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Introduction. The gag reflex is a protection mechanism that prevents food and unwanted agents from entering the lower airways. It is usually part of the physical examination of swallowing to detect oropharyngeal dysphagia, but it is a potentially ambiguous sign.Objective. To evaluate the diagnostic value of the gag reflex in patients with neurogenic oropharyngeal dysphagia and adults without it.Materials and methods. We conducted an analytical observational study in patients with neurogenic oropharyngeal dysphagia (cases) and patients without dysphagia (controls). We evaluated the absence or presence of the reflex bilaterally, by direct visualization, and adjusted it according to sex, age, and other interaction variables.Results. We included 86 patients with neurogenic oropharyngeal dysphagia and 80 control subjects. The gag reflex on swallowing physical examination showed a positive relationship with the patients (right side: OR = 3.97; 95 % CI: 2.01-7.84; left side: OR = 4.84; 95 % CI: 2.41-9.72), but a negative association with the control group. In both groups, neither sex, nor age, nor other interaction variables modified the gag reflex.Conclusions. The gag reflex absence or presence does not confirm or exclude the existence of oropharyngeal dysphagia due to neurological and neuromuscular causes.Therefore, health professionals must not rely on this reflex. Clinicians must go beyond a simple reflex revision, even in neurological patients where it is supposed to be absent., Introducción. El reflejo nauseoso es un mecanismo de protección que impide que alimentos y agentes no deseados penetren en la vía aérea inferior. Usualmente, hace parte del examen físico de la deglución para detectar la disfagia orofaríngea, pero es un signo potencialmente ambiguo.Objetivo. Evaluar el valor diagnóstico del reflejo nauseoso en pacientes con disfagia orofaríngea neurogénica y en pacientes sin ella.Materiales y métodos. Se trata de un estudio observacional, analítico, en pacientes con disfagia orofaríngea neurogénica (casos) y en personas sin disfagia (controles), en el cual se evaluó por visualización directa la ausencia o la presencia del reflejo nauseoso de forma bilateral. Este resultado se ajustó por sexo, edad y otras variables de interacción.Resultados. Se evaluaron 86 pacientes con disfagia orofaríngea neurogénica y 80 personas sin ella. En el examen físico de la deglución, la presencia del reflejo mostró una relación positiva con los pacientes (lado derecho: OR = 3,97; IC95%: 2,01-7,84; lado izquierdo: OR = 4,84; IC95%: 2,41-9,72), pero una asociación negativa con los controles. En ambos grupos, ni el sexo ni la edad, ni otras variables de interacción modificaron el reflejo nauseoso. Conclusiones. La ausencia o la presencia del reflejo nauseoso no confirma ni excluye la existencia de una disfagia orofaríngea por causas neurológicas o neuromusculares; por lo tanto, no es recomendable que los profesionales de la salud se fíen del resultado de este reflejo. Los médicos tratantes deben ir más allá de una simple revisión del reflejo nauseoso, incluso en pacientes neurológicos en quienes se supone que debería estar ausente.

Post-extubation dysphagia (PED) is a common complication in patients undergoing orotracheal intubation (OTI). Currently, there is significant heterogeneity in the reported incidence, ranging from 3% to 81%. Consensus on its risk factors is also lacking. This study aimed to determine the incidence and risk factors for PED in non-neurological adult patients. A retrospective longitudinal study was conducted by reviewing clinical records of patients who underwent OTI in a public hospital in Chile between June 2018 and June 2019. Cumulative incidence was estimated, and univariate and multivariate logistic regression models were used to identify risk factors. The presence/absence of PED was considered the response variable, with age, gender, days of OTI, assessment time, and admission diagnosis to the intensive care unit (ICU) as predictor variables. Data from 141 patients, comprising 72 males and 69 females, with an average age of 59 years, were collected. Of the patients, 73,05% presented with PED, and both age and days of OTI were identified as risk factors for PED. Gender, time elapsed until assessment, and the cause of admission to the ICU were not associated with the presence of PED. During the study period, a PED incidence of 73,05% was observed. The primary risk factor for PED was the duration of OTI, followed by age. The remaining variables studied did not demonstrate an association with the risk of PED., La disfagia post extubación (DPE) es una complicación frecuente en pacientes sometidos a intubación orotraqueal (IOT). Actualmente, existe gran heterogeneidad en los reportes de su incidencia, fluctuando entre un 3 y un 81%. Tampoco existe consenso en relación con sus factores de riesgo. El objetivo del presente estudio fue determinar la incidencia y los factores de riesgo de DPE en pacientes adultos no neurológicos. Se realizó un estudio longitudinal retrospectivo. Se revisaron registros clínicos de pacientes sometidos a IOT en un hospital público de Chile entre junio del 2018 y junio del 2019. Se estimó la incidencia acumulada y se estimaron modelos de regresión logística univariados y multivariados para determinar los factores de riesgo. Se consideró la presencia/ausencia de DPE como variable respuesta, y edad, sexo, días de IOT, tiempo de la evaluación y diagnóstico de ingreso a UPC como variables predictoras. Se recopiló información de 141 pacientes, 72 hombres y 69 mujeres, con una edad promedio de 59 años. De los pacientes, el 73,05% presentó DPE. Tanto la edad como los días de IOT evidenciaron ser factores de riesgo de DPE. El sexo, el tiempo transcurrido hasta la evaluación y la causa de ingreso a la UPC no se asociaron a la presencia de DPE. En el periodo estudiado, se obtuvo una incidencia de un 73,05% de DPE. El principal factor de riesgo para DPE fue el tiempo de IOT, seguido por la edad. El resto de las variables estudiadas no evidenciaron ser factores de riesgo.

Purpose Since 2010, a comprehensive symptom/problem (S/P) assessment has been carried out in Danish specialist palliative care using the EORTC QLQ-C15-PAL questionnaire and the open-ended “Write In three Symptoms/Problems” (WISP) instrument. On WISP patients can report up to three S/Ps not included in the EORTC QLQ-C15-PAL. However, little is known about which S/Ps patients with non-cancer diseases report using WISP. Therefore, we investigated the prevalence and severity of S/Ps reported on WISP by non-cancer patients in specialist palliative care and compared these S/Ps with those previously reported by cancer patients. Methods This register-based study collected data from the Danish Palliative Care Database. We included adult patients with non-cancer diseases answering the EORTC QLQ-C15-PAL at admittance to specialist palliative care between 2016 and 2021. WISP responses were qualitatively categorized, and their prevalence and severity calculated. Results Of the 2323 patients with non-cancer diseases answering the EORTC QLQ-C15-PAL, 812 (34.9%) reported at least one S/P using WISP. A total of 1340 S/Ps were reported on WISP, of which 56.7% were not included in the EORTC QLQ-C15-PAL (i.e., were new). Edema, existential problems, dizziness, cough, and dysphagia were the most prevalent new S/Ps. Overall, 88.7% of the S/Ps were scored as moderate-severe. The prevalence of S/Ps reported on WISP did not significantly differ between cancer and non-cancer patients, except for existential problems, dysphagia, myoclonus, speaking problems, sweats, and vomiting. Conclusion The similarities and differences in the prevalence of the most common S/Ps reported on WISP confirm that WISP improves symptom assessment regardless of patient diagnosis., PURPOSE: Since 2010, a comprehensive symptom/problem (S/P) assessment has been carried out in Danish specialist palliative care using the EORTC QLQ-C15-PAL questionnaire and the open-ended "Write In three Symptoms/Problems" (WISP) instrument. On WISP patients can report up to three S/Ps not included in the EORTC QLQ-C15-PAL. However, little is known about which S/Ps patients with non-cancer diseases report using WISP. Therefore, we investigated the prevalence and severity of S/Ps reported on WISP by non-cancer patients in specialist palliative care and compared these S/Ps with those previously reported by cancer patients.METHODS: This register-based study collected data from the Danish Palliative Care Database. We included adult patients with non-cancer diseases answering the EORTC QLQ-C15-PAL at admittance to specialist palliative care between 2016 and 2021. WISP responses were qualitatively categorized, and their prevalence and severity calculated.RESULTS: Of the 2323 patients with non-cancer diseases answering the EORTC QLQ-C15-PAL, 812 (34.9%) reported at least one S/P using WISP. A total of 1340 S/Ps were reported on WISP, of which 56.7% were not included in the EORTC QLQ-C15-PAL (i.e., were new). Edema, existential problems, dizziness, cough, and dysphagia were the most prevalent new S/Ps. Overall, 88.7% of the S/Ps were scored as moderate-severe. The prevalence of S/Ps reported on WISP did not significantly differ between cancer and non-cancer patients, except for existential problems, dysphagia, myoclonus, speaking problems, sweats, and vomiting.CONCLUSION: The similarities and differences in the prevalence of the most common S/Ps reported on WISP confirm that WISP improves symptom assessment regardless of patient diagnosis.

Purpose Since 2010, a comprehensive symptom/problem (S/P) assessment has been carried out in Danish specialist palliative care using the EORTC QLQ-C15-PAL questionnaire and the open-ended “Write In three Symptoms/Problems” (WISP) instrument. On WISP patients can report up to three S/Ps not included in the EORTC QLQ-C15-PAL. However, little is known about which S/Ps patients with non-cancer diseases report using WISP. Therefore, we investigated the prevalence and severity of S/Ps reported on WISP by non-cancer patients in specialist palliative care and compared these S/Ps with those previously reported by cancer patients. Methods This register-based study collected data from the Danish Palliative Care Database. We included adult patients with non-cancer diseases answering the EORTC QLQ-C15-PAL at admittance to specialist palliative care between 2016 and 2021. WISP responses were qualitatively categorized, and their prevalence and severity calculated. Results Of the 2323 patients with non-cancer diseases answering the EORTC QLQ-C15-PAL, 812 (34.9%) reported at least one S/P using WISP. A total of 1340 S/Ps were reported on WISP, of which 56.7% were not included in the EORTC QLQ-C15-PAL (i.e., were new). Edema, existential problems, dizziness, cough, and dysphagia were the most prevalent new S/Ps. Overall, 88.7% of the S/Ps were scored as moderate-severe. The prevalence of S/Ps reported on WISP did not significantly differ between cancer and non-cancer patients, except for existential problems, dysphagia, myoclonus, speaking problems, sweats, and vomiting. Conclusion The similarities and differences in the prevalence of the most common S/Ps reported on WISP confirm that WISP improves symptom assessment regardless of patient diagnosis., PURPOSE: Since 2010, a comprehensive symptom/problem (S/P) assessment has been carried out in Danish specialist palliative care using the EORTC QLQ-C15-PAL questionnaire and the open-ended "Write In three Symptoms/Problems" (WISP) instrument. On WISP patients can report up to three S/Ps not included in the EORTC QLQ-C15-PAL. However, little is known about which S/Ps patients with non-cancer diseases report using WISP. Therefore, we investigated the prevalence and severity of S/Ps reported on WISP by non-cancer patients in specialist palliative care and compared these S/Ps with those previously reported by cancer patients.METHODS: This register-based study collected data from the Danish Palliative Care Database. We included adult patients with non-cancer diseases answering the EORTC QLQ-C15-PAL at admittance to specialist palliative care between 2016 and 2021. WISP responses were qualitatively categorized, and their prevalence and severity calculated.RESULTS: Of the 2323 patients with non-cancer diseases answering the EORTC QLQ-C15-PAL, 812 (34.9%) reported at least one S/P using WISP. A total of 1340 S/Ps were reported on WISP, of which 56.7% were not included in the EORTC QLQ-C15-PAL (i.e., were new). Edema, existential problems, dizziness, cough, and dysphagia were the most prevalent new S/Ps. Overall, 88.7% of the S/Ps were scored as moderate-severe. The prevalence of S/Ps reported on WISP did not significantly differ between cancer and non-cancer patients, except for existential problems, dysphagia, myoclonus, speaking problems, sweats, and vomiting.CONCLUSION: The similarities and differences in the prevalence of the most common S/Ps reported on WISP confirm that WISP improves symptom assessment regardless of patient diagnosis.

