jelly and Reset gel. Oral transit time and pharyngeal transit time for Thick liquid were significantly smaller than that for Jelly and Reset gel. Pharyngeal delay time was significantly smaller for Thick liquid than that for Jelly and Reset gel. There was no difference in hyoid elevation time and hyoid movement time among the conditions., Conclusion: Mildly thick liquid material may be optimal for patients with primarily oral motor function impairment and jelly, such as Reset gel, may be more suitable for patients with primarily pharyngeal motor function impairment or oral and pharyngeal coordinative motor function decline., (© 2024 John Wiley & Sons Ltd.)
- Published
- 2024
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3. Effect of Bolus Viscosity on the Safety and Efficacy of Swallowing and the Kinematics of the Swallow Response in Patients with Oropharyngeal Dysphagia: White Paper by the European Society for Swallowing Disorders (ESSD).
- Author
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Newman R, Vilardell N, Clavé P, and Speyer R
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- Biomechanical Phenomena, Europe, Humans, Peristalsis physiology, Pharynx physiopathology, Reaction Time, Societies, Medical, Viscosity, Deglutition physiology, Deglutition Disorders physiopathology, Food
- Abstract
Background: Fluid thickening is a well-established management strategy for oropharyngeal dysphagia (OD). However, the effects of thickening agents on the physiology of impaired swallow responses are not fully understood, and there is no agreement on the degree of bolus thickening., Aim: To review the literature and to produce a white paper of the European Society for Swallowing Disorders (ESSD) describing the evidence in the literature on the effect that bolus modification has upon the physiology, efficacy and safety of swallowing in adults with OD., Methods: A systematic search was performed using the electronic Pubmed and Embase databases. Articles in English available up to July 2015 were considered. The inclusion criteria swallowing studies on adults over 18 years of age; healthy people or patients with oropharyngeal dysphagia; bolus modification; effects of bolus modification on swallow safety (penetration/aspiration) and efficacy; and/or physiology and original articles written in English. The exclusion criteria consisted of oesophageal dysphagia and conference abstracts or presentations. The quality of the selected papers and the level of research evidence were assessed by standard quality assessments., Results: At the end of the selection process, 33 articles were considered. The quality of all included studies was assessed using systematic, reproducible, and quantitative tools (Kmet and NHMRC) concluding that all the selected articles reached a valid level of evidence. The literature search gathered data from various sources, ranging from double-blind randomised control trials to systematic reviews focused on changes occurring in swallowing physiology caused by thickened fluids. Main results suggest that increasing bolus viscosity (a) results in increased safety of swallowing, (b) also results in increased amounts of oral and/or pharyngeal residue which may result in post-swallow airway invasion, (c) impacts the physiology with increased lingual pressure patterns, no major changes in impaired airway protection mechanisms, and controversial effects on oral and pharyngeal transit time, hyoid displacements, onset of UOS opening and bolus velocity-with several articles suggesting the therapeutic effect of thickeners is also due to intrinsic bolus properties, (d) reduces palatability of thickened fluids and (e) correlates with increased risk of dehydration and decreased quality of life although the severity of dysphagia may be an confounding factor., Conclusions: The ESSD concludes that there is evidence for increasing viscosity to reduce the risk of airway invasion and that it is a valid management strategy for OD. However, new thickening agents should be developed to avoid the negative effects of increasing viscosity on residue, palatability, and treatment compliance. New randomised controlled trials should establish the optimal viscosity level for each phenotype of dysphagic patients and descriptors, terminology and viscosity measurements must be standardised. This white paper is the first step towards the development of a clinical guideline on bolus modification for patients with oropharyngeal dysphagia.
- Published
- 2016
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4. Early swallowing training after free flap surgery in oral cancer: A randomized controlled trial.
- Author
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Wu HY, Shan XF, Cai ZG, Zhang J, Li PJ, Zhang L, and Yang Y
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- Humans, Male, Female, Middle Aged, Prospective Studies, Aged, Adult, Plastic Surgery Procedures methods, Intubation, Gastrointestinal, Deglutition Disorders etiology, Weight Loss, Mouth Neoplasms surgery, Quality of Life, Free Tissue Flaps, Deglutition physiology
- Abstract
Objective: To explore the effect of early swallowing training on postoperative outcomes of patients who had undergone oral cancer surgery plus free flap reconstruction., Subjects and Methods: In this prospective, randomized controlled trial, 121 patients who had undergone oral cancer surgery plus free flap reconstruction were randomly assigned to the control (n = 59) or intervention group (n = 62). The control group underwent routine nursing measures. The intervention group received swallowing training on the sixth postoperative day. On the 15th day and 1 month after surgery, the swallowing function (Mann Assessment of Swallowing Ability-Oral Cancer [MASA-OC] score), weight loss rate, time of nasogastric tube removal, and quality of life were evaluated., Results: Patients in the intervention group had higher MASA-OC scores and better weight loss rates than those in the control group on the 15th day (MASA-OC: p = 0.014, weight loss: p < 0.001) and 1 month (both p < 0.001) after surgery. The time of nasogastric tube removal and the quality of life was statistically significant between groups (p < 0.001)., Conclusion: Early swallowing training improves the swallowing function, nutritional status, and quality of life and shortens the indwelling time of nasogastric tube of patients who have undergone oral cancer surgery plus free flap reconstruction., (© 2023 Wiley Periodicals LLC.)
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- 2024
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5. Three-dimensional Analysis of the Muscles Related to the So-Called "Pterygomandibular Raphe": An Anatomical and Histological Study.
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Fukino K, Iitsuka M, Kitagawa N, Tubbs RS, Akita K, and Iwanaga J
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- Humans, Male, Female, Aged, Aged, 80 and over, Imaging, Three-Dimensional methods, Pharynx anatomy & histology, Mandible anatomy & histology, Middle Aged, Pharyngeal Muscles anatomy & histology, Pharyngeal Muscles physiology, Masticatory Muscles anatomy & histology, Masticatory Muscles physiology, Cadaver, Deglutition physiology
- Abstract
The pterygomandibular raphe (PMR) is a tendinous bundle between the bucinator (BM) and the superior constrictor of pharynx (SC) and has been considered essential for swallowing. Despite its functional significance, previous studies reported that the PMR is not always present. Another study reported presence of the connecting fascia between the BM and deep temporalis tendon (dTT). Therefore, the present study analyzed the three-dimensional relationship between the BM, SC, and dTT. We examined 13 halves of 11 heads from adult Japanese and Caucasian cadavers: eight halves macroscopically and five halves histologically. There was no clear border between the BM and SC in any specimens macroscopically. The BM attachment varied depending on its levels. At the level of the superior part of the internal oblique line, the BM fused with the SC with no clear border. At the level of the midpart of the internal oblique line of the mandible, the BM attached to the dTT directly, and the SC attached to the dTT via collagen fibers and the BM. Based on these results, these muscles should be described as the BM/dTT/SC (BTS) complex. The three-dimensional relationship of the BTS complex might result in the so-called "pterygomandibular raphe." The BTS complex could be important as a muscle coordination center in chewing and swallowing., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2024
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6. Sleep apnea patients with epiglottic collapse elevate their larynx more with swallowing; videofluoroscopic swallowing study of 80 patients.
- Author
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Yang HC, Umugire A, Song MK, Man SC, Kim HC, Kim J, Vena D, Huyett P, Choi I, and Wellman AD
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- Humans, Male, Female, Middle Aged, Fluoroscopy, Adult, Video Recording, Larynx physiopathology, Larynx diagnostic imaging, Deglutition Disorders physiopathology, Deglutition Disorders diagnostic imaging, Aged, Epiglottis physiopathology, Epiglottis diagnostic imaging, Sleep Apnea, Obstructive physiopathology, Polysomnography, Deglutition physiology
- Abstract
Objective: The epiglottis plays an integral role in the swallowing mechanism and is also implicated as an obstruction site in obstructive sleep apnea (OSA). The underlying causes of epiglottic collapse during sleep remain unclear. This study aimed to investigate the cognitive functions using the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and the neurophysiological and anatomical factors using videofluoroscopic swallowing studies (VFSS). We compared patients with OSA exhibiting epiglottic collapse to those without, assessing differences in anatomical or neurophysiological characteristics., Methods: The study included 12 patients with epiglottic collapse (Epi-group) and 68 without (non-Epi group), all undergoing overnight polysomnography (PSG), drug-induced sleep endoscopy (DISE), LOTCA, and VFSS. Oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were considered as neurophysiological traits, and laryngeal elevation length (LE) as anatomical trait, and were measured across various test diets (10 ml of liquid, soft, or solid)., Results: The study comprised 80 individuals, 57 men and 23 women, with no significant age, sex, body mass index or PSG parameters between groups, or DISE findings, with the exception of epiglottic collapse. Swallowing metrics from VFSS were normal, with no differences in OTT, PDT, PTT, or LOTCA scores. Notably, patients with epiglottic collapse showed a greater laryngeal elevation when swallowing soft and solid foods (p = 0.025 and p = 0.048, respectively)., Conclusions: Patients with epiglottic collapse do not exhibit neurophysiological or cognitive impairments when compared to non-Epi group. However, the Epi-group displayed a significantly increased laryngeal elevation length. This suggests that anatomical factors may have a more substantial role in the development of epiglottic collapse than neurophysiological factors., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
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- 2024
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7. Feeding and Swallowing Outcomes in Children Who Use Long-Term Ventilation: A Scoping Review.
- Author
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Lee S, Marshall J, Clarke M, and Smith CH
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- Humans, Child, Child, Preschool, Female, Male, Deglutition Disorders therapy, Deglutition Disorders etiology, Deglutition Disorders physiopathology, Quality of Life, Deglutition physiology, Respiration, Artificial adverse effects, Respiration, Artificial methods
- Abstract
The last two decades have seen increasing use of long-term ventilation (LTV) as an intervention in childhood. Children who use LTV have many risk factors for feeding and swallowing difficulties, including their underlying respiratory and/or neurological etiology, long hospitalizations, medical interventions, and limited exposure to oral feeding experiences. This review aimed to answer two questions: 1) 'What specific swallowing and feeding characteristics do these children experience?'; and 2) 'What impacts do these swallowing and feeding characteristics have on health status and quality of life?'. Texts were identified across bibliographic databases, reference lists, and grey literature. Studies were analyzed according to ventilation, feeding and swallowing, assessment and intervention, and quality of life parameters. Overall, 1919 papers were screened, with 31 papers included in the final data extraction process. A range of feeding and swallowing characteristics were observed, including oral secretion management difficulties, oral aversion, swallowing difficulties, and clinical signs of aspiration. Non-oral feeding was found to be the primary feeding method used. Little information on health status and quality of life was reported in scoping review texts. Children with LTV needs present with a range of feeding and swallowing concerns, and non-oral feeding is common. Further research is needed to understand the feeding and swallowing journey of this population. This will assist in future service planning and delivery, and in turn contribute to improving patient outcomes and quality of life., (© 2024. Crown.)
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- 2024
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8. Exploring the Acceptability of Behavioral Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study of Patients' Experience.