STUDY OBJECTIVES: Hypotonia, commonly seen in infants with Down syndrome (I-DS), can contribute to masticatory and oropharyngeal muscle weakness, increasing the risk for dysphagia and sleep-disordered breathing. Data describing the occurrence of dysphagia and sleep-disordered breathing in I-DS are limited. This study aims to determine the frequency and severity of dysphagia and its relationship to polysomnogram parameters in I-DS. METHODS: We included I-DS who underwent polysomnography at a single academic center over a 6-year period. Data collected included sex, age, presence of dysphagia (low suspicion of dysphagia vs dysphagia vs feeding tube), and polysomnographic data. Dysphagia was determined by a video fluoroscopic swallow study in the presence of clinical suspicion. RESULTS: A total of 40 I-DS were identified (mean age 6.6 months ± 3; male 65%). There were 11, 13, and 16 I-DS with low suspicion of dysphagia, dysphagia, and feeding tube, respectively. Obstructive sleep apnea was more severe in I-DS in the feeding tube group when compared with the group with a low suspicion of dysphagia and (apnea-hypopnea index mean [standard error] = 49.3 [7.6] vs 19.2 [9.2] events/h; P = .016). Dysphagia severity was positively correlated with a higher obstructive apnea-hypopnea index (r = .43, P = .006). CONCLUSIONS: There is a high incidence of dysphagia and sleep-disordered breathing in I-DS. Dysphagia severity correlated with obstructive apnea-hypopnea index severity. Our results suggest that I-DS need early evaluation of both sleep-disordered breathing and dysphagia. CITATION: Cho Y, Kwon Y, DelRosso L, Sobremonte-King M. Dysphagia severity is associated with worse sleep-disordered breathing in infants with Down syndrome. J Clin Sleep Med. 2023;19(5):883-887.

OBJECTIVE: To report the first successful full-term delivery following Per Oral Endoscopic Myotomy (POEM) performed during pregnancy. METHODS/BACKGROUND: Achalasia is an esophageal motility disorder characterized by dysphagia, regurgitation, reflux, recurrent vomiting, and weight loss. Achalasia in pregnancy can affect nutritional status of the mother, and subsequently, the child, increasing morbidity and creating potential pregnancy complications. POEM is a novel endoscopic procedure which involves cutting the lower esophageal sphincter to allow food to pass, and is considered a safe and effective management option for achalasia in non-pregnant individuals. RESULTS: We discuss the case of a patient with achalasia and a prior Heller myotomy who presented with recrudescence of severe symptoms prompting evaluation and treatment with POEM. CONCLUSION: This is the first report of successful full-term delivery following POEM performed during pregnancy, demonstrating its feasibility and safety in this patient population when approached with a multidisciplinary team.

Introduction: Dysphagia results from several pathophysiological mechanisms where its symptoms are not static or homogeneous in people, especially when there is neurogenic oropharyngeal dysphagia. Objective: to know the perception and behavior over time of symptoms of dysphagia using the Eating Assessment Tool-10 (EAT-10) in patients with neurogenic oropharyngeal dysphagia to visualize the clinical dynamics of this form of dysphagia. Methodology: Observational cohort study in patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes with, follow-up at three and six months, and completion of the EAT-10 at baseline, third and sixth month. Results: A total of 90 people with baseline evaluation were included, of whom 56.7% (51/90) achieved follow-up at the third month and 25.6% (23/90) at the sixth month. Symptoms of dysphagia with greater self-perception at all three moments were difficulty swallowing solids, sensation of food stuck in the throat and coughing when eating. Odynophagia was not a commonly perceived symptom. The total score of the EAT-10 was between 16.61±9 and 18.1±9.5 points in general. In patients with complete follow-up, variation in self-perception of swallowing liquids and pills was observed. Variation of the score when adjusting for the reception of therapies. Discussion: Neurological and neuromuscular diseases directly impact swallowing with mild to profound severity, where self-perception of swallowing symptoms is dynamic, but with cardinal symptoms of oropharyngeal dysphagia over time. Conclusions: The recognition and monitoring of dysphagia symptoms should be usual aspects in the care of patients with neurological and neuromuscular diseases, Introducción: la disfagia resulta de varios mecanismos fisiopatológicos donde sus síntomas no son estáticos ni homogéneos en las personas, especialmente cuando existe disfagia orofaríngea neurogénica. Objetivo:conocer la percepción y comportamiento en el tiempo de síntomas de disfagia mediante el instrumento Eating Assessment Tool-10 (EAT-10) en pacientes con disfagia orofaríngea neurogénica, con el fin de visualizar la dinámica clínica de esta forma de disfagia. Metodología: estudio observacional tipo cohorte en pacientes con disfagia orofaríngea neurogénica de causas neurológicas y neuromusculares, con seguimiento a tres y seis meses y diligenciamiento del EAT-10 al momento basal, tercer y sexto mes. Resultados: un total de 90 personas con evaluación basal, de las cuales el 56,7% (51/90) lograron seguimiento al tercer mes y 25,6% (23/90) al sexto mes. Los síntomas de disfagia con mayor autopercepción en los tres momentos fueron la dificultad para tragar sólidos, sensación de comida pegada en garganta y tos al comer. La odinofagia no fue un síntoma habitualmente percibido. La puntuación total del EAT-10 estuvo entre 16,61 ± 9 y 18,1 ± 9,5 puntos en general. En pacientes con seguimiento completo se observó variación en la autopercepción para tragar líquidos y pastillas. Se observó variación del puntaje al ajustarlo por recepción de terapias. Discusión: las enfermedades neurológicas y neuromusculares impactan directamente la deglución con gravedad entre leve a profunda, donde la autopercepción de síntomas deglutorios es dinámica, pero con síntomas cardinales de disfagia orofaríngea en el tiempo. Conclusiones: el reconocimiento y seguimiento de síntomas de disfagia deben ser aspectos usuales en la atención de pacientes con enfermedades neurológicas y neuromusculares.

Anosmia and ageusia are prevalent symptoms in COVID-19 patients and can last for weeks. Sensory and olfactory functions perform an important role in swallowing. This article proposes the possible negative effect of the symptoms of anosmia and ageusia in the swallowing rehabilitation of dysphagia oropharyngeal and post-intubation in patients with COVID-19. It is important to consider that swallowing is a multisensory and pathological process, where taste and smell play a key role. In accordance with these factors, we propose future research incorporating objective evaluation methods of the affected senses in COVID-19 patients., La anosmia y ageusia son síntomas prevalentes en los pacientes COVID-19, cuya duración puede extenderse por semanas. Tanto el gusto como el olfato cumplen un rol fundamental en el proceso deglutorio. Este artículo propone consideraciones de los posibles efectos negativos de los síntomas de anosmia y ageusia en la rehabilitación de la disfagia orofaríngea y post-extubación en pacientes con COVID-19. Es importante considerar que la deglución es un proceso multisensorial y patológico, donde el gusto y el olfato juegan un papel fundamental. De acuerdo con estos factores, proponemos futuras investigaciones que incorporen métodos de evaluación objetiva de los sentidos afectados en pacientes con COVID-19.

BackgroundIntensive care unit (ICU)–acquired dysphagia has severe consequences for patients including increased morbidity and mortality. Standard operating procedures, however, including systematic evaluation of swallowing function and access to specialised assessment and training may be limited. Dysphagia management relies on multiprofessional collaboration, but practice is variable and nonstandardised.ObjectiveThe objective of this study was to explore and compare nurses', physicians’, and occupational therapists' perceptions of dysphagia management in the ICU.Materials and methodsSix focus group interviews with 33 participants (23 nurses, four physicians, and six occupational therapists) were conducted and analysed using the framework method with a matrix developed from the first interview. Content from the interviews was plotted into the matrix, condensed, and refined.FindingsClinical dysphagia management depended on recognising signs of dysphagia in patients at risk. Assessment, therapeutic methods, and care differed among professional groups according to knowledge and roles. Interprofessional collaboration and responsibility for dysphagia management across the care continuum was determined by availability of resources, practical skills, knowledge, and formal decision-making competence and judged effective when based on mutual respect and recognition of healthcare professionals' different perspectives.ConclusionSystematic interprofessional collaboration in ICU dysphagia management requires working towards a common goal of preventing aspiration and rehabilitating the patients' ability to swallow safely. This is based on dysphagia assessment, using appropriate therapeutic interventions, sharing knowledge, and improving skills among professional groups.

Since dysphagia is of long duration, the actions of approaching the patient with this condition require the direct and permanent participation of the main caregiver. People with this role define the processes involved in the care of intake at home. From this perspective, the caregiver of the subject with dysphagia would be the one who should be fully trained in the aforementioned processes, not only as knowledge of the techniques used in rehabilitation but also as a form of approval of their use. In order to describe the relationship of the main caregiver in the use and management of consistency modification, a mixed registration process is proposed that allows the caregiver's perception of the use of this technique to be evidenced. The work is interesting as it shows how limiting aspects are concatenated with social determinants of health. So that, considering the economic perspective, responsibility, and knowledge of the management of consistencies, this work places dysphagia as complicated issue for the caregiver to deal with, due to the different realities., Las acciones de abordaje del paciente con disfagia, al ser la disfagia de larga duración, exigen la participación directa y permanente del cuidador principal, que es, finalmente, quien define los procesos que se desencadenan desde casa para el cuidado de la alteración de ingesta. Bajo esta perspectiva, el cuidador del sujeto con disfagia sería quien debe estar capacitado de manera plena en los procesos de abordaje, no sólo como conocimiento de las técnicas utilizadas en la rehabilitación, sino también como forma de aprobación de su uso. Con el fin de describir la relación del cuidador principal en el uso y manejo de la modificación de consistencia, se plantea un proceso mixto de registro que permita evidenciar la percepción del cuidador hacia el uso de esta técnica. El trabajo evidencia como hallazgos aspectos limitantes que se concatenan con determinantes sociales de la salud y que, desde una mirada económica, de responsabilidad y de conocimiento del manejo de las consistencias, ubican a la disfagia en un lugar complicado de abordar para el cuidador, debido a las distintas realidades.

Unlabelled: To date, the feeding and oral-motor abilities of patients with CHARGE syndrome (CS) have not been longitudinally assessed. This study aims to investigate the level of these abilities at different ages and evaluate how they evolve during growth. We retrospectively analysed oral-motor features of 16 patients with molecularly confirmed CS (age range 4-21 years old; mean 11 years; SD 6 years; median 10 years). Nearly 100% of CS new-borns had weak sucking at birth, and half of them demonstrated poor coordination between breathing and swallowing. Over time, the percentages of children with tube feeding dependence (60% at birth) faced a slow but steady decrease (from 33% at 6 months, 25% at 12 months, to 13% at school age) in tandem with the decreasing risk of aspiration. The ability of eating foods requiring chewing was achieved at school age, after the acquisition of an adequate oral sensory processing. A mature chewing pattern with a variety of food textures was not achieved by more than half of patients, including those requiring artificial enteral nutrition. Most patients started prolonged oral-motor treatments with speech language therapists in early childhood. Conclusions: Although feeding and swallowing disorders are constant features in CS patients, a slow and gradual development of feeding abilities occurs in most cases. Rehabilitation plays a key role in overcoming structural and functional difficulties and attaining appropriate eating skills. What is known: • Feeding problems and swallowing dysfunction have been noted in CHARGE syndrome. • The involvement of multiple factors, including structural problems in the mouth, throat, or esophagus, and neurological impairment, make feeding a complicated task in CHARGE individuals. What is new: • Dysphagia gradually improves in most CHARGE children over time, though with a wide interindividual variability. • The percentages of children with tube feeding dependence decrease over