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Manduchi B, Fitch MI, Ringash JG, Howell D, Hutcheson KA, and Martino R
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- Humans, Female, Male, Middle Aged, Aged, Patient Acceptance of Health Care psychology, Focus Groups, Exercise Therapy methods, Adult, Radiotherapy adverse effects, Radiotherapy methods, Head and Neck Neoplasms radiotherapy, Head and Neck Neoplasms psychology, Deglutition Disorders etiology, Deglutition Disorders psychology, Qualitative Research, Deglutition physiology
- Abstract
The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy namely: reactive, proactive low- ("EAT-RT" only), and high-intensity ("EAT-RT + exercises"). Understanding the perceived acceptability of these interventions is important to inform eventual implementation into clinical practice. This study explored patients' perspectives using qualitative methodology. At 2 Canadian PRO-ACTIVE trial sites, 24 trial participants were recruited for individual semi-structured interviews, representing each of the 3 trial arms. Data collection and thematic analysis were guided by the Theoretical Framework of Acceptability (TFA). Member checking was conducted through follow-up focus groups. Seven themes were derived reflecting the TFA constructs. Overall, regardless of trial arm, patients reported a positive experience with therapy. Patients identified benefits of EAT-RT therapy, reporting that it provided meaningful feedback on diet progress and supported goal setting for oral intake. Patients who received proactive therapies valued the opportunity to set expectations early, build mealtime routine iteratively over time, and have an extended engagement with the SLP. Regardless of trial arm, patients agreed proactive therapy aligned with what they think is best and that therapy intensity should accommodate individual needs. This study identified the value to HNC patients of receiving swallowing interventions during RT and setting realistic expectations around swallowing. Compared to reactive care, proactive therapies were perceived helpful in consolidating habits early, establishing realistic expectations around swallowing and building an extended rapport with the SLP. These findings will inform the implementation of proactive versus reactive swallowing therapies in clinical practice., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2024
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9. European white paper
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Anna C.H. Willemsen, Chris Curtis, Taner Yılmaz, C. René Leemans, Jens Peter Klussmann, Lise Crevier-Buchman, Walmari Pilz, Nathalie Rommel, Leena-Maija Aaltonen, Giovanni Succo, Beatrice Manduchi, Kevin Hansen, Jean Paul Marie, Christoph Arens, Sefik Hosal, Denise MacCarthy, Markus Hess, Jesper Grau Eriksen, Christina Pflug, Annemie M. W. J. Schols, Kate Heathcote, Patrick Cras, Irene Wessel, Antonio Schindler, Laura W. J. Baijens, Wojciech Golusiński, Margaret Walshe, Reinie Cordier, Reza Nouraei, Pere Clavé, Roganie Govender, Renée Speyer, Julie Regan, Claire Parkes, LPP - Laboratoire de Phonétique et Phonologie - UMR 7018 (LPP), Université Sorbonne Nouvelle - Paris 3-Centre National de la Recherche Scientifique (CNRS), Clinicum, Korva-, nenä- ja kurkkutautien klinikka, HUS Head and Neck Center, KNO, RS: GROW - R2 - Basic and Translational Cancer Biology, MUMC+: MA Keel Neus Oorheelkunde (9), RS: MHeNs - R3 - Neuroscience, RS: NUTRIM - R3 - Respiratory & Age-related Health, Pulmonologie, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Otolaryngology / Head & Neck Surgery, and CCA - Cancer Treatment and quality of life
- Subjects
medicine.medical_specialty ,MULTIDISCIPLINARY TEAM MANAGEMENT ,Aging ,MODULATED RADIATION-THERAPY ,ITEM RESPONSE THEORY ,Context (language use) ,FIBEROPTIC ENDOSCOPIC EVALUATION ,SKELETAL-MUSCLE MASS ,03 medical and health sciences ,0302 clinical medicine ,White paper ,TRANSORAL ROBOTIC SURGERY ,QUALITY-OF-LIFE ,Transoral robotic surgery ,medicine ,Humans ,3125 Otorhinolaryngology, ophthalmology ,[SHS.LANGUE]Humanities and Social Sciences/Linguistics ,030223 otorhinolaryngology ,Head and neck cancer ,Papillomaviridae ,business.industry ,General Medicine ,Evidence-based medicine ,Dysphagia ,A300 ,Swallowing ,medicine.disease ,3. Good health ,Deglutition ,Europe ,Systematic review ,Otorhinolaryngology ,Head and Neck Neoplasms ,030220 oncology & carcinogenesis ,Family medicine ,UPPER ESOPHAGEAL SPHINCTER ,SQUAMOUS-CELL CARCINOMA ,Human medicine ,medicine.symptom ,How I do it ,business ,LOCALLY ADVANCED HEAD ,Deglutition Disorders ,Oropharyngeal dysphagia - Abstract
Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
- Published
- 2021
10. White Paper by the European Society for Swallowing Disorders: Screening and Non-instrumental Assessment for Dysphagia in Adults
- Author
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Margaret Walshe, Eric Verin, Reinie Cordier, Virginie Woisard, Weslania Viviane Nascimento, Daniele Farneti, Renée Speyer, Walmari Pilz, RS: MHeNs - R3 - Neuroscience, KNO, and MUMC+: MA Keel Neus Oorheelkunde (9)
- Subjects
medicine.medical_specialty ,Future studies ,Psychometrics ,ORAL-HEALTH ASSESSMENT ,OF-LIFE QUESTIONNAIRE ,B100 ,ITEM RESPONSE THEORY ,Diagnostic accuracy ,FRAIL OLDER-PEOPLE ,Cerebral palsy ,Validity ,03 medical and health sciences ,Speech and Hearing ,0302 clinical medicine ,White paper ,PSYCHOMETRIC CHARACTERISTICS ,Swallowing ,otorhinolaryngologic diseases ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,ASPIRATION PNEUMONIA ,Aged ,ASSESSMENT-TOOL ,Aged, 80 and over ,business.industry ,Swallowing Disorders ,Gastroenterology ,Reproducibility of Results ,Responsiveness ,A300 ,OROPHARYNGEAL DYSPHAGIA ,NEUROLOGICAL DISORDERS ,medicine.disease ,Measures ,Reliability ,Dysphagia ,Deglutition ,Otorhinolaryngology ,Physical therapy ,RISK-FACTORS ,Original Article ,medicine.symptom ,Deglutition Disorders ,business ,030217 neurology & neurosurgery - Abstract
This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.
- Published
- 2022
11. Screening performance of a 100-mL water swallowing test in community-dwelling older adults: A receiver operating characteristic analysis.
- Author
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Yamabe K, Nishida T, Ide Y, and Honda S
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- Humans, Female, Male, Aged, 80 and over, Cross-Sectional Studies, Aged, Predictive Value of Tests, Geriatric Assessment methods, ROC Curve, Water, Japan, Age Factors, Reproducibility of Results, Time Factors, Deglutition Disorders diagnosis, Deglutition Disorders physiopathology, Deglutition, Independent Living
- Abstract
Objective: The development of a dysphagia screening test is an urgent issue in the field of frailty prevention among community-dwelling older people. The purpose of this study was to evaluate the screening performance of a 100-mL water swallowing test (WST)., Methods: The study employed a cross-sectional design. Participants were 304 (65 men and 239 women, mean age = 80 years) Japanese community-dwelling older adults aged over 65 years. We investigated swallowing disorder using the 10-item Eating Assessment Tool (EAT-10), and compared choking signs, swallowing time and number of swallows, and their combination in the 100-mL WST. We calculated the sensitivity and specificity of these indices. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value of swallowing time and number of swallows in the 100-mL WST based on the Youden Index among participants without choking signs., Results: The sensitivity and specificity of choking signs in the 100-mL WST were 20% and 91%, respectively. The discriminating ability of swallowing time and number of swallows among participants without any choking signs was .76 and .72, respectively, in the area under the ROC curve. Diagnostic sensitivity and specificity to discriminate dysphagia from normal swallowing ability were 65% and 74% when the cut-off was >10 s based on maximisation of the Youden Index. The 100-mL WST performed best when the indices of choking signs and swallowing time were combined, with a sensitivity and specificity of 72% and 68%, respectively., Conclusions: The 100-mL WST would be an adequate screening tool when compared to the EAT-10., (© 2024 AJA Inc.)
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- 2024
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12. The Acceptability of Behavioural Swallowing Interventions for Head and Neck Cancer Patients During Radiotherapy: A Qualitative Study Exploring Experiences of Clinical Trial Speech-Language Pathologists.
- Author
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Manduchi B, Fitch MI, Ringash JG, Howell D, Hutcheson KA, and Martino R
- Subjects
- Humans, Male, Female, Middle Aged, Adult, Focus Groups, Attitude of Health Personnel, Aged, Patient Acceptance of Health Care psychology, Canada, Exercise Therapy methods, Deglutition Disorders etiology, Deglutition Disorders psychology, Speech-Language Pathology methods, Head and Neck Neoplasms radiotherapy, Head and Neck Neoplasms psychology, Head and Neck Neoplasms complications, Qualitative Research, Deglutition
- Abstract
The PRO-ACTIVE randomized clinical trial offers 3 swallowing therapies to Head and Neck Cancer (HNC) patients during radiotherapy (RT) namely: reactive, proactive low- ("EAT-RT" only) and high-intensity ("EAT-RT + exercises"). Understanding the experiences of the trial Speech-Language Pathologists (SLPs) will be useful to inform clinical implementation. This study assessed SLP opinions of acceptability and clinical feasibility of the 3 trial therapies. 8 SLPs from 3 Canadian PRO-ACTIVE trial sites participated in individual interviews. Using a qualitative approach, data collection and thematic analysis were guided by the Theoretical Framework of Acceptability. Member checking was conducted through a follow-up focus group with willing participants. Seven themes were derived: intervention coherence, burden, barriers/facilitators, self-efficacy, attitude, ethicality, and perceived effectiveness. SLPs felt all 3 therapies had potential benefit yet perceived more advantages of proactive therapies compared to reactive. Compared to exercises, SLPs particularly endorsed the EAT-RT component. A major barrier was keeping patients motivated, which was impacted by acute toxicity and sometimes conflicting instructions from the healthcare team. Strategies utilized by to overcome barriers included: scaling exercises and/or diet up/down according to the changing patient needs and communicating therapy goals with healthcare team. A model was derived describing the perceived acceptability of the swallowing therapies according to SLPs, based on the interconnection of main themes. Proactive therapies were perceived as more acceptable to trial SLPs, for facilitating patient engagement. The perceived acceptability of the swallowing therapies was related to seven interconnected aspects of providers' experience. These findings will inform the implementation and potential uptake of the PRO-ACTIVE swallowing therapies in clinical practice., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2024
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13. Morphological and functional changes of the geniohyoid muscle in elderly patients after hip fracture surgery: Comparison of ultrasound images with a focus on swallowing function.
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Kiyomiya Y, Fujiu-Kurachi M, Hirata A, Nakasone W, Azuma M, Kishida S, and Tsuda G
- Subjects
- Humans, Female, Aged, Ultrasonography methods, Deglutition physiology, Neck Muscles diagnostic imaging
- Abstract
Objective: The purpose of this study was to clarify, using ultrasound imaging, (1) whether the area and contraction of GH change in elderly patients after hip fracture surgery and (2) whether the changes in the area and contraction of GH are related to decline in swallowing function., Methods: The participants were 21 female patients over 65 years of age who underwent hip fracture surgery. The patients were divided into two groups based on the results of swallowing assessment by water drinking: One with normal swallowing function (NSF) and the other with suspected decline in swallowing function (DSF). Sagittal cross-sectional area (SA) of GH at rest and the shortening rate (SR) of GH upon contraction during swallowing were compared at two time points: immediately and 2 weeks after surgery. Wilcoxon signed-rank test was used for intra-group comparisons, and Mann-Whitney U-test was used for between-group comparisons., Result: SA of GH decreased significantly at 2 weeks after surgery in both groups, regardless of their swallowing function. In the intra-group comparison, SR significantly decreased (worsened) only in DSF group. SR at 2 weeks after surgery was significantly higher in NSF than in the DSF. In the inter-group comparison, DSF showed a significantly smaller (worse) change of SR than NSF in 2 weeks after surgery., Conclusion: Decrease in muscle mass, or atrophy, of GH observed in both NSF and DSF, did not coincide with the post-operative change in GH contraction of the two groups. The results suggest the importance of continuous swallowing assessment in the elderly individuals during their perioperative period., (© 2024 John Wiley & Sons Ltd.)
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- 2024
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14. Optimization of solid oral dosage form administration to patients with swallowing difficulties: An integrative review.
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Ferreira-Neto CJB, de Lara JAA, Cominato A, Tonin FS, and Wiens A
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- Humans, Capsules, Administration, Oral, Deglutition, Deglutition Disorders
- Abstract
Aim: To appraise and synthesize research investigating optimizing the administration of solid oral dosage forms (SODFs) to adults with swallowing difficulties., Design: An integrative review., Methods: An electronic search was conducted on Medical Literature Analysis and Retrieval System Online (Public Medline interface), Elsevier SciVerse Scopus and Scientific Electronic Library Online (updated February 2023). Restriction regarding the publication date was not considered for the inclusion of records. Studies addressing risks, general aspects, recommendations about patient postural adjustments, swallowing techniques, swallowing aids and aspects of concealment of SODFs were included., Results: Fifty-three records published between 2002 and 2021 were included. The main administration risks were aspiration, asphyxia and solid oral dosage form-induced oral/oesophageal mucosal lesions. The most frequent general aspect reported was administering one oral dosage form at a time. The sitting position was the most patient postural adjustment mentioned. The most frequently reported solid oral dosage form swallowing technique was the lean-forward method for capsules. Solid oral dosage form swallowing aids cited: tongue and throat lubricant and solid oral dosage form coating device, swallowing cup and swallowing straw., Conclusion: The literature data on administering SODFs for adults with swallowing difficulties were appraised and synthesized. Some aspects, for example, not administering SODFs simultaneously, can make swallowing safer. Postural adjustments and solid oral dosage form swallowing aids are important to avoid administration risks. Swallowing SODFs can be easier if learned by techniques. Liquid and food are helpful as vehicles, and several of these have been listed., Implications for the Profession And/or Patient Care: By optimizing the contributing factors of administering oral pharmacotherapy, the nurse can use appropriate practices to improve patient safety. Additionally, knowing and establishing the administration aspects are reasonable steps for standardizing care for patients with swallowing oral dosage form difficulties., Impact: This study addressed administering SODFs to adult patients with swallowing difficulties. The administration of SODFs to adult patients with swallowing difficulties can be optimized if only one oral dosage form at a time is administrated and if patient postural adjustments, swallowing techniques and swallowing aids are used. This investigation will impact the care of patients with swallowing difficulties., Reporting Method: The authors declare they adhered to the relevant EQUATOR guidelines and report following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Statement., Patient or Public Contribution: No patient or public contribution., (© 2023 John Wiley & Sons Ltd.)
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- 2024
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15. Effects of Food and Liquid Properties on Swallowing Physiology and Function in Adults.
- Author
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Peña-Chávez RE, Schaen-Heacock NE, Hitchcock ME, Kurosu A, Suzuki R, Hartel RW, Ciucci MR, and Rogus-Pulia NM
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- Humans, Adult, Quality of Life, Food, Pharynx, Deglutition physiology, Deglutition Disorders
- Abstract
Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2023
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16. Communication and swallowing training of stroke-specialized health professionals using transdisciplinary knowledge in a patient-actor scenario: A case report.
- Author
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Coelho de Matos MDA, Pinheiro AR, da Costa IMM, and Alvarelhão J
- Subjects
- Humans, Health Personnel, Communication, Delivery of Health Care, Deglutition, Stroke complications
- Abstract
Background: Most people with stroke exhibit a variety of impairments that need to be addressed by a multidisciplinary team. Communication and swallowing disorders are common and should be screened very early. To guarantee a patient-centred approach, all patients, even those with speech and language disorders, must be actively engaged in the healthcare process. Effective communication is essential to success in many of the needed interventions. However, healthcare professionals often do not receive formal training in communicating with these patients, thus increasing the risk of preventable adverse events., Aims: To describe the design, implementation and evaluation of a post-acute stroke multidisciplinary team training using patient actors in a simulation approach., Methods & Procedures: A 2-day course focused on the transdisciplinary knowledge related to communication and swallowing that all members of the multidisciplinary stroke team should acquire was implemented. A case-based learning methodology used simulation and resorting to patients' actors. Learning outcomes were evaluated by comparing the results obtained in two knowledge tests, one for each topic, which participants performed before and after each day course. Reaction to the training was gathered concerning the content, teacher quality and course organization. The follow-up was performed 6 months later to assess training skills transfer to the workplace environment., Outcomes & Results: All the participants considered that the programme objectives were relevant or truly relevant and revealed that the programme's dynamic, rhythm and scenarios set were excellent. After the end of the programme, both communication and swallowing knowledge increased. Most participants had the opportunity to employ the acquired training skills in their work environment. The main barriers identified to implementing these skills were the 'need for additional training', the 'lack of time' or 'the lack of opportunities'., Conclusions & Implications: Simulation is a central method to increase and improve health professionals' skills when intervening with stroke patients. Using simulation with patient actors allows flexibility and diversification of clinical situations under analysis, which can provide a multiplier effect of reflection and learning. The implemented training achieved its objectives., What This Paper Adds: What is already known on this subject Simulation in the training of health professionals is increasingly used as a good practice, allowing the recreation of scenarios identical to those in the context of professional practice. This strategy is used not only in initial training but also for the development of advanced skills. What this study adds to the existing knowledge This study reports the use of simulation using actor patients for the development of transdisciplinary skills in the topics of communication and swallowing in people with stroke What are the clinical and practical implications of this work? The study demonstrates that in a short period of training, the use of simulation with actor patients favours the development of transdisciplinary skills in the topics of communication and swallowing in people with stroke. At the same time, the skills developed are transferable to professional practice., (© 2023 Royal College of Speech and Language Therapists.)
- Published
- 2024
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17. Review of the effect of amylase-resistant dysphagia products on swallowing safety.
- Author
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Burnip E and Cichero JAY
- Subjects
- Amylases, Beverages, Food Additives, Humans, Plant Gums, Pneumonia, Aspiration prevention & control, Starch, Deglutition, Deglutition Disorders etiology, Deglutition Disorders therapy
- Abstract
Purpose of Review: Thickened fluids are a widely utilised compensatory management strategy for people with impaired swallowing (dysphagia). Over recent years there has been a shift in practice to offer gum-based instead of starch-based products. A key marketing message has been that gum-based thickeners with amylase-resistant properties are superior in promoting 'safer swallowing'. This review sought evidence to evaluate the effect of amylase-resistant products on swallowing safety., Recent Findings: No studies directly compared the effect of amylase-resistant products with usual care or products without amylase resistance. Five studies cited amylase-resistant properties and compared gum-based to starch-based dysphagia products or thin fluids. Swallowing safety was frequently judged subjectively with rating scales. Swallowing biomechanics were not included and clinically meaningful outcomes, such as incidence of aspiration pneumonia, were not reported. A scoping review of the grey literature found little evidence that amylase-resistant properties of dysphagia products were of significant concern to clinicians or patients., Summary: Despite references to the 'importance' of amylase-resistant properties of dysphagia products there is no evidence that this property improves swallowing safety. Further research is needed using objective and clinically meaningful outcome measures to allow clinicians and patients to make informed decisions for dysphagia management., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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18. Relationship between tongue muscle quality and swallowing speed in community-dwelling older women.
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Suzuki M, Koyama S, Kimura Y, Ishiyama D, Ohji S, Otobe Y, Nishio N, Kunieda Y, Ichikawa T, Ito D, Ogawa H, and Yamada M
- Subjects
- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Independent Living, Pressure, Tongue diagnostic imaging, Deglutition, Deglutition Disorders diagnostic imaging
- Abstract
Objective: The aim of this study was to investigate the relationship between tongue muscle quality index, which was represented as tongue muscle pressure divided by tongue muscle mass, and swallowing speed in community-dwelling older women., Methods: The inclusion criteria for this cross-sectional study were that participants be community-dwelling older women aged 65 years and above without dysphagia. The exclusion criteria were stroke and Parkinson's disease that directly cause dysphagia. We measured tongue muscle thickness and maximum tongue pressure and the tongue muscle quality index, which was defined as the maximum tongue pressure divided by tongue muscle thickness. We investigated swallowing speed via a 100 ml water swallowing test. To assess the relationship between tongue muscle characteristics and swallowing speed, we performed stepwise multiple regression analysis., Results: Ninety-three participants were enrolled in this study (mean age: 84.2 ± 4.7 years). A stepwise multiple regression analysis showed that age (β = - 0.292, p < 0.01) and tongue muscle quality index (β = 0.267, p < 0.01) were related to swallowing speed., Conclusion: We found that tongue muscle quality index was related to swallowing speed in community-dwelling older women. According to our findings, it is possible that the tongue muscle quality index is a useful parameter for assessing swallowing speed in older women without dysphagia.
- Published
- 2020
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19. The American Broncho-Esophagological Association Position Statement on Swallowing Fluoroscopy.
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Dhar SI, Nativ-Zeltzer N, Starmer H, Morimoto LN, Evangelista L, O'Rourke A, Fritz M, Rameau A, Randall DR, Cates D, Allen J, Postma G, Kuhn M, and Belafsky P
- Subjects
- Adult, Humans, Fluoroscopy methods, Consensus, Deglutition, Deglutition Disorders diagnostic imaging, Deglutition Disorders therapy
- Abstract
Objectives: To develop an expert consensus statement on the clinical use of swallowing fluoroscopy in adults that reduces practice variation and identifies opportunities for quality improvement in the care of patients suffering from swallowing impairment., Methodology: A search strategist reviewed data sources (PubMed, Embase, Cochrane, Web of Science, Scopus) to use as evidence for an expert development group to compose statements focusing on areas of controversy regarding swallowing fluoroscopy. Candidate statements underwent two iterations of a modified Delphi protocol to reach consensus., Results: A total of 2184 publications were identified for title and abstract review with 211 publications meeting the criteria for full text review. Of these, 148 articles were included for review. An additional 116 publications were also included after reviewing the references of the full text publications from the initial search. These 264 references guided the authors to develop 41 candidate statements in various categories. Forty statements encompassing patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study and esophagram techniques, and interpretation of swallowing fluoroscopy met criteria for consensus. One statement on esophagram technique reached near-consensus., Conclusions: These 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults can guide the development of best practices, improve quality and safety of care, and influence policy in both the outpatient and inpatient settings. The lack of consensus on some aspects of esophagram technique likely reflects gaps in knowledge and clinical practice variation and should be a target for future research. Laryngoscope, 133:255-268, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)
- Published
- 2023
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20. Safety and the effectiveness of a new education program for nurses to assess swallowing function using fiberoptic endoscopic evaluation of swallowing (FEES).