Background The randomized clinical trial ESO-SPARE investigates if oesophagus-sparing radiotherapy (RT) can reduce dysphagia in patients with metastatic spinal cord compression (MSCC). Patient-reported outcome (PRO) is the only follow-up measure. Due to the fragile patient population, low respondent compliance was anticipated. We performed a planned interim analysis of dosimetry and respondent compliance, to ensure that the protocol requirements were met. Methods Patients >18 years referred for cervical/thoracic MSCC radiotherapy in 1-10 fractions were included from two centres. Patients were randomized (1:1) to standard RT or oesophagus-sparing RT, where predefined oesophageal dose constraints were prioritized over target coverage. Patients completed a trial diary with daily reports of dysphagia for 5 weeks (PRO-CTC-AE) and weekly quality of life reports for 9 weeks (QLQ-C30, EQ-5D-5L). According to power calculation, 124 patients are needed for primary endpoint analysis. The sample size was inflated to 200 patients to account for the fragile patient population. The co-primary endpoints, peak patient-reported dysphagia, and preserved ability to walk (EQ-5D-5L), are analysed at 5 and 9 weeks, respectively. The interim analysis was conducted 90 days after the inclusion of patient no 100. Respondent compliance was assessed at 5 and 9 weeks. In all RT plans, oesophagus and target doses were evaluated regarding adherence to protocol constraints. Results From May 2021 to November 2022, 100 patients were included. Fifty-two were randomized to oesophagus-sparing RT. In 23% of these plans, oesophagus constraints were violated. Overall, the dose to both target and oesophagus was significantly lower in the oesophagus-sparing plans. Only 51% and 41% of the patients were evaluable for co-primary endpoint analysis at five and nine weeks, respectively. Mortality and hospitalization rates were significantly larger in patients who completed <4 da, BACKGROUND: The randomized clinical trial ESO-SPARE investigates if oesophagus-sparing radiotherapy (RT) can reduce dysphagia in patients with metastatic spinal cord compression (MSCC). Patient-reported outcome (PRO) is the only follow-up measure. Due to the fragile patient population, low respondent compliance was anticipated. We performed a planned interim analysis of dosimetry and respondent compliance, to ensure that the protocol requirements were met.METHODS: Patients >18 years referred for cervical/thoracic MSCC radiotherapy in 1-10 fractions were included from two centres. Patients were randomized (1:1) to standard RT or oesophagus-sparing RT, where predefined oesophageal dose constraints were prioritized over target coverage. Patients completed a trial diary with daily reports of dysphagia for 5 weeks (PRO-CTC-AE) and weekly quality of life reports for 9 weeks (QLQ-C30, EQ-5D-5L). According to power calculation, 124 patients are needed for primary endpoint analysis. The sample size was inflated to 200 patients to account for the fragile patient population. The co-primary endpoints, peak patient-reported dysphagia, and preserved ability to walk (EQ-5D-5L), are analysed at 5 and 9 weeks, respectively. The interim analysis was conducted 90 days after the inclusion of patient no 100. Respondent compliance was assessed at 5 and 9 weeks. In all RT plans, oesophagus and target doses were evaluated regarding adherence to protocol constraints.RESULTS: From May 2021 to November 2022, 100 patients were included. Fifty-two were randomized to oesophagus-sparing RT. In 23% of these plans, oesophagus constraints were violated. Overall, the dose to both target and oesophagus was significantly lower in the oesophagus-sparing plans. Only 51% and 41% of the patients were evaluable for co-primary endpoint analysis at five and nine weeks, respectively. Mortality and hospitalization rates were significantly larger in patients who completed <4 days PRO quest

BACKGROUND & AIMS: Efforts to assess and improve the effectiveness of Barretts esophagus (BE) screening and surveillance are ongoing in the United States. Currently, there are limited population-based data in the United States to guide these efforts. METHODS: We performed a retrospective cohort study using data from large commercial and Medicare Advantage health plans in the United States from 2004 - 2019. We identified individuals with BE and analyzed the proportion who developed EAC. EACs were classified as prevalent EAC (diagnosed within 30 days of index endoscopy), post-endoscopy esophageal adenocarcinoma (PEEC, diagnosed 30 - 365 days after index endoscopy), and incident EAC (diagnosed 365 days or more after index endoscopy). Using this cohort, we performed a nested case-control study to identify factors associated with prevalent EAC at BE diagnosis and study healthcare utilization prior to BE diagnosis. RESULTS: We identified 50,817 individuals with incident BE. Of the 366 who developed EAC, 67.2%, 13.7%, and 19.1% were diagnosed with prevalent EAC, PEEC, and incident EAC respectively. Factors positively associated with prevalent EAC versus BE without prevalent EAC included male sex, dysphagia, weight loss, and Charlson-Deyo comorbidity score. In those with prevalent EAC, most patients with dysphagia or weight loss had their symptoms first recorded within three months of EAC diagnosis. Healthcare utilization rates were similar between those with and without prevalent EAC. CONCLUSIONS: Two-thirds of EACs among individuals with BE are diagnosed at the time of BE diagnosis. Additionally, PEEC accounts for 14% of these EACs. These results may guide future research studies that investigate novel BE diagnostic strategies that reduce the morbidity and mortality of EAC.

Dysphagia or difficulty swallowing in childhood necessitates multi-disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work-up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.

Dysphagia or difficulty swallowing in childhood necessitates multi-disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work-up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.

Dysphagia or difficulty swallowing in childhood necessitates multi-disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work-up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.

Objective: To explore swallowing function and risk factors associated with delayed recovery of swallowing in patients with COVID-19 post–invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). Design: Longitudinal cohort study. Setting: Three secondary-level hospitals. Participants: Invasively ventilated patients (N=28) who were hospitalized with severe COVID-19 and referred to the hospitals’ speech and language pathology (SLP) departments after mechanical ventilation between March 5 and July 5, 2020 for an evaluation of swallowing function before commencing oral diet. Interventions: SLP assessment, advice, and therapy for dysphagia. Main Outcome Measures: Oral intake levels at baseline and hospital discharge according to the FOIS. Patients were stratified according to FOIS (1-5, dysphagia; 6-7, functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning, and SLP evaluation were collected. Results: Dysphagia was found in 71% of the patients at baseline (79% men; age, 61±12y; body mass index, 30±8 kg/m2). The median FOIS score at baseline was 2 (interquartile range [IQR], 1) vs 5 (IQR, 2.5) at hospital discharge. Patients with dysphagia were older (64±8.5y vs 53±16y; P=.019), had a higher incidence of hypertension (70% vs 12%; P=.006), and were ventilated invasively longer (16±7d vs 10±2d; P=.017) or had a tracheostomy (9±9d vs 1±2d; P=.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=–0.471, P=.01), and number of days in the intensive care unit (ICU) (r=–0.48, P=.01). Conclusion: Dysphagia is prevalent in COVID-19 patients after invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (P<.001).

Objective: To explore swallowing function and risk factors associated with delayed recovery of swallowing in patients with COVID-19 post–invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). Design: Longitudinal cohort study. Setting: Three secondary-level hospitals. Participants: Invasively ventilated patients (N=28) who were hospitalized with severe COVID-19 and referred to the hospitals’ speech and language pathology (SLP) departments after mechanical ventilation between March 5 and July 5, 2020 for an evaluation of swallowing function before commencing oral diet. Interventions: SLP assessment, advice, and therapy for dysphagia. Main Outcome Measures: Oral intake levels at baseline and hospital discharge according to the FOIS. Patients were stratified according to FOIS (1-5, dysphagia; 6-7, functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning, and SLP evaluation were collected. Results: Dysphagia was found in 71% of the patients at baseline (79% men; age, 61±12y; body mass index, 30±8 kg/m2). The median FOIS score at baseline was 2 (interquartile range [IQR], 1) vs 5 (IQR, 2.5) at hospital discharge. Patients with dysphagia were older (64±8.5y vs 53±16y; P=.019), had a higher incidence of hypertension (70% vs 12%; P=.006), and were ventilated invasively longer (16±7d vs 10±2d; P=.017) or had a tracheostomy (9±9d vs 1±2d; P=.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=–0.471, P=.01), and number of days in the intensive care unit (ICU) (r=–0.48, P=.01). Conclusion: Dysphagia is prevalent in COVID-19 patients after invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (P<.001).

Objective: To explore swallowing function and risk factors associated with delayed recovery of swallowing in patients with COVID-19 post–invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). Design: Longitudinal cohort study. Setting: Three secondary-level hospitals. Participants: Invasively ventilated patients (N=28) who were hospitalized with severe COVID-19 and referred to the hospitals’ speech and language pathology (SLP) departments after mechanical ventilation between March 5 and July 5, 2020 for an evaluation of swallowing function before commencing oral diet. Interventions: SLP assessment, advice, and therapy for dysphagia. Main Outcome Measures: Oral intake levels at baseline and hospital discharge according to the FOIS. Patients were stratified according to FOIS (1-5, dysphagia; 6-7, functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning, and SLP evaluation were collected. Results: Dysphagia was found in 71% of the patients at baseline (79% men; age, 61±12y; body mass index, 30±8 kg/m2). The median FOIS score at baseline was 2 (interquartile range [IQR], 1) vs 5 (IQR, 2.5) at hospital discharge. Patients with dysphagia were older (64±8.5y vs 53±16y; P=.019), had a higher incidence of hypertension (70% vs 12%; P=.006), and were ventilated invasively longer (16±7d vs 10±2d; P=.017) or had a tracheostomy (9±9d vs 1±2d; P=.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=–0.471, P=.01), and number of days in the intensive care unit (ICU) (r=–0.48, P=.01). Conclusion: Dysphagia is prevalent in COVID-19 patients after invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (P<.001).

The study aimed to determine the status of dysphagia clinics and procedures applied in dysphagia clinics during the COVID-19 pandemic. Clinicians working in an outpatient dysphagia clinic were included. A 30-question survey inquiring about the descriptive information of the participants and their clinics, their clinical practice, and the tele-health applications during the COVID-19 pandemic. The survey was administered via Google forms. The participants were asked to fill out the survey on behalf of their clinics. One survey was completed per dysphagia clinic. Twenty-three clinicians responded on behalf of their clinics. The number of patients and dysphagia evaluations decreased during the COVID-19 pandemic (p < 0.05). The COVID-19 screening procedures mostly performed before dysphagia evaluations were temperature check (n = 14, 60.9%), nasopharyngeal swab test (n = 9, 39.1%), anamnestic risk assessment (n = 6, 26.1%), and saturation test (n = 6, 26.1%). Protective equipments mostly used while dysphagia evaluations were surgical mask, FFP3 mask, standard gloves, glasses, and face shield. It was found that 69.6% (n = 16) of the dysphagia clinics were reported to be suitable for working under pandemic conditions, and 30.4% (n = 7) were reported to be unsuitable. The use of tele-health applications significantly increased from 13.0% (n = 3) to 52.2% (n = 12) (p = 0.003). The present study provides a general overview of the status of dysphagia clinics and procedures applied in dysphagia clinics during the COVID-19 pandemic period. The study showed that working conditions, the number of patients, and the total number of evaluations have changed throughout the pandemic, and the use of tele-health applications increased.