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Yoshida M, Kagaya H, Kamakura Y, Miura Y, Saitoh E, Okawa Y, and Sanada H
- Subjects
- Adult, Female, Humans, Japan, Male, Prospective Studies, Deglutition, Deglutition Disorders physiopathology, Education, Nursing methods, Endoscopy methods
- Abstract
Aim: Nurses have the potential to perform fiberoptic endoscopic evaluation of swallowing (FEES) in Japan, which can aid in their provision of swallowing care appropriate to individual patients' swallowing functions. We aimed to confirm the safety and effectiveness of a new nursing education program on FEES by examining its impact on autonomy in performing FEES and accuracy in observing bolus swallowing., Methods: In this prospective descriptive study, we developed a FEES education program comprising three phases: (a) obtaining knowledge and skills through e-leaning and a practical workshop; (b) becoming proficient in skills for assessing healthy adults through self-learning; and (c) obtaining clinical competence through 30 cases of on-the-job training (OJT). The trends in autonomy and in accuracy of FEES were evaluated by the data during OJT., Results: Of the three certified nurses in dysphagia nursing, a trainee completed 30 cases of OJT and the other two trainees experienced 20 cases and 10 cases, respectively without any adverse event. Autonomy in the four major FEES skills gradually increased over the OJT. The correct answer rate, sensitivity, and specificity of the penetration-aspiration scale and severity of residue in the pyriform sinus and epiglottis valley were above 95% at the first 10 cases of OJT among three trainees and they were 100% after the 11th case of OJT., Conclusions: Our results suggest that the developed education program helped nurses with experience being present at FEES obtain sufficient knowledge and skills to appropriately and safely perform FEES with 30 cases of OJT., (© 2019 Japan Academy of Nursing Science.)
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- 2020
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21. Effects of Carbonation on Swallowing: Systematic Review and Meta-Analysis.
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Nagano A, Maeda K, Shimizu A, Murotani K, and Mori N
- Subjects
- Adult, Humans, Deglutition, Deglutition Disorders prevention & control
- Abstract
Objectives: The effectiveness of the use of carbonation in preventing penetration/aspiration or enhancing swallowing function in adults remains unclear. This systematic review aimed to evaluate the effectiveness of carbonation on improving swallowing function in adult subjects., Methods: Literature published before March 2021 was inspected using MEDLINE, CINAHL, Web of Science Core Collection, The Cochrane Library, Cochrane Central Register of Controlled Trials, and Ichushi-web databases. We searched for intervention studies or randomized control trials considering the effects of carbonated liquids on swallowing function. The risk of bias was assessed using the Cochrane tool for assessing the risk of bias for randomized controlled trials and the Risk of Bias Assessment Tool for Nonrandomized Studies., Results: The systematic review identified 19 studies with a total of 586 participants. The effects of carbonation on swallowing function are diverse. Overall, most studies showed that carbonation promotes swallowing function compared to other liquids. Five studies were included in the quantitative synthesis. Meta-analysis showed that carbonated liquids prevent aspiration (risk difference [RD] -0.27%, 95% confidence interval [CI] -0.44 to -0.10; I
2 = 0%; number needed to treat 3.8, 95% CI 2.2 to 15.0; moderate quality of evidence) when compared to noncarbonated thin liquids. Carbonated liquids also increased the duration of swallowing apnea than did noncarbonated liquids (standardized mean difference 0.25 (mean difference 0.36 seconds), 95% CI 0.03 to 0.47; I2 = 0%; low quality of evidence)., Conclusions: Carbonation had favorable effects on swallowing function. Further in-depth studies are needed to clarify the benefits of carbonation., Level of Evidence: NA Laryngoscope, 132:1924-1933, 2022., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)- Published
- 2022
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22. Instrumental Swallowing Assessments in the Neonatal and Pediatric Populations: A Systematic Review.
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Christovam CA, Manica D, Schweiger C, Sekine L, Miranda PP, and Levy DS
- Subjects
- Child, Fluoroscopy methods, Humans, Infant, Infant, Newborn, Reproducibility of Results, Video Recording methods, Deglutition, Deglutition Disorders diagnostic imaging
- Abstract
The scientific scope of swallowing disorders in the neonatal and pediatric populations is growing exponentially; however, the preponderance of evidence for evaluation protocols has been concentrated in non-instrumental evaluations creating a lack of research about protocols for instrumental swallowing assessment. Thus, the purpose of this study was to systematically review the literature to identify and to report protocols used in instrumental assessments through videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) in the neonatal and pediatric populations to support clinical decision making. The search strategy was applied in five online databases, no filters were applied to restrict languages or publication dates and the gray literature was reviewed. PRISMA statement was used to guide the construction of this review. The studies included validated and unvalidated protocols, the validated protocols had their risk of bias estimated using the QUADAS-2. In total, 13 studies were included in the final review, of these eleven assessed through QUADAS-2, and two classified with low risk of bias. One study is in the process of standardization and validation of an instrumental assessment protocol for swallowing in bottle-fed infants through VFSS. Information about validity and reliability of published protocols for instrumental evaluation in the neonatal and pediatric populations is limited. Therefore, further research is needs to development studies aiming to standardize and validate protocols for instrumental assessments in these populations., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2022
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23. Surgical quality assurance in head and neck cancer trials: an EORTC Head and Neck Cancer Group position paper based on the EORTC 1420 'Best of' and 24954 'larynx preservation' study.
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Simon, Christian, Caballero, Carmela, Gregoire, Vincent, Thurnher, Dietmar, Koivunen, Petri, Ceruse, Philippe, Spriano, Giuseppe, Nicolai, Piero, Licitra, Lisa, Machiels, Jean-Pascal, Hamoir, Marc, Andry, Guy, Mehanna, Hisham, Hunter, Keith D., Dietz, Andreas, and René Leemans, C.
- Subjects
- *
DEGLUTITION , *HEAD tumors , *MEDICAL protocols , *NECK tumors , *QUALITY assurance , *TREATMENT effectiveness , *HUMAN services programs , *SURGERY - Abstract
Abstract Quality improvement of care for patients with head and neck cancer remains a constant objective for the multidisciplinary team of physicians managing these patients. The purpose of quality assurance (QA) for head and neck surgical oncology and surgical trials however differs. While QA for the general head and neck patient aims to improve global outcome through structural changes of health-care systems, QA for surgical trials pursues the goal to help providing meaningful results from a clinical trial through the definition of structure, process and outcome measures within the trial. Establishing a QA program for surgical trials is challenging largely due to the variation in the execution of surgical techniques. Within this article, we describe the surgical QA program, which was developed for the phase III European Organisation for Research and Treatment of Cancer (EORTC) 1420 study, a trial assessing swallowing function after transoral surgery compared with radiation therapy. We propose based on our experience to further develop surgical QA for surgical clinical trials by introducing two separate components, one adaptable and one non-adaptable. The adaptable is tailored to the scientific question and specific procedure; the non-adaptable consists of minimal structural requirements of the clinical unit to participate in surgical trials at EORTC as well as guidelines and incentives for protocol adherence based on our experience in EORTC 24954. Finally, we strongly believe that surgical QA designed for clinical trials may serve as a basis for the development of QA surgical guidelines in clinical practice. Highlights • Quality assurance (QA) programs for surgical trials are challenging. • We propose a QA framework consisting of an adaptable and a non-adaptable component. • The adaptable is tailored to the scientific question and specific procedure. • The non-adaptable consists of minimal structural requirements of the clinical unit. • Surgical QA within clinical trials may serve as the basis for guidelines in clinical practice. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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24. Latent changes in the pharyngeal stage of swallowing in non-aspirating older adults.
- Author
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Nakajima J, Karaho T, Kawahara K, Hayashi Y, Nakamura M, Matsuura N, and Kohno N
- Subjects
- Aged, Aged, 80 and over, Cineradiography methods, Esophageal Sphincter, Upper physiology, Female, Humans, Hyoid Bone physiology, Male, Deglutition physiology, Deglutition Disorders diagnostic imaging
- Abstract
Purpose: The characteristic changes in the swallowing mechanism with aging are collectively termed presbyphagia. Although several studies have investigated presbyphagia in older adults, few have assessed oldest-old adults. We aimed to characterize the latent changes of swallowing function in oldest-old adults and to consider risk ages for presbyphagia., Methods: We analyzed the records of 85 individuals (44 males and 41 females, aged 25-101 years) who underwent videofluoroscopic swallowing studies. The included participants had penetration and aspiration scores of ≤ 2 and no history of aspiration, pneumonia, or diseases that affect swallowing. They were divided into four age groups: 25-64 years (non-older), 65-74 years (young-old), 75-84 years (middle-old), and ≥ 85 years (oldest-old). We analyzed and compared the pharyngeal delay time (PDT), duration of tongue base and posterior pharyngeal wall contact, duration and dimension of upper esophageal sphincter opening (UES-O), and maximal hyoid bone displacement between the age groups., Results: Among the older groups, the oldest-old showed significantly longer PDT than younger-old adults, and the UES-O tended to be wider in the former. However, no other remarkable differences were found between the oldest-old and other old groups. Statistical comparisons between the < 75 and ≥ 75-year age groups revealed significant age-related changes in the PDT and duration and dimension of UES-O., Conclusion: On videofluoroscopic evaluation, physiological changes with aging affected few parameters of swallowing in our cohort. These findings indicate that in non-aspirating oldest-old adults, any deterioration may be adjusted for by compensatory changes to maintain swallowing function., (© 2021. The Author(s), under exclusive licence to European Geriatric Medicine Society.)
- Published
- 2022
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25. Acoustic characteristics associated with liquid swallowing sounds of different bolus consistencies in young healthy adults.
- Author
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Ng ML and Ki A
- Subjects
- Acoustics, Auscultation methods, Female, Humans, Male, Young Adult, Deglutition, Deglutition Disorders diagnosis
- Abstract
Background: Cervical auscultation has been used clinically as an augmentative procedure for swallow examination. Despite its frequent use for screening and preliminary assessment of swallowing, the usefulness of cervical auscultation is controversial due to a lack of sufficient research, particularly in quantifying swallowing sounds., Aims: To document the acoustic characteristics of normal swallowing sound associated with swallowing bolus of different consistencies among younger healthy adults., Methods & Procedures: A total of 30 healthy young adult participants swallowed 5 ml thickened liquids of four different consistencies (slightly thick, mildly thick, moderately thick and extremely thick) prepared using a starch-based commercial thickener, and the corresponding swallowing sounds were recorded using a wireless accelerometric stethoscope. An array of acoustic measures including duration of swallowing sound (DSS), duration to peak intensity (DPI), frequency at peak intensity (FPI), peak intensity (PI), average intensity (AI), and difference between peak and average intensity (DPAI) values associated with the swallowing signals were obtained., Outcomes & Results: In general, increased durational measures of the swallowing sounds were associated with an increase in bolus consistency. Intensity measures including PI, AI and DPAI were found to be stable across different consistencies. The change in FPI did not appear to be particularly meaningful due to its high variability. In addition, no significant differences were observed between men and women., Conclusions & Implications: Swallow sounds associated with different bolus consistencies could be quantified and used to differentiate consistencies. The present findings could serve as a reference for future swallowing research of normal and dysphagic population., What This Paper Adds: What is already known on the subject Cervical auscultation using traditional stethoscope has been used as part of an informal clinical swallow examination by practitioners. Validity of cervical auscultation is controversial, possibly due to the lack of normative data on swallow sounds. What this paper adds to existing knowledge The present study explored the possibility of using wireless accelerometric stethoscopy for cervical auscultation for dysphagia screening. Acoustic profiles of swallow sounds associated with boluses of different consistencies in healthy individuals were examined. What are the potential or actual clinical implications of this work? Findings contribute to our knowledge about the acoustic characteristics of swallow sounds of boluses of different consistencies in healthy young individuals. The study provides normative clinical data on cervical auscultation using wireless accelerometric stethoscope for normal swallow., (© 2022 Royal College of Speech and Language Therapists.)
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- 2022
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26. Fabrication of Skin-Mountable Flexible Sensor Patch for Monitoring of Swallowing Function.
- Author
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Park H, Kim MK, Malandraki GA, and Lee CH
- Subjects
- Electromyography, Humans, Movement, Parkinson Disease, Deglutition, Deglutition Disorders diagnosis
- Abstract
Swallowing is a critical function that enables humans to sustain life. When swallowing is compromised, the consequences can be devastating and include malnutrition, dehydration, respiratory compromise, and even death. Swallowing disorders (i.e., dysphagia) are very common in many disorders and diseases, such as stroke, ALS, Parkinson disease, and more, and in fact millions of people across the world are diagnosed with oropharyngeal swallowing disorders every year. Current rehabilitative interventions for dysphagia can be effective, but require daily performance of swallowing exercises that primarily rely on expensive biofeedback devices (e.g., oral manometers, electromyographic (EMG) devices, and endoscopic devices). These types of devices are often only available in medical facilities. However, it is not feasible or economically viable for patients to make multiple visits per day or week to a clinic to receive intensive treatment, especially given mobility limitations that many affected patients often experience. This can reduce treatment adherence and result in decreased rehabilitation potential, re-hospitalizations, and increased healthcare costs. To address this gap, we designed a novel specialized portable skin-mounted flexible sensor system that allows remote signal acquisition of swallowing-related signals. Herein, we report technical details for the fabrication of the skin-mounted flexible sensor patch that is tailored for the human submental (under the chin) area, enabling the continuous, reliable monitoring of both muscles' activity (i.e., EMG signals) and laryngeal movements during swallowing events. The sensor patch is wired to a portable reusable wireless (Bluetooth) unit compatible with smart watches, phones, and tablets for post-data analysis and reporting through a cloud server, which would potentially enable telemonitoring of patients with dysphagia., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2022
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27. Effects of different viscous liquids and solid foods on swallowing speeds and sounds among healthy adults.
- Author
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Feng C, Volkman K, Wagoner C, and Siu KC
- Subjects
- Acoustics, Adult, Food, Humans, Middle Aged, Viscosity, Young Adult, Deglutition, Deglutition Disorders diagnosis
- Abstract
Background: Digital cervical auscultation (CA) has been proposed since the 1950s for screening aspiration among patients with dysphagia. Researchers have investigated the 'external' effects such as bolus viscosity, volume, and head and neck positions. However, the influences of standardized liquid viscosity and food texture on swallowing sounds have not been fully understood due to lacking uniform standardization of bolus preparation. Furthermore, a paucity of the literature recommends proper viscous liquids and foods to start swallowing training or monitor the swallowing progress during the continuum of disease based on acoustic signals., Aims: To investigate the effects of eight-level liquids and foods on swallowing sound features based on the International Dysphagia Diet Standardisation Initiative (IDDSI)., Methods & Procedures: We collected swallowing sounds from 30 healthy participants ranging in age from 19 to 60 years and who were self-reporting no history of swallowing disorders. Each participant swallowed liquids and foods regarding different consistency or texture with their head-trunk in a neutral position., Outcomes & Results: Features of swallowing acoustic signals and the IDDSI flow test as well as food test confirmed the level 3 moderately thick (MO3) was more suitable to categorize into liquids and the level 4 extremely thick (EX4) was more corresponded to the properties of food bolus. We found significant differences in duration of acoustic signals across different liquids and foods except between swallowing level 0 thin liquid and level 1 slightly thick liquid, as well as EX4 and level 5 minced and moist. Our results also demonstrated liquid viscosity significantly impacted the peak intensity of swallowing sounds., Conclusions & Implications: As an initial exploration of digital CA across eight levels of different liquids and foods according to the IDDSI, we established the baseline findings for future comparisons with other study populations or other various consistent liquids/foods. Although both MO3 and EX4 can be considered as liquid or food boluses with high thickness, MO3 might be suitable as the 'start liquid' for patients with dysphagia; however, the decision still needs to be confirmed by the healthcare provider based on patients' safety and the area of deficit. We also concluded there are influences of varied fluid consistency and food texture on swallowing sounds. Furthermore, future investigations should explore whether changing viscosity levels could either continuously or discretely disturb the swallowing acoustic signals., What This Paper Adds: What is already known on the subject Previous studies have found that the 'external' effects such as bolus viscosity, volume, and head and neck positions. Due to lacking uniform standardization of bolus preparation, there is limited information about the influences of standardized liquid viscosity and food texture on swallowing sounds. What this paper adds to the existing knowledge As an initial exploration, we utilized digital CA with a large sample of viscous liquids and different textures of foods based on the IDDSI to investigate the swallowing sounds. What are the potential or actual clinical implications of this work? This study confirms that the effects of various fluid consistency and food texture on swallowing acoustic signals. However, the findings of this study support the need for further research relating to changing viscosity could either continuously or discretely disturb the swallowing acoustic signals., (© 2021 Royal College of Speech and Language Therapists.)
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- 2022
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28. Effect of the rheological properties of the liquid carrier on the in vitro swallowing of solid oral dosage forms.
- Author
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Lavoisier A, Shreeram S, Jedwab M, and Ramaioli M
- Subjects
- Capsules, Humans, Rheology, Tablets chemistry, Deglutition, Deglutition Disorders
- Abstract
Solid oral dosage forms (SODF) are the most popular oral drug delivery forms, but they can be difficult to swallow, especially for patients suffering from swallowing disorders. This study investigated the dynamics of different combinations of liquid carriers and SODF during the oral phase of swallowing using an in vitro model. The rheological properties of the carriers were characterized using shear and extensional rheometry, and their effect on bolus velocity, bolus shape, post-swallow residues, and SODF position within the bolus was evaluated. The latter has been identified as a novel and promising variable to discriminate between alternative formulations. When swallowed with water, capsules and tablets did not impact significantly the velocity of the bolus, but they lagged behind the liquid bolus, suggesting that low viscosity Newtonian fluids are not efficient carriers for SODF. Increasing the viscosity of the carrier at high shear rates improved the ability of the liquid to transport the SODF but also increased the amount of post-swallow residues. At equivalent shear viscosity, elastic and extensional properties of carriers influenced positively the position of the SODF in the bolus. Capsules and tablets were transported toward the front of these boluses, during the oral phase of swallowing, which is considered beneficial to avoid SODF sticking to the mucosa in the following stages of swallowing. Thin elastic liquids appear as an interesting option to promote safe swallowing of capsules and tablets. Clinical studies are, however, necessary to confirm this positive effect in healthy and dysphagic patients., (© 2021 Wiley Periodicals LLC.)
- Published
- 2021
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29. Age-related composition changes in swallowing-related muscles: a Dixon MRI study.
- Author
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Nakao Y, Uchiyama Y, Honda K, Yamashita T, Saito S, and Domen K
- Subjects
- Aged, Cross-Sectional Studies, Humans, Magnetic Resonance Imaging, Muscles, Pressure, Deglutition, Tongue diagnostic imaging
- Abstract
Background: Dysphagia is considered a social problem in the super-aging society. However, age-related changes in swallowing-related muscles have not been fully deciphered., Aims: We aimed to identify intramuscular fatty infiltration and muscle atrophy in multiple swallowing-related muscles on magnetic resonance imaging (MRI). Moreover, an appropriate muscle strength parameter for the evaluation of swallowing-related muscle mass was examined., Methods: We analyzed the Dixon MRI results of 20 elderly and 20 young adults without head and neck cancer, stroke, neuromuscular disease, or whole-body sarcopenia to evaluate intramuscular fatty infiltration (IMF) and lean muscle mass (LMM) in the tongue, geniohyoid, and pharyngeal muscles. The pharyngeal lumen size was also assessed. Tongue pressure, jaw-opening strength, occlusal force, and head-lifting strength were evaluated within a week before and after MRI., Results: Aging significantly affected the IMF of the swallowing-related muscles, and the tongue muscle was most affected, followed by the pharyngeal muscle and then the geniohyoid muscle. Only the LMM of the geniohyoid muscle significantly decreased with aging. The pharyngeal lumen size did not significantly differ between the elderly and young participants, and only tongue pressure was significantly correlated with tongue, geniohyoid, and pharyngeal muscle mass., Conclusions: IMF is primarily associated with age-related composition changes in swallowing-related muscles, and it is commonly observed in the tongue and pharyngeal muscles. The geniohyoid muscle is more at risk of muscle atrophy rather than fatty infiltration. In addition, tongue pressure can be a parameter for the evaluation of swallowing-related muscle mass., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)
- Published
- 2021
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30. Tongue cleaning in the elderly and its role in the respiratory and swallowing functions: Benefits and medical perspectives.
- Author
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Izumi M and Akifusa S
- Subjects
- Aged, Humans, Pressure, Sulfur Compounds, Tongue, Deglutition, Oral Hygiene, Pneumonia, Aspiration prevention & control
- Abstract
Oral dysfunction, including oral uncleanness and decline in tongue motor function, tongue pressure and swallowing function, precedes frailty. The tongue's dorsum is a reservoir of oral microbiota, desquamated epithelial mucosa and leukocytes due to the multi-papillate anatomy, and leads to tongue coating. The tongue coating is frequently found in older adults because of hyposalivation, immunity's hypoactivity, diminished motor function and compromised tongue's pressure with age. Anaerobe-driven volatile sulphur compounds in tongue coating are a major cause of intra-oral malodor. Dysbiosis of the tongue-coating microbiome rather than the amount of microorganisms is associated with a risk of aspiration pneumonia. Daily tongue cleaning with a brush or scraper is an easy way to control tongue coating deposits and quality. Using mouth wash or rinse-containing germicides is also a way to control the microbiota of tongue coating. The tongue function is closely related to swallowing. Tongue and suprahyoid muscles are linked with respiratory muscles through the endothoracic fascia. The mechanical stimulation during the cleaning of the tongue may stimulate the respiratory muscles. An intervention trial revealed that tongue cleaning by mucosal brush improves tongue pressure, swallowing and respiratory function in old residents of nursing homes, suggesting a rehabilitative effect of tongue cleaning on the swallowing and respiratory functions, preventing aspiration pneumonia. This narrative review assesses the tongue-cleaning benefits for respiratory and swallowing functions and the possibility of preventing aspiration pneumonia., (© 2021 John Wiley & Sons Ltd.)
- Published
- 2021
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31. Effective training duration and frequency for lip-seal training in older people using a self-training instrument.
- Author
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Oki T, Ohta M, Takano T, Sakurai K, and Ueda T
- Subjects
- Aged, Cross-Over Studies, Female, Humans, Muscle Strength, Deglutition, Lip
- Abstract
Objective: To determine the effects of the training duration and frequency on lip-seal strength (LSS) in older people., Background: Lip-seal is important for speaking, eating and swallowing. LSS decreases after training ends; therefore, continuous training is essential., Materials and Methods: Participants underwent the resistance training of LSS. Regarding training duration, eight women aged ≥65 years participated in a crossover study with trainings A (direction: 1, duration: 50 seconds) and B (directions: 3, duration: 3 minutes), daily for 4 weeks. Regarding training frequency, 40 women aged ≥65 years were divided into four groups based on frequency (everyday, every-other-day, once-a-week and control groups), and all groups excluding the control group performed training B for 4 weeks. LSS was measured at weeks 0, 2 and 4 using a digital strain gauge. Friedman's test was used, followed by Steel-Dwass test (α = 0.05)., Results: Regarding the effects of the training duration, significant differences in LSS were noted between weeks 0 and 4 for training B, but no difference was noted for training A. Regarding training frequency, significant differences were observed between weeks 0 and 2 or 4 in the everyday and once-a-week groups. Significant differences were observed in the every-other-day group between weeks 0 and 4 and no difference in the control group. For all groups, median LSS was higher in week 2 or 4 than that in week 0., Conclusion: Lip-seal training for 3 minutes per session everyday, every-other-day or once-a-week for 4 weeks increased LSS of older people., (© 2021 Gerodontology Association. John Wiley & Sons Ltd.)