Introduction: Oropharyngeal dysphagia is defined as a set of neuromuscular changes/mechanical obstruction that make swallowing difficult, jeopardizing the safety of the airway and the person's ability to maintain their nutritional needs. Its incidence increases with age causing respiratory complications, malnutrition and dehydration. It is aimed, therefore to know the prevalence of dysphagia in institutionalized erderly people in Portugal. Methodology: Study of the prevalence of dysphagia in institutionalized elderly, using a non-probabilistic convenience sampling in five residential structures for the elderly in mainland Portugal and the islands, using the Gugging Swallowing Screen as a data collection instrument. Results: Of the 93 residents included in the study, 60,22% had dysphagia. Discussion: The prevalence of dysphagia identified is higher than the existing evidence on these data for Portugal. Conclusion: These results may have implications for the practice of health professionals who work in these institutions, especially the need to integrate nurses who are specialists in Rehabilitation Nursing for early identification and intervention, thus seeking to minimize complications., Introducción: La disfagia orofaríngea se define como un conjunto de cambios neuromusculares/obstrucción mecánica que dificultan la deglución, comprometiendo la seguridad de la vía aérea y la capacidad de la persona para mantener sus necesidades nutricionales. Su incidencia aumenta con la edad causando complicaciones respiratorias, desnutrición y deshidratación. Se pretende, por tanto, conocer la prevalencia de disfagia en ancianos institucionalizados en Portugal Metodología: Estudio de la prevalencia de disfagia en ancianos institucionalizados, utilizando un muestreo no probabilístico por conveniencia en cinco estructuras residenciales para ancianos en Portugal continental e islas, utilizando el Gugging Swallowing Screen como instrumento de recopilación de datos. Resultados: De los 93 residentes incluidos en el estudio, el 60,22% presentaba disfagia. Discusión: La prevalencia de disfagia identificada es superior a la evidencia existente sobre estos datos para Portugal. Conclusión: Estos resultados pueden tener implicaciones para la práctica de los profesionales de la salud que actúan en estas instituciones, especialmente la necesidad de integrar enfermeras especialistas en Enfermería de Rehabilitación para la identificación e intervención temprana, buscando así minimizar las complicaciones., Introdução: A disfagia orofaríngea é definida como um conjunto de alterações neuromusculares/obstrução mecânica que dificultam a deglutição, colocando em risco a segurança da via aérea e capacidade de a pessoa manter as suas necessidades nutritivas. A sua incidência aumenta com a idade causando complicações respiratórias, má nutrição e desidratação. Pretende-se, assim, conhecer a prevalência da disfagia em idosos institucionalizados em Portugal. Metodologia: Estudo de prevalência da disfagia em idosos institucionalizados, com recurso a uma amostragem não probabilística por conveniência em cinco estruturas residenciais para idosos em Portugal continental e Ilhas e usando como instrumento de recolha de dados o Gugging Swallowing Screen. Resultados: Dos 93 residentes incluídos no estudo, 60,22% apresentavam disfagia. Discussão: A prevalência de disfagia identificada é superior à evidência existente sobre estes dados para Portugal. Conclusão: Estes resultados poderão ter implicações na prática dos profissionais de saúde que exercem nestas instituições, especialmente a necessidade de se integrarem nestas equipas enfermeiros especialistas em Enfermagem de Reabilitação para identificação e intervenção precoces, procurando assim minimizar complicações.

We examined factors related to dietary intake status (food form) of long-term care facility (LTCF) residents to identify factors related to proper food form choice for older individuals requiring nursing care. We surveyed 888 residents from 37 LTCFs in Japan. We evaluated basic information (age, sex, body mass index [BMI]), food form (swallowing-adjusted diet class), Barthel Index (BI), Clinical Dementia Rating (CDR), simply evaluated eating and swallowing functions, the number of present/functional teeth, oral diadochokinesis, repetitive saliva swallowing test (RSST), and modified water swallowing test. To clarify factors associated with food form, participants who had good nutrition by oral intake were categorized into the dysphagic diet (DD) and normal diet (ND) groups. Multi-level analyses were used to detect oral functions associated with food form status. Among objective assessments, BMI (odds ratio [OR] 0.979, 95% confidence interval [CI] - 0.022- to 0.006, p = 0.001), BI (OR 0.993, 95% CI - 0.007 to - 0.004, p < 0.001), CDR 3.0 (OR 1.002, 95% CI 0.002-0.236, p = 0.046), present teeth (OR 0.993, 95% CI - 0.007 to - 0.001, p = 0.011), functional teeth (OR 0.989, 95% CI - 0.011 to - 0.005, p < 0.001), and RSST (OR 0.960, 95% CI - 0.041 to - 0.007, p = 0.006) were significantly associated with DD vs ND discrimination. Simple evaluations of coughing (OR 1.056, 0.054-0.198, p = 0.001) and rinsing (OR 1.010, 0.010-0.174, p = 0.029) could also discriminate food form status. These simple evaluations provide insight into the discrepancies between food form status and eating abilities of LTCF residents. Periodic evaluations by the nursing caregiver may help to prevent aspiration by older individuals with dysphagia.

Dysphagia or difficulty swallowing in childhood necessitates multi-disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work-up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.

Objectives/hypothesisTo evaluate the safety and potential efficacy of autologous muscle-derived cells (AMDCs) for the treatment of swallowing impairment following treatment for oropharynx cancer.Study designProspective, phase I, open label, clinical trial.MethodsOropharynx cancer survivors disease free ≥2 years post chemoradiation were recruited. All patients had swallowing impairment but were not feeding tube dependent (Functional Oral Intake Scale [FOIS] ≥ 5). Muscle tissue (50-250 mg) was harvested from the vastus lateralis and 150 × 106 AMDCs were prepared (Cook MyoSite Inc., Pittsburgh, PA). The cells were injected into four sites throughout the intrinsic tongue musculature. Participants were followed for 24 months. The primary outcome measure was safety. Secondary endpoints included objective measures on swallowing fluoroscopy, oral and pharyngeal pressure, and changes in patient-reported outcomes.ResultsTen individuals were enrolled. 100% (10/10) were male. The mean age of the cohort was 65 (±8.87) years. No serious adverse event occurred. Mean tongue pressure increased significantly from 26.3 (±11.1) to 31.8 (±9.5) kPa (P = .017). The mean penetration-aspiration scale did not significantly change from 5.6 (±2.1) to 6.8 (±1.8), and the mean FOIS did not significantly change from 5.4 (±0.5) to 4.6 (±0.7). The incidence of pneumonia was 30% (3/10) and only 10% (1/10) experienced deterioration in swallowing function throughout 2 years of follow-up. The mean eating assessment tool (EAT-10) did not significantly change from 24.1 (±5.57) to 21.3 (±6.3) (P = .12).ConclusionResults of this phase I clinical trial demonstrate that injection of 150 × 106 AMDCs into the tongue is safe and may improve tongue strength, which is durable at 2 years. A blinded placebo-controlled trial is warranted.Level of evidence3 Laryngoscope, 132:523-527, 2022.

Introduction. The treatment selection for patients with dysphagia should be based on the best possible quality evidence. This treatment may involve reactivating strategies with the aim of modifying swallowing physiology and promoting long-term changes. Objective. To explore the effects of exercises and maneuvers aimed at reactivating swallowing function in people with oropharyngeal dysphagia after a stroke, through existing scientific publications from the last ten years. Methodology. A literature review was carried out in the PubMed databases with the MeSH terms “Deglutition Disorders” and “Exercise Therapy”, and with the free terms “Dysphagia” and “Swallowing Therapy”, combined with the Boolean intersection "AND". Results. The tongue-to-palate resistance training exercises, expiratory muscle strength training (EMST), Chin tuck against resistance (CTAR), Shaker, and jaw opening were those that showed, with greater bibliographic support, positive effects in the treatment of dysphagia. Conclusions. The information collected could be of clinical utility to guide the selection of one or another therapeutic procedure. Evidence should continue to be generated regarding the effectiveness of swallowing exercises in oropharyngeal dysphagia after stroke., Introducción. La selección del tratamiento para pacientes con disfagia debe basarse en evidencia con la mejor calidad posible. Este tratamiento puede involucrar estrategias reactivadoras con el objetivo de modificar la fisiología de la deglución y promover cambios a largo plazo. Objetivo. Explorar los efectos de ejercicios y maniobras destinadas a la reactivación de la función de deglución en personas con disfagia orofaríngea posterior a un accidente cerebrovascular, a través de publicaciones científicas existentes en los últimos diez años. Metodología. Se realizó una revisión de la literatura en las bases de datos PubMed con los términos MeSH “Deglutition Disorders” y “Exercise Therapy”, y con los términos libres “Dysphagia” y “Swallowing Therapy”, combinados con el booleano de intersección “AND”. Resultados. Los ejercicios con entrenamiento de resistencia de lengua al paladar, entrenamiento de la fuerza muscular espiratoria (EMST), Chin tuck contra resistencia (CTAR), Shaker y apertura mandibular fueron los que mostraron, con mayor respaldo bibliográfico, efectos positivos en el tratamiento de la disfagia. Conclusiones. La información recopilada podría ser de utilidad clínica para guiar la selección de uno u otro procedimiento terapéutico. Se debe continuar generando evidencia relacionada con la efectividad de los ejercicios deglutorios en la disfagia orofaríngea posterior a un ACV.

Objective: To explore swallowing function and risk factors associated with delayed recovery of swallowing in patients with COVID-19 post–invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). Design: Longitudinal cohort study. Setting: Three secondary-level hospitals. Participants: Invasively ventilated patients (N=28) who were hospitalized with severe COVID-19 and referred to the hospitals’ speech and language pathology (SLP) departments after mechanical ventilation between March 5 and July 5, 2020 for an evaluation of swallowing function before commencing oral diet. Interventions: SLP assessment, advice, and therapy for dysphagia. Main Outcome Measures: Oral intake levels at baseline and hospital discharge according to the FOIS. Patients were stratified according to FOIS (1-5, dysphagia; 6-7, functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning, and SLP evaluation were collected. Results: Dysphagia was found in 71% of the patients at baseline (79% men; age, 61±12y; body mass index, 30±8 kg/m2). The median FOIS score at baseline was 2 (interquartile range [IQR], 1) vs 5 (IQR, 2.5) at hospital discharge. Patients with dysphagia were older (64±8.5y vs 53±16y; P=.019), had a higher incidence of hypertension (70% vs 12%; P=.006), and were ventilated invasively longer (16±7d vs 10±2d; P=.017) or had a tracheostomy (9±9d vs 1±2d; P=.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=–0.471, P=.01), and number of days in the intensive care unit (ICU) (r=–0.48, P=.01). Conclusion: Dysphagia is prevalent in COVID-19 patients after invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (P<.001).

We examined factors related to dietary intake status (food form) of long-term care facility (LTCF) residents to identify factors related to proper food form choice for older individuals requiring nursing care. We surveyed 888 residents from 37 LTCFs in Japan. We evaluated basic information (age, sex, body mass index [BMI]), food form (swallowing-adjusted diet class), Barthel Index (BI), Clinical Dementia Rating (CDR), simply evaluated eating and swallowing functions, the number of present/functional teeth, oral diadochokinesis, repetitive saliva swallowing test (RSST), and modified water swallowing test. To clarify factors associated with food form, participants who had good nutrition by oral intake were categorized into the dysphagic diet (DD) and normal diet (ND) groups. Multi-level analyses were used to detect oral functions associated with food form status. Among objective assessments, BMI (odds ratio [OR] 0.979, 95% confidence interval [CI] - 0.022- to 0.006, p = 0.001), BI (OR 0.993, 95% CI - 0.007 to - 0.004, p < 0.001), CDR 3.0 (OR 1.002, 95% CI 0.002-0.236, p = 0.046), present teeth (OR 0.993, 95% CI - 0.007 to - 0.001, p = 0.011), functional teeth (OR 0.989, 95% CI - 0.011 to - 0.005, p < 0.001), and RSST (OR 0.960, 95% CI - 0.041 to - 0.007, p = 0.006) were significantly associated with DD vs ND discrimination. Simple evaluations of coughing (OR 1.056, 0.054-0.198, p = 0.001) and rinsing (OR 1.010, 0.010-0.174, p = 0.029) could also discriminate food form status. These simple evaluations provide insight into the discrepancies between food form status and eating abilities of LTCF residents. Periodic evaluations by the nursing caregiver may help to prevent aspiration by older individuals with dysphagia.