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- 2021
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32. The Influence of Age, Eating a Meal, and Systematic Fatigue on Swallowing and Mealtime Parameters.
- Author
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Brates D and Molfenter S
- Subjects
- Adolescent, Adult, Aged, Female, Humans, Meals, Pressure, Saliva, Tongue, Young Adult, Deglutition, Deglutition Disorders diagnosis, Deglutition Disorders etiology
- Abstract
Fatigue is widely accepted as a clinically relevant factor in the diagnosis, treatment, and management of dysphagia. Despite the relative importance that is placed on swallowing-related fatigue, the occurrence and effects of fatigue during swallowing is unclear. The goal of this study was to explore effects of eating a meal on measures of tongue strength, endurance, and other parameters of swallowing function under normal conditions compared to when the tongue is intentionally fatigued. Thirty healthy females, 15 "Young" (18-35 years old), and 15 "Old" (70 + years old) were seen for two data collection sessions one week apart. On both days, pre-meal measures were collected, then participants consumed a standardized meal based on a previously published protocol (half a bagel with peanut butter and 8 baby carrots) followed by post-meal measures. An additional pre-meal fatigue task was included on one of the test days (counterbalanced), involving maximal tongue presses until participants could not achieve 40% of baseline maximum pressure. Pre- and post-meal measures included anterior and posterior maximum tongue pressures, saliva swallow pressure, tongue endurance, surface electromyography (sEMG), the modified Borg scale, and the Test of Mastication and Swallowing of Solids (TOMASS). Linear mixed effects regressions compared pre- and post-meal outcome measures (1) on the non-fatigue day and (2) between fatigue and non-fatigue days while controlling for participant and age. The fatigue task caused significant reductions in maximum anterior and posterior tongue pressure. After a normal meal (i.e., without fatigue), we found decreased anterior pressures in the older group only. Older participants also had decreased saliva swallow pressures after the meal compared to pre-meal, while this measure increased post-mean in the young participants. When compared to the non-fatigue meal, eating a meal after tongue fatigue resulted in significantly lower post-meal posterior pressures, regardless of age group. The same pattern was observed with posterior functional reserve. Our results demonstrate that a systematic, participant-specific tongue fatigue task induced measurable changes in maximum tongue pressure. A meal by itself was observed to reduce anterior tongue strength and saliva swallow pressures only in older participants. Overall, it appears that older adults may be more vulnerable to fatigue-induced changes in tongue strength, though the relationship between these measures and changes to functional swallowing remains unknown., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)
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- 2021
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33. A retrospective cross-sectional analysis of swallowing and tongue functions in maxillectomy patients.
- Author
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Ogino Y, Fujikawa N, Koga S, Moroi R, and Koyano K
- Subjects
- Aged, Cross-Sectional Studies, Female, Humans, Male, Pressure, Retrospective Studies, Deglutition, Tongue
- Abstract
Purpose: To investigate the profiles of swallowing and tongue functions, and to identify factors influencing swallowing in maxillectomy patients., Methods: Maxillectomy patients whose swallowing function defined by Eating Assessment Tool (EAT-10) score and tongue functions (oral diadochokinesis: ODK, maximum tongue pressure: MTP) with or without obturator prostheses had been evaluated were enrolled in this study. The effects of the history of radiotherapy and soft palate defect on swallowing function were evaluated. The effect of radiotherapy on oral dryness was also evaluated. To examine correlations of swallowing function with continuous variables, Spearman correlation coefficients were calculated., Results: A total of 47 maxillectomy patients (23 males and 24 females, median age: 71 [IQR: 63-76]) were registered. The median value of EAT-10 scores was 3 [IQR: 0-14]. Patients with the history of radiotherapy, but not with soft palate defect, showed significantly declined swallowing function. ODK and MTP of patients wearing obturator prostheses were significantly improved. No significant effect of radiotherapy on oral dryness was found. A significant correlation was found between EAT-10 score and MTP (P = 0.04)., Conclusions: Swallowing function in maxillectomy patients was relatively impaired and the patients with the history of radiotherapy showed lower swallowing function. Obturator prostheses could contribute to the improvement of MTP and ODK (/ta/). MTP may play a crucial role in swallowing in maxillectomy patients., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2021
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34. Evaluating the safety of oral methylene blue during swallowing assessment: a systematic review.
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Tariq, Bina, Simon, Sorina R., Pilz, Walmari, Maxim, Andra, Kremer, Bernd, and Baijens, Laura W. J.
- Subjects
METHYLENE blue ,DEGLUTITION disorders ,DEGLUTITION ,SEROTONIN syndrome ,CONFERENCE papers ,FOOD safety - Abstract
Objective: Methylene blue (MB) is frequently administered during fiberoptic endoscopic evaluation of swallowing (FEES) to enhance visualization of pharyngeal bolus transit. However, the safety of MB is being questioned since serious adverse events (AEs) such as hemodynamic instability, hemolysis, and serotonin syndrome were reported. The aim of this study is a systematic analysis of the literature to obtain an evidence-based overview of AEs due to oral administration of MB and to determine its safety as a food dye during swallowing assessment. Methods: A systematic literature search was carried out in PubMed, Embase, and Cochrane Library. Two reviewers independently selected articles describing oral administration of MB as a main diagnostic/therapeutic intervention, dosage, and AEs. Expert opinions, conference papers, sample size < 10, and animal studies were excluded. Level of evidence of the included studies was determined. Results: A total of 2264 unduplicated articles were obtained. Seventeen studies met the inclusion criteria with 100% agreement between the two reviewers. Among these, twelve studies were randomized controlled trials. In a pooled population of 1902 patients receiving oral MB, three serious AEs were reported related to MB. Non-serious AEs showed a dose-related trend and were usually mild and self-limiting. A meta-analysis could not be performed as studies were methodologically too heterogeneous. Conclusion: Serious AEs due to oral administration of MB are rare (n = 3, 0.16%). MB-related non-serious AEs are mild, self-limiting, and show a dose-related trend. These findings indicate that it is safe to use small amounts of MB as a food dye during swallowing examinations. [ABSTRACT FROM AUTHOR]
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- 2021
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35. Reliability and Validity of the Chinese Mandarin Version of the Swallowing Quality of Life Questionnaire.
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Lai X, Zhu H, Du H, Wang J, Bo L, and Huo X
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- China, Humans, Psychometrics, Reproducibility of Results, Surveys and Questionnaires, Deglutition, Quality of Life
- Abstract
Swallowing disorders can adversely affect quality of life (QOL). To develop the Chinese version of the Swallowing Quality of Life Questionnaire (ChSWAL-QOL) and evaluate its reliability and validity, the ChSWAL-QOL was generated by forward translation of the original SWAL-QOL, backward translation, cultural adaptation, and revision using the Delphi method. The ChSWAL-QOL was administered to 376 patients with dysphagia treated at Peking Union Medical College Hospital between November 1, 2017 and December 31, 2018. Reliability was evaluated using Cronbach's α and test-retest reliability. Content validity was assessed using the content validity index (CVI). Structural validity was evaluated by exploratory factor and confirmatory factor analyses. The 44-item, 11-dimension of ChSWAL-QOL was considered semantically relevant, clearly expressed and easy to understand in a preliminary study. The final analysis included 360 of 376 questionnaires (95.7%). Cronbach's α was 0.906 for the whole scale and ranged from 0.815 to 1.000 for the individual dimensions, and the test-retest reliability was 0.847, indicating that the ChSWAL-QOL had excellent internal consistency. CVI was 0.964 overall and ranged from 0.870 to 1.000 for the individual dimensions. Exploratory factor analysis identified a dysphagia-related component (psychological burden, feeding duration, swallowing symptoms, eating desire, communication, feeding fear, mental health, and social function) and a generic component (fatigue and sleep) explaining 52.8% and 10.8% of the variance, respectively. The ChSWAL-QOL has excellent reliability and validity. This scale could be used as a tool to assess the QOL of patients with dysphagia in mainland China., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2021
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36. Enhancing the learning and supervision framework for training in flexible endoscopic evaluation of swallowing.
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Robinson HF
- Subjects
- Clinical Competence, Curriculum, Endoscopy, Humans, Deglutition, Deglutition Disorders diagnosis, Deglutition Disorders therapy
- Abstract
Purpose of Review: This article reviews the literature on the development of competency-based training and assessment in endoscopy, comparing gastrointestinal endoscopy and flexible endoscopic evaluation of swallowing (FEES). The discussion focusses on how a robust and explicit learning framework can be translated to the delivery of training in FEES to optimize trainee outcomes and supervisor skill., Recent Findings: Specialist Speech and Language Therapists (SLT) carry out FEES to inform the diagnosis and management of swallowing and voice disorders. Taught courses are generally followed by local workplace-based supervised practice to attain the competencies identified in the relevant professional guidelines. However, the curriculum for the workplace-based FEES training lacks a learning and assessment framework and little direction for the workplace-based supervisor. In gastrointestinal endoscopy training, this previously led to less than optimal outcomes for trainees and patients and so new models of training were developed., Summary: A new learning framework for FEES underpinned by medical pedagogy has shown early promise in supporting the acquisition of competence. Incorporating a new FEES-specific systematic assessment, the framework provides direction for the supervisor and evidence of trainee progression, which subsequently enhances supervisor confidence to determine trainee competence., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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37. Changes of bolus properties and the triggering of swallowing in healthy humans.
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Kochi I, Takei E, Maeda R, Ito K, Magara J, Tsujimura T, Kulvanich S, and Inoue M
- Subjects
- Bite Force, Food, Humans, Mastication, Pressure, Deglutition, Tongue
- Abstract
There is wide variation in chewing behaviours, even among healthy humans. Further, the way in which humans determine swallowing initiation when chewing solid foods remains unclear. The current study sought to investigate how the bolus properties change over time during chewing, and to clarify which factors affect chewing and swallowing behaviours, including swallowing initiation, in healthy humans. Twenty-four healthy volunteers were instructed to chew 8 g of steamed rice and spit it out at 50%, 100% and 150% of their own chewing duration, defined as the time of chewing from onset of the first chewing cycle to onset of the first swallow. Chewing and swallowing behaviours were monitored and determined by visual inspection of video recordings. The physical properties such as hardness, cohesiveness and adhesiveness as well as water content of the bolus were measured. In each subject, maximum bite force, tongue pressure and stimulated salivary flow rate were also measured. Hardness gradually decreased, and the cohesiveness and water content of the bolus did not change up to 50% of chewing duration, followed by a slight but significant increase. The adhesiveness of the bolus rapidly decreased at the beginning of chewing. Chewing duration was significantly related to stimulated salivary flow rate; greater salivary flow rate was associated with shorter chewing duration. Variation of chewing duration and swallowing initiation was not dependent on bolus properties during the chewing of steamed rice, but mainly depended on the surface lubrication of the bolus., (© 2021 John Wiley & Sons Ltd.)
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- 2021
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38. Simple oral exercise with chewing gum for improving oral function in older adults.