Introduction: Oropharyngeal dysphagia is defined as a set of neuromuscular changes/mechanical obstruction that make swallowing difficult, jeopardizing the safety of the airway and the person's ability to maintain their nutritional needs. Its incidence increases with age causing respiratory complications, malnutrition and dehydration. It is aimed, therefore to know the prevalence of dysphagia in institutionalized erderly people in Portugal. Methodology: Study of the prevalence of dysphagia in institutionalized elderly, using a non-probabilistic convenience sampling in five residential structures for the elderly in mainland Portugal and the islands, using the Gugging Swallowing Screen as a data collection instrument. Results: Of the 93 residents included in the study, 60,22% had dysphagia. Discussion: The prevalence of dysphagia identified is higher than the existing evidence on these data for Portugal. Conclusion: These results may have implications for the practice of health professionals who work in these institutions, especially the need to integrate nurses who are specialists in Rehabilitation Nursing for early identification and intervention, thus seeking to minimize complications., Introducción: La disfagia orofaríngea se define como un conjunto de cambios neuromusculares/obstrucción mecánica que dificultan la deglución, comprometiendo la seguridad de la vía aérea y la capacidad de la persona para mantener sus necesidades nutricionales. Su incidencia aumenta con la edad causando complicaciones respiratorias, desnutrición y deshidratación. Se pretende, por tanto, conocer la prevalencia de disfagia en ancianos institucionalizados en Portugal Metodología: Estudio de la prevalencia de disfagia en ancianos institucionalizados, utilizando un muestreo no probabilístico por conveniencia en cinco estructuras residenciales para ancianos en Portugal continental e islas, utilizando el Gugging Swallowing Screen como instrumento de recopilación de datos. Resultados: De los 93 residentes incluidos en el estudio, el 60,22% presentaba disfagia. Discusión: La prevalencia de disfagia identificada es superior a la evidencia existente sobre estos datos para Portugal. Conclusión: Estos resultados pueden tener implicaciones para la práctica de los profesionales de la salud que actúan en estas instituciones, especialmente la necesidad de integrar enfermeras especialistas en Enfermería de Rehabilitación para la identificación e intervención temprana, buscando así minimizar las complicaciones., Introdução: A disfagia orofaríngea é definida como um conjunto de alterações neuromusculares/obstrução mecânica que dificultam a deglutição, colocando em risco a segurança da via aérea e capacidade de a pessoa manter as suas necessidades nutritivas. A sua incidência aumenta com a idade causando complicações respiratórias, má nutrição e desidratação. Pretende-se, assim, conhecer a prevalência da disfagia em idosos institucionalizados em Portugal. Metodologia: Estudo de prevalência da disfagia em idosos institucionalizados, com recurso a uma amostragem não probabilística por conveniência em cinco estruturas residenciais para idosos em Portugal continental e Ilhas e usando como instrumento de recolha de dados o Gugging Swallowing Screen. Resultados: Dos 93 residentes incluídos no estudo, 60,22% apresentavam disfagia. Discussão: A prevalência de disfagia identificada é superior à evidência existente sobre estes dados para Portugal. Conclusão: Estes resultados poderão ter implicações na prática dos profissionais de saúde que exercem nestas instituições, especialmente a necessidade de se integrarem nestas equipas enfermeiros especialistas em Enfermagem de Reabilitação para identificação e intervenção precoces, procurando assim minimizar complicações.

We examined factors related to dietary intake status (food form) of long-term care facility (LTCF) residents to identify factors related to proper food form choice for older individuals requiring nursing care. We surveyed 888 residents from 37 LTCFs in Japan. We evaluated basic information (age, sex, body mass index [BMI]), food form (swallowing-adjusted diet class), Barthel Index (BI), Clinical Dementia Rating (CDR), simply evaluated eating and swallowing functions, the number of present/functional teeth, oral diadochokinesis, repetitive saliva swallowing test (RSST), and modified water swallowing test. To clarify factors associated with food form, participants who had good nutrition by oral intake were categorized into the dysphagic diet (DD) and normal diet (ND) groups. Multi-level analyses were used to detect oral functions associated with food form status. Among objective assessments, BMI (odds ratio [OR] 0.979, 95% confidence interval [CI] - 0.022- to 0.006, p = 0.001), BI (OR 0.993, 95% CI - 0.007 to - 0.004, p < 0.001), CDR 3.0 (OR 1.002, 95% CI 0.002-0.236, p = 0.046), present teeth (OR 0.993, 95% CI - 0.007 to - 0.001, p = 0.011), functional teeth (OR 0.989, 95% CI - 0.011 to - 0.005, p < 0.001), and RSST (OR 0.960, 95% CI - 0.041 to - 0.007, p = 0.006) were significantly associated with DD vs ND discrimination. Simple evaluations of coughing (OR 1.056, 0.054-0.198, p = 0.001) and rinsing (OR 1.010, 0.010-0.174, p = 0.029) could also discriminate food form status. These simple evaluations provide insight into the discrepancies between food form status and eating abilities of LTCF residents. Periodic evaluations by the nursing caregiver may help to prevent aspiration by older individuals with dysphagia.

Dysphagia affects a person's ability to swallow, and it causes health problems by directly limiting nutritional intake, being the elderly the most at-risk group and also likely to be deficient in nutrition. Diets for patients with dysphagia require textural modifications to offer soft and safe food to swallow. Puree is easily consumed by the elderly, being an alternative food preparation providing essential nutrition for people with dysphagia. In this study, we aimed to create different formulations with soy protein and agar added to potato puree to add nutritional value and end up with printable material by designing food for the elderly and people with dysphagia. Some enriched potato puree formulations were obtained by adding soy protein (3%, 5%, and 7%) and up to 0.2% agar. The use of three-dimensional food printing allows visual customization with appeal benefits of nutritional food formulations for specific consumers. The rheology and texture profile analysis of the different formulations has been performed. According to International Dysphagia Diet Standardisation Initiative (IDDSI) scales, the texture of all modified samples was suitable for people with swallowing difficulties. The samples with agar presented a better-printed shape and a more viscous-like behavior than the samples with soy protein. These findings highlight that soy protein could modify the texture and, from the nutritional point of view, add value to the formulations. The addition of 0.2% agar can establish good material for designing three-dimensional (3D)-printed food that allows the creation of textures in accordance with the needs of the elderly and people with dysphagia., Peer Reviewed, Postprint (published version)

Introduction: Dysphagia is defined as the difficulty in transporting food and liquids from the mouth to the stomach. The gold standard to diagnose this condition is the videofluoroscopic swallowing study. However, it exposes patients to ionizing radiation. Surface electromyography is a non-radioactive alternative for dysphagia evaluation that records muscle electrical activity during swallowing.Objective: To evaluate the relationship between the relative activation times of the muscles involved in the oral and pharyngeal phases of swallowing and the kinematic events detected in the videofluoroscopy.Materials and methods: Electromiographic signals from ten patients with neurological involvement who presented symptoms of dysphagia were analyzed simultaneously withvideofluoroscopy. Patients were given 5 ml of yogurt, 10 ml of water, and 3 g of crackers. Masseter, suprahyoid, and infrahyoid muscle groups were studied bilaterally. The bolus transit through the mandibular line, vallecula, and the cricopharyngeus muscle was analyzed in relation to the onset and offset times of each muscle group activation. Results: The average time of the pharyngeal phase was 0.89 ± 0.12 s. Muscle activation was mostly observed prior to the bolus transit through the mandibular line and vallecula. The end of the muscle activity suggested that the passage of the bolus through the cricopharyngeus muscle was almost complete.Conclusión: The muscle activity times, duration of the pharyngeal phase, and sequence of the muscle groups involved in swallowing were determined using sEMG validated with the videofluoroscopic swallowing study., Introducción. La disfagia se define como la dificultad para movilizar la comida desde la boca hasta el estómago. La prueba diagnóstica para esta condición es la videofluoroscopia, la cual no es totalmente inocua pues utiliza radiación ionizante. La electromiografía de superficie registra la actividad eléctrica de los músculos de manera no invasiva, por lo que puede considerarse como una alternativa para evaluar la deglución y estudiar la disfagia. Objetivo. Evaluar la relación entre los tiempos relativos de activación de los músculos implicados en la fase oral y faríngea de la deglución, con los movimientos registrados durante la videofluoroscopia.Materiales y métodos. Se analizaron las señales de la electromiografía de superficie de 10 pacientes neurológicos con síntomas de disfagia, captadas en forma simultánea con la videofluoroscopia. Se suministraron 5 ml de yogur y 10 ml de agua, y 3 g de galleta. Se estudiaron bilateralmente los grupos musculares maseteros, suprahioideos e infrahioideos. Se analizó el paso del bolo por la línea mandibular, las valleculas y el músculo cricofaríngeo, correlacionándolo con el tiempo inicial y el final de la activación de cada uno de los grupos musculares.Resultados. El tiempo promedio de la fase faríngea fue de 0,89 ± 0,12 s. En la mayoría de los casos, hubo activación muscular antes del paso por la línea mandibular y las valleculas. La terminación de la actividad muscular parece corresponder al momento en que se completa el paso del bolo alimenticio por el músculo cricofaríngeo.Conclusión. Se determinaron los tiempos de actividad muscular, la duración de la fase faríngea y la secuencia de la activación de los grupos musculares involucrados en la deglución, mediante electromiografía de superficie, validada con la videofluoroscopia.

The diagnosis and treatment of head and neck cancer (HNC) can have substantial impact on swallowing function, nutritional balance, physical function and quality of life (QoL). Early initiated swallowing exercises are hypothesized to improve swallowing function in HNC patients. The aim was to investigate the effects of swallowing exercises and progressive resistance training (PRT) during radiotherapy on swallowing function, physical function and QoL in patients with pharynx-, larynx-, oral cavity cancer or unknown primary compared to usual care. In a multi-centre RCT participants were assigned to (a) twice-weekly PRT and daily swallowing exercises throughout treatment or (b) usual care. Outcomes were measured at end of treatment and 2, 6 and 12 months after. Primary outcome was penetration aspiration score (PAS). Data were analysed on an “intention-to-treat” basis by GEE logistic regression model, linear mixed effects model and cox regression. Of 371 invited HNC patients, 240 (65%) enrolled. Five participants were excluded. At 12 months follow-up, 59 (25%) participants were lost. Analyses showed significant effect on mouth opening, QoL, depression and anxiety at 12 months when comparing intervention to non-active controls. The trial found no effect on swallowing safety in HNC undergoing radiotherapy, but several positive effects were found on secondary outcomes when comparing to non-active controls. The intervention period may have been too short, and the real difference between groups is too small. Nevertheless, the need to identify long-lasting intervention to slow down or avoid functional deteriorations is ever more crucial as the surviving HNC population is growing.

Dysphagia or difficulty swallowing in childhood necessitates multi-disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work-up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented.

Modifying the consistency of food allude to the reconfiguring of food texture to inhibit the risks in the transport of the food bolus presented by patients with dysphagia. In the management of dysphagia at home, the handling, preparation and support of food is carried out by a family member / main caregiver who, occasionally, does not know or interpret considerations for the management of consistencies. The objective of this systematic review was to document the limiting factors of the consistency modification strategy as a follow-up and support resource for dysphagia care. To do this, the PRISMA methodology was followed, conducting a search in the ScienceDirect, Virtual Health Library (VHL) and Scielo databases to identify articles published between 2016 and 2021. 9 studies were selected in English and Spanish, which met all the inclusion criteria and link the perception of the main caregiver in relation to the modification of consistencies for the management of dysphagia. This review synthesizes the most up-to-date data on consistency management by the caregiver in seven work categories related to knowledge of dysphagia, evidence of signs and symptoms, understanding of the consistency modification strategy, costs, biopsychosocial factor of the diet, psychosocial state of the patient and professional support. Future studies are proposed to deepen these issues., La modificación de la consistencia de los alimentos consiste en la reconfiguración de la textura del alimento para inhibir de los riesgos en el transporte del bolo alimenticio que presentan los pacientes con disfagia. En el manejo dado en casa a la disfagia, la manipulación, preparación y apoyo del alimento está a cargo de un familiar/cuidador principal que, ocasionalmente, no conoce ni interpreta consideraciones para el manejo de las consistencias El objetivo de esta revisión sistemática fue indagar documentalmente los factores limitantes de la estrategia de modificación de consistencias como recurso de acompañamiento y apoyo a la atención de la disfagia. Para ello se siguió la metodología PRISMA, realizando una búsqueda en las bases de datos ScienceDirect, Biblioteca Virtual para la Salud (BVS) y Scielo para identificar artículos publicados entre 2016 y 2021. Se seleccionaron 9 estudios en inglés y español, que cumplieron con todos los criterios de inclusión y vinculan la percepción del cuidador principal en relación con la modificación de consistencias para el abordaje de la disfagia. Esta revisión sintetiza los datos más actualizados sobre el manejo de consistencias por parte del cuidador en siete categorías de trabajo relacionadas con el conocimiento de la disfagia, evidencia de signos y síntomas, comprensión de la estrategia de modificación de consistencias, costos, factor biopsicosocial de la alimentación, estado psicosocial del paciente y acompañamiento profesional. Se proponen estudios a futuro para profundizar en estas temáticas.