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Kim HJ, Lee JY, Lee ES, Jung HJ, Ahn HJ, Jung HI, and Kim BI
- Subjects
- Aged, Exercise, Humans, Salivation, Chewing Gum, Deglutition, Saliva
- Abstract
Background: As general and oral health are closely interrelated, promoting oral health may extend a healthy life expectancy., Aims: To evaluate the long-term effects of simple oral exercise (SOE) and chewing gum exercise on mastication, salivation, and swallowing function in adults aged ≥ 65 years., Methods: Ninety-six participants were assigned to control, SOE, and GOE (chewing gum exercise with SOE) groups. The SOE comprised exercises to improve mastication, salivation, and swallowing function. Control group participants performed no exercises. The intervention period was 8 weeks, followed by a 3-week maintenance period. The Mixing Ability Index (MAI), occlusal force, unstimulated saliva, and repetitive saliva swallowing test were evaluated at baseline and 2, 5, 8, and 11 weeks later. Self-reported discomfort was re-evaluated after 8 weeks., Results: After 8 weeks, mean MAI differences from baseline significantly increased in both groups; the increase in the GOE group was largest and four times higher than in the control group. Mean differences of occlusal force from baseline increased by 56 N (SOE group) and 60 N (GOE group). The increase of salivation was greater in the SOE (3.6-fold) and GOE (2.2-fold) groups than in the control group. Furthermore, 27% and 18% of SOE and GOE group participants, respectively, were re-categorized as having good swallowing function. Participants reported less discomfort as oral functions improved., Discussion: These findings may facilitate the development of clinical practice guidelines for optimal oral care in older adults., Conclusion: While both SOE and GOE may improve oral function in older adults, GOE is recommended for those with impaired mastication., Trial Registration: KCT0003305, retrospectively registered 31/10/2018.
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- 2021
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39. Dysphagia management in Parkinson's disease: Comparison of the effect of thickening agents on taste, aroma, and texture.
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Baert F, Vlaemynck G, Beeckman AS, Van Weyenberg S, and Matthys C
- Subjects
- Aged, Aged, 80 and over, Beverages analysis, Case-Control Studies, Cross-Sectional Studies, Deglutition Disorders etiology, Disease Management, Female, Humans, Male, Middle Aged, Polysaccharides, Bacterial chemistry, Rheology, Viscosity, Deglutition, Deglutition Disorders diet therapy, Food Additives chemistry, Food Preferences, Odorants analysis, Parkinson Disease complications, Taste
- Abstract
Dysphagia is a frequent symptom in Parkinson's disease (PD). Thickening liquids facilitates safe swallowing, however, low treatment compliance is a major issue, due to patients' dislike of thickened liquids. Some studies suggest a negative impact of gum-based thickeners, currently most used in clinical practice, on sensory properties compared to starch-based thickeners. This has not yet been investigated in PD. This study's aim was to compare taste, texture, and aroma of gum-based and starch-based thickened soups in participants with PD. Gum-based resource thicken up clear (RTUC) and starch-based kitchen products potato starch (PS) and quinoa flour (QF) were evaluated in broccoli soup. Texture, aroma, and taste were characterized by rheology, volatile, and sensory profiling. Thickened soups were evaluated in participants with PD and controls through a paired comparison test. Reduced release of 61.4%, 46.2%, and 38.5% of volatiles was observed after thickening with RTUC, PS, and QF, respectively. Overall taste intensity was reduced in RTUC- and PS-thickened soup, respectively. Taste and aroma of PS-thickened soup were considered more intense by 70.3% and 63.8% of all participants, respectively (n = 36 PD, n = 41 controls), 56.3% preferred the PS-thickened soup's texture . Taste and aroma of QF-thickened soup were considered more intense by 68.1% and 65.6% of all participants, respectively (n = 47 PD, n = 31 controls), 58.0% preferred the QF-thickened soup's texture. Starch-based thickeners demonstrated higher taste and aroma intensity. However, volatile and sensory profiling demonstrated reduced taste and aroma in all thickeners. Combining kitchen products with flavor enhancers may increase palatability of thickened beverages., (© 2021 Institute of Food Technologists®.)
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- 2021
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40. Oral diadochokinesis is related to decline in swallowing function among community-dwelling Japanese elderly: a cross-sectional study.
- Author
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Takeuchi N, Sawada N, Ekuni D, and Morita M
- Subjects
- Aged, Cross-Sectional Studies, Humans, Japan, Pressure, Tongue, Deglutition physiology, Independent Living
- Abstract
Background: Since oral organs function in the first stage of the swallowing process, it is possible that decline in swallowing function can be partly related to oral frailty., Aims: The purpose of this study was to investigate the association between swallowing function and oral function among community-dwelling elderly Japanese and to propose cut-off values for screening of decline in swallowing function., Methods: A total of 188 participants were included in the analysis. The number of present teeth and functioning teeth were counted. Bacteria counts in tongue coat, oral wettability, tongue pressure, oral diadochokinesis (ODK), masticatory ability and bite force were examined. Swallowing function was assessed using the 10-item Eating Assessment Tool (EAT-10). Receiver operating characteristic curves were used to determine the cut-off points of each oral function parameter. A logistic regression model was performed to determine the combination of parameters with the highest accuracy for differentiating decline in swallowing function from normal., Results: Subjects with ODK /pa/ sound < 6.2 times/second had higher prevalence of swallowing problems than those with 6.2 times/second or more. EAT-10 scores of one or more were significantly related to older age (≥ 71 years old; odds ratio [OR] 4.321) and reduced ODK /pa/ sound (< 6.2 times/second; OR 2.914)., Conclusions: Among community-dwelling elderly Japanese, those who were suspected of having decline in swallowing function had lower oral function than those who did not, and the cut-off values were 71 years of age and ODK /pa/ sound 6.2 times/s.
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- 2021
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41. Effects of age and gender on swallowing activity assessed by electromyography and laryngeal elevation.
- Author
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Endo H, Ohmori N, Chikai M, Miwa H, and Ino S
- Subjects
- Electromyography, Female, Humans, Male, Neck Muscles, Deglutition, Deglutition Disorders
- Abstract
Background: Quantitative assessment of swallowing function is necessary to prevent swallowing impairment due to ageing. Though surface electromyography (EMG) has been widely used to measure swallowing activity, the relationship between EMG results and swallowing function is unclear., Objective: This study examined the relationship between the temporal characteristics of muscle activity and laryngeal elevation (LE) during swallowing., Methods: This study analysed 60 healthy volunteers in two age groups (young, between 20 and 38 years; old, between 65 and 75 years), each containing the same number of male and female participants. Surface EMG signals were recorded from the suprahyoid and infrahyoid muscle groups (SH-EMG and IH-EMG, respectively). LE was measured using an array of pressure sensors. The participants swallowed 3 mL of water under three swallowing speed conditions: fast, normal and slow swallowing. The EMG duration, EMG time intervals before and after the onset of LE (pre-LE and post-LE intervals, respectively), and the LE velocity were analysed., Results: Both EMG duration and the post-LE interval of IH-EMG were significantly longer in the older group. As for the gender effect, the pre-LE interval of SH-EMG was significantly longer and the LE velocity was significantly higher in men than in women. Furthermore, there was a negative correlation between pre-LE interval and LE velocity in the fast swallowing condition., Conclusion: Though ageing slightly prolonged the muscle activity time, gender influenced swallowing activity in a more complex manner. Therefore, it is important to take gender into account when examining swallowing function with increasing age., (© 2020 John Wiley & Sons Ltd.)
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- 2020
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42. Effects of lingual exercises on oral muscle strength and salivary flow rate in elderly adults: a randomized clinical trial.
- Author
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Lee KH, Jung ES, and Choi YY
- Subjects
- Aged, Aged, 80 and over, Case-Control Studies, Female, Humans, Male, Muscle Strength physiology, Republic of Korea, Deglutition physiology, Exercise Therapy methods, Oral Health, Salivation physiology, Tongue physiology
- Abstract
Aim: The present study investigated the effects of two types of lingual exercise (tongue-hold swallowing and tongue-pressure resistance training) on oral muscle strength, salivary flow rate and subjective oral health of the elderly., Methods: We randomly assigned 74 elderly adults (≥65 years) to three groups (tongue-hold swallowing, tongue-pressure resistance training and control groups). Each group participated in 8 weeks of their appropriately prescribed intervention. We measured anterior tongue strength, posterior tongue strength, lip strength, salivary flow rate and Oral Health Impact Profile-14 score before and after 8 weeks. Differences before and after intervention were observed with a paired sample t-test. Moreover, analyses of covariance and variance were performed to determine the differences in the measured values between the groups., Results: The tongue-hold swallowing group showed improvement in both anterior and posterior tongue strength, while the tongue-pressure resistance training group showed a significant increase in only anterior tongue strength. Both the tongue-hold swallowing and tongue-pressure resistance training groups showed increased salivary secretion, with the tongue-pressure resistance training group showing a higher level of salivary secretion. However, the difference in the subjective oral health scores before and after the intervention was not significant., Conclusions: The two lingual exercises strengthened some aspects of tongue muscles and increased the salivary flow rate, with more salivary secretion in the tongue-pressure resistance training group than in the tongue-hold swallowing group. Any evidence of the lingual exercises being able to enhance subjective oral health could not be found. Geriatr Gerontol Int 2020; ••: ••-••., (© 2020 Japan Geriatrics Society.)
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- 2020
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43. Approaches and experiences implementing remote, electronic consent at the Leeds Clinical Trials Research Unit.
- Author
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Cragg, William J, Taylor, Chris, Moreau, Lauren, Collier, Howard, Gilberts, Rachael, McKigney, Niamh, Dennett, Joanna, Graca, Sandra, Wheeler, Ian, Bishop, Liam, Barrett, Adam, Hartley, Suzanne, Greenwood, John P, Swoboda, Peter P, and Farrin, Amanda J
- Subjects
CLINICAL trials ,MEDICAL research ,PATIENT preferences ,NEUROLINGUISTICS ,DATA protection ,DEGLUTITION ,PUBLIC health research - Abstract
Background: Use of electronic methods to support informed consent ('eConsent') is increasingly popular in clinical research. This commentary reports the approach taken to implement electronic consent methods and subsequent experiences from a range of studies at the Leeds Clinical Trials Research Unit (CTRU), a large clinical trials unit in the UK. Main text: We implemented a remote eConsent process using the REDCap platform. The process can be used in trials of investigational medicinal products and other intervention types or research designs. Our standard eConsent system focuses on documenting informed consent, with other aspects of consent (e.g. providing information to potential participants and a recruiter discussing the study with each potential participant) occurring outside the system, though trial teams can use electronic methods for these activities where they have ethical approval. Our overall process includes a verbal consent step prior to confidential information being entered onto REDCap and an identity verification step in line with regulator guidance. We considered the regulatory requirements around the system's generation of source documents, how to ensure data protection standards were upheld and how to monitor informed consent within the system. We present four eConsent case studies from the CTRU: two randomised clinical trials and two other health research studies. These illustrate the ways eConsent can be implemented, and lessons learned, including about differences in uptake. Conclusions: We successfully implemented a remote eConsent process at the CTRU across multiple studies. Our case studies highlight benefits of study participants being able to give consent without having to be present at the study site. This may better align with patient preferences and trial site needs and therefore improve recruitment and resilience against external shocks (such as pandemics). Variation in uptake of eConsent may be influenced more by site-level factors than patient preferences, which may not align well with the aspiration towards patient-centred research. Our current process has some limitations, including the provision of all consent-related text in more than one language, and scalability of implementing more than one consent form version at a time. We consider how enhancements in CTRU processes, or external developments, might affect our approach. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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44. Commentary on: an evaluation of a speech and language therapy eating, drinking, and swallowing service for adults with intellectual disability (Crocker et al., 2024).