Objective: To explore swallowing function and risk factors associated with delayed recovery of swallowing in patients with COVID-19 post–invasive mechanical ventilation using the Functional Oral Intake Scale (FOIS). Design: Longitudinal cohort study. Setting: Three secondary-level hospitals. Participants: Invasively ventilated patients (N=28) who were hospitalized with severe COVID-19 and referred to the hospitals’ speech and language pathology (SLP) departments after mechanical ventilation between March 5 and July 5, 2020 for an evaluation of swallowing function before commencing oral diet. Interventions: SLP assessment, advice, and therapy for dysphagia. Main Outcome Measures: Oral intake levels at baseline and hospital discharge according to the FOIS. Patients were stratified according to FOIS (1-5, dysphagia; 6-7, functional oral intake). Data regarding comorbidities, frailty, intubation and tracheostomy, proning, and SLP evaluation were collected. Results: Dysphagia was found in 71% of the patients at baseline (79% men; age, 61±12y; body mass index, 30±8 kg/m2). The median FOIS score at baseline was 2 (interquartile range [IQR], 1) vs 5 (IQR, 2.5) at hospital discharge. Patients with dysphagia were older (64±8.5y vs 53±16y; P=.019), had a higher incidence of hypertension (70% vs 12%; P=.006), and were ventilated invasively longer (16±7d vs 10±2d; P=.017) or had a tracheostomy (9±9d vs 1±2d; P=.03) longer. A negative association was found between swallowing dysfunction at bedside and days hospitalized (r=–0.471, P=.01), and number of days in the intensive care unit (ICU) (r=–0.48, P=.01). Conclusion: Dysphagia is prevalent in COVID-19 patients after invasive mechanical ventilation and is associated with number of days in hospital and number of days in the ICU. Swallowing function and tolerance of oral diet improved at discharge (P<.001).

ObjectiveLiquid thickeners are commonly recommended in individuals with dysphagia and recurrent aspiration as a strategy for pneumonia prevention. The goal of this study was to examine the effects of small amounts of aspirated liquid thickener on the lungs.Study designAnimal model. Prospective small animal clinical trial.MethodsAdult Sprague Dawley rats (n = 19) were divided into two groups and underwent three intratracheal instillations of either xanthan gum-based nectar-thick water (0.1-0.25 mL/kg) or water-only control over the course of 8 days. Blood was collected from a peripheral vein on days 1 and 8 and submitted for complete blood count (CBC) analysis. Rats were euthanized 10 days after the last instillation, and the lungs were harvested. Histopathology was conducted on lung specimens by a blinded licensed veterinary pathologist and scored for evidence of lung injury and pneumonia.ResultsFifteen animals (8 nectar-thickener group, 7 control group) survived until the endpoint of the study (day 18). Serum CBC did not show abnormalities at any timepoint in either group. Histological evidence of lung inflammation and edema were significantly greater in the nectar-thick group compared to controls (P < .05). Signs of inflammation included aggregates of foamy macrophages, expansion of bronchiolar lymphoid tissue, and large numbers of eosinophilic intraalveolar crystals. Histiocytic and neutrophilic pneumonia was noted in one animal that received thickened liquids.ConclusionRecurrent aspiration of small amounts of thickened water resulted in significant pulmonary inflammation in a murine model of aspiration. Results of this study support the need for further investigation of liquid thickener safety and its efficacy in reducing the pulmonary complications of swallowing disorders.Level of evidenceNA Laryngoscope, 131:1223-1228, 2021.

The study aimed to determine the status of dysphagia clinics and procedures applied in dysphagia clinics during the COVID-19 pandemic. Clinicians working in an outpatient dysphagia clinic were included. A 30-question survey inquiring about the descriptive information of the participants and their clinics, their clinical practice, and the tele-health applications during the COVID-19 pandemic. The survey was administered via Google forms. The participants were asked to fill out the survey on behalf of their clinics. One survey was completed per dysphagia clinic. Twenty-three clinicians responded on behalf of their clinics. The number of patients and dysphagia evaluations decreased during the COVID-19 pandemic (p < 0.05). The COVID-19 screening procedures mostly performed before dysphagia evaluations were temperature check (n = 14, 60.9%), nasopharyngeal swab test (n = 9, 39.1%), anamnestic risk assessment (n = 6, 26.1%), and saturation test (n = 6, 26.1%). Protective equipments mostly used while dysphagia evaluations were surgical mask, FFP3 mask, standard gloves, glasses, and face shield. It was found that 69.6% (n = 16) of the dysphagia clinics were reported to be suitable for working under pandemic conditions, and 30.4% (n = 7) were reported to be unsuitable. The use of tele-health applications significantly increased from 13.0% (n = 3) to 52.2% (n = 12) (p = 0.003). The present study provides a general overview of the status of dysphagia clinics and procedures applied in dysphagia clinics during the COVID-19 pandemic period. The study showed that working conditions, the number of patients, and the total number of evaluations have changed throughout the pandemic, and the use of tele-health applications increased.

[ES] La disfagia es una enfermedad en la que se produce una reducción de la capacidad para deglutir. Esta condición suele aparecer en personas mayores y también puede darse en pacientes con patologías que afecten a las capacidades neurológicas, como el ictus o Parkinson. La dificultad para tragar supone un gran problema a la hora de consumir ciertos tipos de alimentos, tanto sólidos como líquidos. Los purés son la comida más segura para estas personas ya que presentan más viscosidad que un líquido, aumentando el tiempo de tránsito en la faringe y permitiendo así una mejor respuesta de los músculos cuando el bolo atraviesa este conducto. Al mismo tiempo, es fácil de controlar su viscosidad modificándola con hidrocoloides. En el presente trabajo se ha evaluado la influencia de la adición de almidón modificado (AM) y mucílago de semillas de chía (CSM) como espesantes, sobre el color, la textura, la reología, las propiedades sensoriales y de digestibilidad de un puré de pollo y verduras orientado a personas con disfagia. Ambos hidrocoloides se utilizaron para modificar la textura de las muestras a nivel pudin. Los resultados mostraron que la adición de AM y CSM aumentó la consistencia y firmeza del puré, además estas muestras presentaron un comportamiento de gel débil, considerándose apropiadas para pacientes disfágicos. La evaluación sensorial reflejó que la adición de AM y CSM a los purés no modificó el color, el sabor y la aceptación general, pero estas muestras presentaron la puntuación más alta en relación a la consistencia oral. Sin embargo, el puré elaborado con AM fue menos aceptado que el CSM en cuanto a adhesividad oral. El ensayo de masticación indicó que el puré con CSM mantuvo mejor la consistencia, la adhesividad y la viscosidad aparente en presencia de saliva, lo que puede facilitar una deglución segura en pacientes con disfagia. Durante la digestión gastrointestinal simulada, el CSM mantuvo la mayor consistencia y viscosidad aparente durante las primeras, [EN] Dysphagia is a disease in which the ability to swallow is reduced. This disorder is common in older people and can also appear in patients with pathologies that affect their neurological capacities, such as stroke or Parkinson's disease. Swallowing difficulty is a major problem when consuming certain types of food, both solids and liquids. Purees are the safest food for these people as their viscosity is higher than that of a liquid, increasing the transit time in the pharynx and allowing a better response of the muscles when the bolus passes through the throat. At the same time, it is easy to control viscosity of purees by modifying it with the use of hydrocolloids. In the present work, the influence of the addition of modified starch (AM) and chia seed mucilage (CSM) as thickeners on colour, texture, rheology, sensory, and digestibility properties of a chicken and vegetable puree for people with dysphagia has been evaluated. Both hydrocolloids were used to modify the texture of the samples for achieving a pudding level. The results showed that the addition of AM and CSM increased the consistency and firmness of the puree, and these samples showed a weak gel behaviour, making them suitable for dysphagic patients. Sensory evaluation showed that the addition of AM and CSM to the purees did not change the colour, taste, and acceptance of the purees, but these samples had the highest score in relation to oral consistency. However, the puree with AM was less acceptable than that with CSM in terms of oral adhesiveness. The mastication assay showed that the CSM puree maintained better consistency, adhesiveness, and apparent viscosity in the presence of saliva, which would facilitate a safe swallowing in patients with dysphagia. During simulated gastrointestinal digestion, CSM maintained the highest consistency and apparent viscosity during the early stages of digestion, being the sample least affected by enzymatic action during the oral and gastric phases. However, p

[ES] La disfagia es una enfermedad en la que se produce una reducción de la capacidad para deglutir. Esta condición suele aparecer en personas mayores y también puede darse en pacientes con patologías que afecten a las capacidades neurológicas, como el ictus o Parkinson. La dificultad para tragar supone un gran problema a la hora de consumir ciertos tipos de alimentos, tanto sólidos como líquidos. Los purés son la comida más segura para estas personas ya que presentan más viscosidad que un líquido, aumentando el tiempo de tránsito en la faringe y permitiendo así una mejor respuesta de los músculos cuando el bolo atraviesa este conducto. Al mismo tiempo, es fácil de controlar su viscosidad modificándola con hidrocoloides. En el presente trabajo se ha evaluado la influencia de la adición de almidón modificado (AM) y mucílago de semillas de chía (CSM) como espesantes, sobre el color, la textura, la reología, las propiedades sensoriales y de digestibilidad de un puré de pollo y verduras orientado a personas con disfagia. Ambos hidrocoloides se utilizaron para modificar la textura de las muestras a nivel pudin. Los resultados mostraron que la adición de AM y CSM aumentó la consistencia y firmeza del puré, además estas muestras presentaron un comportamiento de gel débil, considerándose apropiadas para pacientes disfágicos. La evaluación sensorial reflejó que la adición de AM y CSM a los purés no modificó el color, el sabor y la aceptación general, pero estas muestras presentaron la puntuación más alta en relación a la consistencia oral. Sin embargo, el puré elaborado con AM fue menos aceptado que el CSM en cuanto a adhesividad oral. El ensayo de masticación indicó que el puré con CSM mantuvo mejor la consistencia, la adhesividad y la viscosidad aparente en presencia de saliva, lo que puede facilitar una deglución segura en pacientes con disfagia. Durante la digestión gastrointestinal simulada, el CSM mantuvo la mayor consistencia y viscosidad aparente durante las primeras, [EN] Dysphagia is a disease in which the ability to swallow is reduced. This disorder is common in older people and can also appear in patients with pathologies that affect their neurological capacities, such as stroke or Parkinson's disease. Swallowing difficulty is a major problem when consuming certain types of food, both solids and liquids. Purees are the safest food for these people as their viscosity is higher than that of a liquid, increasing the transit time in the pharynx and allowing a better response of the muscles when the bolus passes through the throat. At the same time, it is easy to control viscosity of purees by modifying it with the use of hydrocolloids. In the present work, the influence of the addition of modified starch (AM) and chia seed mucilage (CSM) as thickeners on colour, texture, rheology, sensory, and digestibility properties of a chicken and vegetable puree for people with dysphagia has been evaluated. Both hydrocolloids were used to modify the texture of the samples for achieving a pudding level. The results showed that the addition of AM and CSM increased the consistency and firmness of the puree, and these samples showed a weak gel behaviour, making them suitable for dysphagic patients. Sensory evaluation showed that the addition of AM and CSM to the purees did not change the colour, taste, and acceptance of the purees, but these samples had the highest score in relation to oral consistency. However, the puree with AM was less acceptable than that with CSM in terms of oral adhesiveness. The mastication assay showed that the CSM puree maintained better consistency, adhesiveness, and apparent viscosity in the presence of saliva, which would facilitate a safe swallowing in patients with dysphagia. During simulated gastrointestinal digestion, CSM maintained the highest consistency and apparent viscosity during the early stages of digestion, being the sample least affected by enzymatic action during the oral and gastric phases. However, p

Altres ajuts: Acord transformatiu CRUE-CSIC, Financial support received from research grants from Nutricia Danone Advanced Medical Nutrition (HESDY Grant); Fundació Salut del CSdM, Strategic Action Grant in Oropharyngeal Dysphagia provided by the Centro de Investigación Biomédica en Red en el Área de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, DJO Global, and la Fundació la Marató de TV3 (11/2310)., Background and purpose: The healthcare economic costs of post-stroke oropharyngeal dysphagia (OD) are not fully understood. The purpose of this study was to assess the acute, subacute and long-term costs related to post-stroke OD and its main complications (malnutrition and respiratory infections). Methods: A cost of illness study of patients admitted to Mataró Hospital (Catalonia, Spain) from May 2010 to September 2014 with a stroke diagnosis was performed. OD, malnutrition and respiratory infections were assessed during hospitalization and follow-up (3 and 12 months). Hospitalization and long-term costs were measured from hospital and healthcare system perspectives. Multivariate linear regression analysis was performed to assess the independent effect of OD, malnutrition and respiratory infections on healthcare costs during hospitalization, and at 3 and 12 months' follow-up. Results: In all, 395 patients were included of whom 178 had OD at admission. Patients with OD incurred major total in-hospital costs (€5357.67 ± €3391.62 vs. €3976.30 ± €1992.58, p < 0.0001), 3-month costs (€8242.0 ± €5376.0 vs. €5320.0 ± €4053.0, p < 0.0001) and 12-month costs (€11,617.58 ± €12,033.58 vs. €7242.78 ± €7402.55, p < 0.0001). OD was independently associated with a cost increase of €789.68 (p = 0.011) during hospitalization and of €873.5 (p = 0.084) at 3 months but not at 12 months. However, patients with OD who were at risk of malnutrition or malnourished and suffered respiratory infections incurred major mean costs compared with those patients without OD (€19,817.58 ± €13,724.83 vs. €7242.8 ± €7402.6, p < 0.0004) at 12 months' follow-up. Conclusion: Oropharyngeal dysphagia causes significant high economic costs during hospitalization that strongly and significantly increase with the development of malnutrition and respiratory infections at long-term follow-up.

[ES] La disfagia es una enfermedad en la que se produce una reducción de la capacidad para deglutir. Esta condición suele aparecer en personas mayores y también puede darse en pacientes con patologías que afecten a las capacidades neurológicas, como el ictus o Parkinson. La dificultad para tragar supone un gran problema a la hora de consumir ciertos tipos de alimentos, tanto sólidos como líquidos. Los purés son la comida más segura para estas personas ya que presentan más viscosidad que un líquido, aumentando el tiempo de tránsito en la faringe y permitiendo así una mejor respuesta de los músculos cuando el bolo atraviesa este conducto. Al mismo tiempo, es fácil de controlar su viscosidad modificándola con hidrocoloides. En el presente trabajo se ha evaluado la influencia de la adición de almidón modificado (AM) y mucílago de semillas de chía (CSM) como espesantes, sobre el color, la textura, la reología, las propiedades sensoriales y de digestibilidad de un puré de pollo y verduras orientado a personas con disfagia. Ambos hidrocoloides se utilizaron para modificar la textura de las muestras a nivel pudin. Los resultados mostraron que la adición de AM y CSM aumentó la consistencia y firmeza del puré, además estas muestras presentaron un comportamiento de gel débil, considerándose apropiadas para pacientes disfágicos. La evaluación sensorial reflejó que la adición de AM y CSM a los purés no modificó el color, el sabor y la aceptación general, pero estas muestras presentaron la puntuación más alta en relación a la consistencia oral. Sin embargo, el puré elaborado con AM fue menos aceptado que el CSM en cuanto a adhesividad oral. El ensayo de masticación indicó que el puré con CSM mantuvo mejor la consistencia, la adhesividad y la viscosidad aparente en presencia de saliva, lo que puede facilitar una deglución segura en pacientes con disfagia. Durante la digestión gastrointestinal simulada, el CSM mantuvo la mayor consistencia y viscosidad aparente durante las primeras, [EN] Dysphagia is a disease in which the ability to swallow is reduced. This disorder is common in older people and can also appear in patients with pathologies that affect their neurological capacities, such as stroke or Parkinson's disease. Swallowing difficulty is a major problem when consuming certain types of food, both solids and liquids. Purees are the safest food for these people as their viscosity is higher than that of a liquid, increasing the transit time in the pharynx and allowing a better response of the muscles when the bolus passes through the throat. At the same time, it is easy to control viscosity of purees by modifying it with the use of hydrocolloids. In the present work, the influence of the addition of modified starch (AM) and chia seed mucilage (CSM) as thickeners on colour, texture, rheology, sensory, and digestibility properties of a chicken and vegetable puree for people with dysphagia has been evaluated. Both hydrocolloids were used to modify the texture of the samples for achieving a pudding level. The results showed that the addition of AM and CSM increased the consistency and firmness of the puree, and these samples showed a weak gel behaviour, making them suitable for dysphagic patients. Sensory evaluation showed that the addition of AM and CSM to the purees did not change the colour, taste, and acceptance of the purees, but these samples had the highest score in relation to oral consistency. However, the puree with AM was less acceptable than that with CSM in terms of oral adhesiveness. The mastication assay showed that the CSM puree maintained better consistency, adhesiveness, and apparent viscosity in the presence of saliva, which would facilitate a safe swallowing in patients with dysphagia. During simulated gastrointestinal digestion, CSM maintained the highest consistency and apparent viscosity during the early stages of digestion, being the sample least affected by enzymatic action during the oral and gastric phases. However, p

With the advancement in Computer Vision, many new applications of mobile sensing platforms have emerged that can satisfy the unique needs of specific population groups and enhance their daily lives. However, there are still some unsolved challenges. This thesis focuses on two population groups and presents our explorations in resolving some of their crucial needs. For the deaf-mute, there are significant barriers to communicate with the hearing population. However, given the complexity of data collection remains a challenge in realizing a realistic smartwatch-based sign language recognition system. We describe our exploration in transferring online sign language videos into training data for smartwatch-based sign language recognition. We tested pipelines of different human pose/mesh 3D reconstruction methods from imagery and data processing techniques to eliminate the need to collect actual smartwatch-collected data. Dysphagia is a common disease for many older people, making them subject to choking risk if the viscosity of liquid intake is not well controlled. We present ViscoCam, the first fluid viscosity classification system for dysphagia patients or caregivers, requiring only a smartphone. It is easy to operate, widely deployable, and robust for daily use. ViscoCam classifies visually indistinguishable liquid of various viscosity levels by exploiting the sloshing motion of viscous liquid decays faster than thin liquid. To perform a measurement, the user shakes a cup of liquid and their smartphone to induce the liquid sloshing motion. Then, ViscoCam senses the cup's movement using the smartphone's built-in accelerometer or microphone and infers liquid viscosity from the fluid surface motion captured by the flashlight camera. To combat changes in camera position, lighting conditions, and liquid sloshing motion, a 3D convolutional neural network is trained to extract reliable motion features for classification. We present the evaluation of ViscoCam's performance i

Dysphagia is a swallowing disorder that is characterized by difficulty to swallow and to control saliva as well as by feeding difficulties. Dysphagia is a common symptom of laryngeal cancer, or a consequence of surgical treatment as well as radiotherapy and chemotherapy of this neoplasma. The patients after laryngectomy are at risk of developing malnutrition, and aspiration pneumonia. Removal of anatomical structures and reorganization of remaining tissues has a significant impact on the physiology of swallowing. For most patients, safe swallowing is the main feature of a positive treatment outcome. Swallowing therapy is important before, during and after treatment of larynx cancer. The aim of this paper is to explore a correlation between swallowing disorders and laryngeal cancer treatment, and to understand the anatomical and physiological bases of dysphagia treatment, Disfagiju definišemo kao poremećaj gutanja. Poremećaji gutanja obuhvataju kako teškoće u gutanju i kontrolisanju pljuvačke, tako i teškoće u hranjenju. Disfagija podrazumeva čest simptom karcinoma larinksa, ali i posledicu hirurškog lečenja kao i radioterapije i hemoterapije ove neoplazme. Laringektomirani bolesnici su u riziku za malnutriciju i pneumoniju. Uklanjanje ključnih anatomskih struktura i reorganizacija preostalih tkiva ima značajan uticaj na fiziologiju gutanja. Izbor tretmana lečenja za očuvanje funkcije gutanja najvažnije je pitanje. Za većinu pacijenata bezbedno gutanje je glavna odlika pozitivnog ishoda lečenja. Tretman poremećaja gutanja je važna karika pre, u toku i nakon lečenja. Cilj rada bio je da se utvrdi korelacija između poremećaja gutanja, lečenja karcinoma larinksa, laringektomije kao izbora lečenja, odnosno razumevanje anatomskih i fizioloških osnova tretmana disfagija.

Objectives To understand the barriers and facilitators of medication administration to aged care residents with swallowing difficulties. Methods Health‐care workers in aged care facilities across Australia involved in medication administration to residents completed an online survey. Results Of 355 respondents, 90.9% reported ‘everyday’ encounters with residents with swallowing difficulties and 94.1% modified medications to facilitate administration. Time constraints (63.4%) and workload (69.0%) were common barriers. Only 39.0% believed swallowing abilities are considered at the prescribing stage. Pill size (95.8%), polypharmacy (75.2%) and lack of alternative formulations (74.9%) contributed to these challenges. Support from other health‐care professionals (91.5%) and training (85.9%) were the most favoured facilitators. Conclusion Health‐care workers are faced with various challenges when caring for residents with swallowing difficulties. Promoting multidisciplinary collaborations, provision of training and medication review services, and improving skill mix and staffing composition in aged care facilities are needed to address these challenges.

Emergency rooms are spaces with coordinate protocols and sequential diagnostic and therapeutic actions. Emergency rehabilitation professionals contribute to decision-making on hospitalization or egress behaviors, home plans, diagnostic aids, and referral to specialists. The purpose of this literature analysis was to identify international evidence, about the phono-audiologist in the emergency room and his professional actions with patients, family members and health teams. Materials and methods. Evidence was reviewed from the Ebsco, PubMed, Scielo, Elsevier and Web of Science databases, from January 2015 to September 2020, with search terms: speech language pathology, speech therapy, emergency room in Spanish and English. They selected documents informing about emergency room rehabilitation processes, including actions from speech therapy. Sand analyzed 51 documents according to inclusion criteria. The evidence shows the incursion of speech therapy work in a non-traditional context, motivated by the needs in clinical decision-making in interdisciplinary dialogue, mainly under conditions of dysphagia and swallowing disorders. Professional actions in this context include the promotion and prevention of emergency room admissions, up to critical, acute, and end-of-life care. This context represents professional challenges towards clinical judgment skills, professional scientific argumentation, use of detection tools and interdisciplinary work. that make the difference between aspects such as egress and hospitalization, a treatment or procedure and in some cases, between life and death., Las salas de urgencias son espacios con protocolos coordinados y actuaciones diagnósticas y terapéuticas secuenciales. Los profesionales de rehabilitación en urgencias aportan a la toma de decisiones sobre conductas de hospitalización o egreso, planes caseros, ayudas diagnósticas y remisión a especialistas. El propósito de este análisis de literatura fue identificar evidencia internacional, sobre el fonoaudiólogo en sala de urgencias y sus acciones profesionales con pacientes, familiares y equipos de salud. Materiales y métodos. Se revisó evidencia de las bases de datos Ebsco, PubMed, Scielo, Elsevier y Web of Science, entre enero de 2015 hasta septiembre de 2020, con términos de búsqueda: speech language pathology, speech therapy, emergency room en español e inglés. Se seleccionaron documentos que informaran sobre procesos de rehabilitación en salas de urgencias, que incluyeran acciones desde fonoaudiología. Se analizaron 51 documentos según criterios de inclusión. La evidencia muestra la incursión del trabajo fonoaudiológico en un contexto no tradicional, motivado por las necesidades en la toma de decisiones clínicas en diálogo interdisciplinar, principalmente en condiciones de disfagia y alteraciones deglutorias. Las acciones profesionales en este contexto incluyen la promoción y prevención de ingresos a sala de urgencias, hasta la atención en condiciones críticas, agudas y al final de la vida. Este contexto representa retos profesionales hacia habilidades de juicio clínico, argumentación científico profesional, uso de instrumentos de detección y trabajo interdisciplinar. que hacen la diferencia entre aspectos como el egreso y la hospitalización, un tratamiento o procedimiento y en algunos casos, entre la vida y la muerte.