- Author
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Stewart, Kitty, Heckelmann, Nina, and Roos, Alida
- Subjects
NURSES ,OCCUPATIONAL roles ,INTERPROFESSIONAL relations ,CLINICAL competence ,FOOD habits ,DEGLUTITION ,INDIVIDUALIZED medicine ,HEALTH care teams ,SPEECH therapy ,DRINKING behavior - Abstract
Purpose: The purpose of this paper is to expand upon some of the issues raised in "An evaluation of a speech and language therapy eating, drinking and swallowing service for adults with intellectual disability" (Crocker et al., 2024). Design/methodology/approach: This commentary outlines considerations for multidisciplinary team working and professional roles both within and beyond the community learning disability team. It discusses models of service delivery and competency frameworks relating to eating, drinking and swallowing services. Findings: Services should be integrated, include a broad multidisciplinary team and aim to increase competency in all contexts supporting people with eating, drinking and swallowing needs. Outcomes of service provision need to be measured outside of individualised care. Originality/value: This paper broadens the discussion of quality of eating, drinking and swallowing services beyond speech and language therapy and considers a whole systems approach. [ABSTRACT FROM AUTHOR]
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- 2024
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45. Introduction to the Special Issue: Select Papers From the 2018 Charleston Swallowing Conference at Northwestern University.
- Author
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Martin-Harris, Bonnie, Bonilha, Heather Shaw, and Suiter, Debra
- Subjects
- *
THERAPEUTICS , *DEGLUTITION , *DEGLUTITION disorders , *PATIENT-centered care , *MEDICAL technology , *EARLY diagnosis - Abstract
The Charleston Swallowing Conference at Northwestern University is a clinical multidisciplinary conference designed for dysphagia clinicians who practice across all care settings and treat individuals of all ages. This special issue of the American Journal of Speech-Language Pathology contains selected articles from the July 2018 conference dedicated to innovation and implementation of dysphagia practice. The collection of articles includes clinical best practices, new patient-centered assessment and treatment discoveries, re-examination and application of current practices across the age spectrum, and the role of novel technology and data science initiatives. Clinicians and researchers will gain practical, tangible, and directly translatable information toward advanced skill sets in swallowing assessment and treatment. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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46. The use and effects of whole‐body exercises on swallowing function: A scoping review.
- Author
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Pu, Dai and Yao, Theresa Jingyun
- Subjects
ONLINE information services ,CINAHL database ,SYSTEMATIC reviews ,DEGLUTITION disorders ,EXERCISE physiology ,TREATMENT effectiveness ,MEDICAL protocols ,LITERATURE reviews ,MEDLINE - Abstract
Background: Swallowing function can become impaired due to primary medical conditions or age‐related presbyphagia, resulting in swallowing disorders, known as dysphagia. Specific manoeuvres that target different musculature have been innovated and researched, but whole‐body exercises (WBE) that target multiple large groups of body systems and muscles have been rarely considered in dysphagia management, despite the causes of dysphagia being often systemic. Aims: To identify intervention studies that have used or incorporated WBE to target swallowing function in humans, and report on their findings. Methods & Procedures: A scoping review was conducted given the paucity and novelty of this topic in research and practice. Key search terms were used to search five major databases on for all human studies published before 28 November 2022. Studies that were not interventional or used animal models were excluded. All swallowing and oromotor‐related outcomes were extracted from the studies. Two researchers independently reviewed all search results following the PRISMA‐ScR guideline before meeting to resolve any disagreements. Main Contribution: Final analysis was conducted on 11 papers that described 10 studies, with 10 papers (9 studies) reporting positive findings for swallowing or oromotor function‐related outcomes. Studies ranged from randomised controlled trials to case studies in design. The study design and populations were heterogeneous, with outcome measures for swallowing and oromotor function ranging from subjective questionnaires to instrumental assessments. Conclusions & Implications: Dysphagia rehabilitation that incorporates WBE as part of a comprehensive programme appears to be more beneficial than either WBE or swallowing‐related interventions alone. This review is an initial attempt to systematically examine the evidence on this topic. There is a need for future research to study how WBE can be used, either alone or combined with traditional swallowing exercises, to influence swallowing function in different healthy and clinical populations. WHAT THIS PAPER ADDS: What is already known on this subject: Dysphagia rehabilitation usually focuses only on the swallowing muscles and structures of the head, neck, and respiratory system. Whole‐body exercise (WBE) and fitness are associated with stronger performance of the tongue muscles, there may be transference potential of WBE to swallowing function. What this paper adds to existing knowledge: This review found 10 studies conducted in the last decade that investigated the inclusion of WBE in programmes intended to improve swallowing and/or oromotor‐related outcomes. The studies varied widely in design and methodology, but most reported evidence in support of the inclusion of WBE to improve or maintain swallowing and/or oromotor‐related functions. What are the potential or actual clinical implications of this work?: There is potential for WBE to have a synergistic effect on swallowing function when combined with traditional swallowing exercises. Future clinical research should compare different rehabilitation approaches with controls. Clinicians should enlist allied health professionals who can provide whole‐body rehabilitation when managing dysphagia. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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47. The Prevalence of Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-analysis.
- Author
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Ribeiro, Marcos, Miquilussi, Paloma Alves, Gonçalves, Flávio Magno, Taveira, Karinna Veríssimo Meira, Stechman-Neto, José, Nascimento, Weslania Viviane, de Araujo, Cristiano Miranda, Schroder, Angela Graciela Deliga, Massi, Giselle, and Santos, Rosane Sampaio
- Abstract
To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%–70%; I
2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%–36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample. [ABSTRACT FROM AUTHOR]- Published
- 2024
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48. Swallowing-like activity elicited in neonatal rat medullary slice preparation.
- Author
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Kondo T, Yamanishi T, Nishio T, Yokota Y, Seikai T, Enomoto A, Harada T, Tsuji T, and Tanaka S
- Subjects
- Animals, Rats, Electric Stimulation, Solitary Nucleus drug effects, Solitary Nucleus physiology, Rats, Sprague-Dawley, Deglutition physiology, Deglutition drug effects, Medulla Oblongata physiology, Medulla Oblongata drug effects, Animals, Newborn, Bicuculline pharmacology, Bicuculline analogs & derivatives, Vagus Nerve physiology, Vagus Nerve drug effects, Central Pattern Generators physiology, Central Pattern Generators drug effects, Hypoglossal Nerve physiology, Hypoglossal Nerve drug effects
- Abstract
Swallowing is induced by a central pattern generator in the nucleus tractus solitarius (NTS). We aimed to create a medullary slice preparation to elucidate the neural architecture of the central pattern generator of swallowing (Sw-CPG) and record its neural activities. Experiments were conducted on 2-day-old Sprague-Dawley rats (n = 46). The brainstem-spinal cord was transected at the pontomedullary and cervicothoracic junctions; the medulla was sliced transversely at thicknesses of 600, 700, or 800 μm. The rostral end of the slice was 100 μm rostral to the vagus nerve. We recorded hypoglossal nerve activity and electrically stimulated the vagus nerve or microinjected bicuculline methiodide (BIC) into the NTS. The 800-μm slices generated both rhythmic respiratory activity and electrically elicited neural activity. The 700-μm slices generated only respiratory activity, while the 600-μm slices did not generate any neural activity. BIC microinjection into the NTS in 800-μm slices resulted in the typical activity that closely resembled the swallowing activity reported in other experiments. This swallowing-like activity consistently lengthened the respiratory interval. Despite complete inhibition of respiratory activity, weak swallowing-like activity was observed under bath application of a non-NMDA receptor antagonist. Contrastingly, bath application of NMDA receptor antagonists resulted in a complete loss of swallowing-like activity and no change in respiratory activity. These results suggest that the 800-μm medullary slice preparation contains both afferent and efferent neural circuits and pattern generators of swallowing activity. Additionally, NMDA receptors may be necessary for generating swallowing activity. This medullary slice preparation can therefore elucidate Sw-CPG neural networks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
- Published
- 2024
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- View/download PDF
49. Motion reconstruction and finite element analysis of the temporomandibular joint during swallowing in healthy adults.
- Author
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Teng H, Shu J, Ma H, Shao B, and Liu Z
- Subjects
- Humans, Adult, Male, Biomechanical Phenomena, Female, Magnetic Resonance Imaging, Tomography, X-Ray Computed, Healthy Volunteers, Health, Image Processing, Computer-Assisted, Young Adult, Finite Element Analysis, Temporomandibular Joint physiology, Temporomandibular Joint diagnostic imaging, Deglutition physiology, Movement
- Abstract
There is a close physiological connection between swallowing and the temporomandibular joint (TMJ). However, a shortage of quantitative research on the biomechanical behavior of the TMJ during swallowing exists. The purpose of this study was to reconstruct the movement of the temporomandibular joint (TMJ) based on in vivo experiment and analyze the biomechanical responses during swallowing in healthy adults to investigate the role of the TMJ in swallowing. Motion capture of swallowing, computed tomography (CT), and magnet resonance images (MRI) were performed on six healthy subjects. The movements of the TMJ during swallowing were reconstructed from the motion capture data. The three-dimensional finite element model was constructed. The dynamic finite element analysis of the swallowing process was performed based on the motion data. The range of condylar displacement was within 1 mm in all subjects. The left and right condyle movements were asymmetrical in two-thirds of the subjects. The peak stresses of the discs were relatively low, with a maximum of 0.11 MPa. During swallowing, the condylar displacement showed two trends: slow retraction and slow extension. The tendency to extend could lead to a gradual increase in stress on the disc., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 IPEM. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
50. Towards a comprehensive bedside swallow screening protocol using cross-domain transformation and high-resolution cervical auscultation.
- Author
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Anwar A, Khalifa Y, Lucatorto E, Coyle JL, and Sejdic E
- Subjects
- Humans, Algorithms, Male, Female, Point-of-Care Testing, Middle Aged, Deglutition physiology, Deglutition Disorders physiopathology, Deglutition Disorders diagnosis, Deglutition Disorders diagnostic imaging, Auscultation methods
- Abstract
High-resolution cervical auscultation (HRCA) is an emerging noninvasive and accessible option to assess swallowing by relying upon accelerometry and sound sensors. HRCA has shown tremendous promise and accuracy in identifying and predicting swallowing physiology and biomechanics with accuracies equivalent to trained human judges. These insights have historically been available only through instrumental swallowing evaluation methods, such as videofluoroscopy and endoscopy. HRCA uses supervised learning techniques to interpret swallowing physiology from the acquired signals, which are collected during radiographic assessment of swallowing using barium contrast. Conversely, bedside swallowing screening is typically conducted in non-radiographic settings using only water. This poses a challenge to translating and generalizing HRCA algorithms to bedside screening due to the rheological differences between barium and water. To address this gap, we proposed a cross-domain transformation framework that uses cycle generative adversarial networks to convert HRCA signals of water swallows into a domain compatible with the barium swallows-trained HRCA algorithms. The proposed framework achieved a cross-domain transformation accuracy that surpassed 90%. The authenticity of the generated signals was confirmed using a binary classifier to confirm the framework's capability to produce indistinguishable signals. This framework was also assessed for retaining swallow physiological and biomechanical properties in the signals by applying an existing model from the literature that identifies the opening and closure of the upper esophageal sphincter. The outcomes of this model showed nearly identical results between the generated and original signals. These findings suggest that the proposed transformation framework is a feasible avenue to advance HCRA towards clinical deployment for water-based swallowing screenings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
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