Dysphagia is known as the difficulty or disability when it comes to eating food, which is analyzed from different points since it can be generated by anatomical factors, be they birth or acquired, psychological or functional causes. The professional work in dysphagia allows classifying the severity of dysphagia, but not the qualification of the risk of the different functional errors during ingestion. For this reason, this paper proposes to classify the level of risk due to functional swallowing errors. The research was proposed from a prospective nature with a validity relationship, through the Delphi method, through which a list of functional swallowing errors was postulated to be validated by 6 expert judges in the area. A proposal was made in a matrix, which evaluated the different functional errors divided into the swallowing phases and the risk levels to affect dysphagia, according to the items of sufficiency, relevance, coherence and clarity. A list of 38 validated errors was obtained, which are based on risk, since when they materialize, they promote a greater probability of penetration / aspiration of food into the airway in the glutory sequence. The consensus on the classification of these errors according to risk will be a useful tool for professionals in the area. A list of risks due to functional swallowing errors is concluded through Fisher's least significant difference (LSD) for means, in descending order according to the severity of the risk represented by the error in intake., La disfagia es conocida como la dificultad o incapacidad a la hora de la ingesta de alimentos, la cual es analizada desde diferentes puntos ya que puede ser generada por factores anatómicos, sean estos de nacimiento o adquiridos, causas psicológicas o funcionales. El quehacer profesional en disfagia permite clasificar la severidad de la disfagia, pero no la calificación del riesgo de los distintos errores funcionales durante la ingesta. A razón de ello, este escrito propone clasificar el nivel de riesgo por errores funcionales de la deglución. La investigación se planteó desde una naturaleza prospectiva con relación de validez, a través del método Delphi, mediante la cual se postuló una lista de errores funcionales de la deglución para ser validada por 6 jueces expertos en el área. Se realizó una propuesta en una matriz, que les permitió evaluar los distintos errores funcionales divididos en las fases deglutorias y los niveles de riesgo para repercutir en disfagia, según los ítems de suficiencia, relevancia, coherencia y claridad. Se obtuvo una lista de 38 errores validados, los cuales se fundamentan como riesgo, dado que al materializarse fomentan en la secuencia deglutoria una mayor probabilidad de penetración/aspiración de alimento hacia vía aérea. El consenso de la clasificación de estos errores según el riesgo, será una herramienta útil para profesionales del área. Se concluye, a través de la diferencia mínima significativa (LSD) de Fisher para medias, una lista de riesgos por errores funcionales de la deglución, en orden descendente según la severidad del riesgo que representa el error en la ingesta.

The objective is to present the methodology of our protocol of nasofibroscopic evaluation of swallowing in a cooperative manner and to disseminate among otorhinolaryngologists and phonoaudiologists that it is an agile, simple and easily feasible process to study, diagnose and plan the therapy of oropharyngeal dysphagia jointly in the multidisciplinary team. It was a cross-sectional descriptive pilot study where swallowing nasofibroscopy was applied by means of the functional evaluation protocol as a cooperative multidisciplinary method, taking a pilot sample of 29 adults, with an average age of 62.5 years. It was performed in patients without any alteration in the state of consciousness and presenting findings compatible with dysphagia in the context of neurological pathology, post intubation and some dysphonic patients. The protocol begins with anamnesis, physical and functional examination of the orofacial structures, and ends with clinical endoscopic examination of the structures involved in oropharyngeal dysphagia. After the application of the pilot test, the events during the swallowing process were observed. The frequent findings were: presence of residues in the vallecula and pharyngeal recesses after ingestion of pudding-like consistency, in addition to subsequent leakage of liquids in nectar-like consistency. It is concluded that nasofibroscopy of swallowing is a very versatile objective test, easy and safe to perform, that allows an adequate diagnosis of oropharyngeal dysphagia, which if applied in a cooperative manner between the speech therapist and the otolaryngologist can guide the rehabilitation work and the therapeutic behavior. Translated with www.DeepL.com/Translator (free version), El objetivo es presentar la metodología de nuestro protocolo de evaluación nasofibroscópica de la deglución de manera cooperativa y difundir entre los otorrinolaringólogos y fonoaudiólogos que es un proceso ágil, sencillo y fácilmente factible de estudiar, diagnosticar y planear la terapia de las disfagias orofaríngeas de manera conjunta en el equipo multidisciplinar. Fue un estudio piloto descriptivo transversal donde se aplicó la nasofibroscopía de la deglución mediante el protocolo de evaluación funcional como método multidisciplinario cooperativo, tomando una muestra piloto de 29 adultos, con una edad promedio de 62.5 años. Se realizó en pacientes sin ninguna alteración en el estado de conciencia y que presenten hallazgos compatibles con disfagia en el contexto de patología neurológica, post intubación y algunos pacientes disfónicos. El protocolo se inicia con la anamnesis, examen físico y funcional de las estructuras orofaciales, y finaliza con el examen endoscópico clínico de las estructuras implicadas en la disfagia orofaríngea. Después de la aplicación de la prueba piloto, se observó los sucesos durante el proceso de deglución. Los hallazgos frecuentes fueron: presencia de residuos en los valléculas y recesos faríngeos tras ingestión de consistencia tipo pudín, además de escape posterior de líquidos en consistencia tipo néctar. Se concluye que la nasofibrosopia de la deglución es un examen objetivo muy versátil, fácil y seguro de realizar, que permite realizar un diagnóstico adecuado de la disfagia orofaríngea, que si se aplica de la manera cooperativa entre el fonoaudiólogo y el otorrinolaringólogo puede orientar el trabajo de rehabilitación y la conducta terapéutica.

The International Dysphagia Diet Standardisation Initiative (IDDSI) allows, amongst other things, to classify liquid viscosity in different levels. Although it is normally used as a treatment strategy for dysphagia, it may also be used in the execution of different assessment methods to establish how difficult it is for a patient to manage a particular viscosity. Nonetheless, IDDSI doesn´t determine specific amount of thickener required to obtain each viscosity level, also the initiative recommends establishing adaptations according to fixed conditions of application (e.g. type of thickener or foods offered in an institution). This study developed a proposal to prepare viscosities through experimental tests, specifying milliliters of water and grams of thickener for each viscosity. Therefore, measures of water and thickener to obtain viscosity levels 0-4 are defined and verified through flow test. The presented findings take into account influential variables like geographic location, temperature and altitude. It is hoped that this proposal impacts swallowing assessment practices in Colombian clinical area, so that evaluation could be more accurate and effective. Finally, it is appropriate to determine specific measures of thickener to achieve all viscosity levels in liquids other than water. It is also necessary, to replicate this proposal with other thickeners more easily available to clients as well as consideration of other factors like palatability., la iniciativa internacional para la estandarización de la dieta de disfagia (IDDSI) permite, entre otras cosas, clasificar la viscosidad de los líquidos por niveles. Aunque suele ser una herramienta para el tratamiento de la disfagia, puede también usarse en la ejecución de distintos métodos de evaluación para establecer el grado de dificultad que tiene un usuario en el manejo de una viscosidad determinada. Con todo, la iniciativa no determina las medidas específicas de espesante requeridas para obtener cada nivel de viscosidad y sugiere hacer adaptaciones de acuerdo con las condiciones particulares de aplicación (por ejemplo, tipo de espesante o alimentos ofertados en una institución). Este estudio desarrolló una propuesta para la preparación de viscosidades mediante pruebas experimentales, precisando los mililitros de agua y gramos de espesante para cada nivel de viscosidad. Así pues, se especifican las cantidades necesarias de agua y espesante para conseguir los niveles de viscosidad en bebidas de 0-4, verificados a través del test de flujo. Los hallazgos presentados, tienen en cuenta factores influyentes como la ubicación geográfica, temperatura y altitud. Se espera que esta propuesta incida en las dinámicas de evaluación de la deglución en el área clínica colombiana de forma que esta sea más precisa y eficaz. Finalmente, es pertinente realizar futuras investigaciones que determinen medidas específicas de espesante para lograr cambios en la viscosidad de líquidos diferentes al agua e igualmente necesario, replicar esta propuesta con otros espesantes de más fácil acceso para los usuarios y que tengan en cuenta otros aspectos como la palatabilidad.

In the clinical care, the speech language pathologist has evaluative resources to describe the sequential biomechanics of swallowing; one of the resources used is Cervical Auscultation (CA). Taking into account the description of the importance of the timely and effective intervention of the swallowing processes in children with cerebral palsy, it is considered necessary to solve: what is the spectrographic profile that records the pharyngeal phase of swallowing in the pediatric patient with cerebral palsyl?. The Systematic review based of a PRISMA methodology, specifically in the use of cervical auscultation as a reference for the clinical evaluation of swallowing and dysphagia in diagnosed pediatric subjects. with Cerebral Palsy. Of the180 articles found in the cientific databases, taking 6 articles out of the total according to the eligibility criteria, establishing a 3.34% of inclusion. In the absence of instrumental swallowing evaluation processes, CA provides the accessibility of the procedure as a benefit, in addition to temporality characteristics in the sequence of swallowing sounds, without any type of adverse factor for its performance. The CA is an important resource in clinical evaluation, it establishes a first step in the physiological analysis of swallowing with the physiological aspects of the pharyngeal phase. This puts auscultation in a privileged position, but it must be standardized by cientifics and theorists on the subject., Dentro de la atención clínica, el profesional de la fonoaudiología cuenta con recursos evaluativos para describir la biomecánica secuencial de la ingesta; uno de los recursos utilizados es la Auscultación Cervical (AC). Teniendo en cuenta la descripción de la importancia de la intervención oportuna y efectiva de los procesos de alimentación en los niños con parálisis cerebral, se considera necesario resolver ¿cuál es el perfil espectrográfico que registra la fase faríngea de la deglución en el paciente pediátrico con parálisis cerebral? Su metodología contempla una Revisión sistemática bajo metodología PRISMA, estableciendo la búsqueda de artículos científicos en la utilización de la AC en la evaluación clínica de la deglución en sujetos pediátricos diagnosticados con Parálisis Cerebral. Como resultado se hallan 180 artículos en las bases de datos indagadas, tomando de acuerdo a los criterios de elegibilidad 6 artículos del total, estableciendo un 3,34% de inclusión. En ausencia de procesos instrumentales de evaluación deglutoria, la AC aporta como beneficio la accesibilidad del procedimiento, además de características de temporalidad en la secuencia de los sonidos deglutorio, sin ningún tipo de factor adverso para su realización. Es por ello que la auscultación es un recurso importante en la evaluación clínica, establece un primer paso en el análisis fisiológico de la deglución con los aspectos fisiológicos de la fase faríngea. Esto, pone a la auscultación en una posición privilegiada, pero que debe ser estandarizada por los estudiosos y teóricos del tema.

The aging process, as in the whole organism, generates a series of changes in the stomatognathic structures, and these morphological changes, characteristic in the swallowing mechanism in healthy elderly subjects, characterize Presbyophagia. An interesting discussion is generated around presbyophagia and the parameters of safety, effectiveness, competence and comfort, given that neurological-structural changes are frequent in the elderly, which carry various consequences, from mild to severe degrees, that impact in a differentiated way in the indicators that are usually described in the clinic. However, the conceptualization used is not clear when making a distinction between a transitional state or a state of affection. For this reason, it is analyzed whether there are key factors that allow elucidating the contemporary conception to create a unified language in favor of directing speech therapy actions towards the areas of health promotion of the swallowing function and prevention of dysphagia in this population., El proceso de envejecimiento, al igual que en todo el organismo, genera una serie de cambios en las estructuras estomatognáticas, y estos cambios morfológicos, característicos en el mecanismo de la deglución en sujetos sanos de edad avanzada caracterizan a la Presbifagia. Una interesante discusión se genera en torno a la presbifagia y los parámetros de seguridad, efectividad, competencia y confortabilidad, dado que los cambios neurológicos-estructurales son frecuentes en la tercera edad, los cuales acarrean diversas consecuencias, desde grados leves a severos, que impactan de forma diferenciada en los indicadores que habitualmente se describen en la clínica. Sin embargo, la conceptualización utilizada no es clara al realizar una distinción entre un estado transicional o de afección. Por este motivo, se analiza si existen factores claves que permitan dilucidar la concepción contemporánea para crear un lenguaje unificado en pro de dirigir las acciones fonoaudiológicas hacia las áreas de promoción de la salud de la función deglutoria y prevención de la disfagia esta población.