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Current speech-language pathology (SLP) services in Cambodia are limited in scope, service accessibility and integration into government systems. However, momentum is growing to develop an internationally recognised profession. This paper examines the depth and breadth of SLP support available to people with communication and/or swallowing difficulties in relation the Sustainable Development Goals (SDGs). Qualitative interview data collected from service facilities (n = 13) and speech therapy practitioners (n = 27) were mapped and analysed for accessibility and scope of SLP services. Data revealed a workforce density of 0.16:100 000. Disparity in service accessibility was identified between provincial and urban locations, adult and paediatric populations and range of practice areas. The findings demonstrate the importance of partnerships (SDG 17) among government departments, non-government organisations and private sector entities to establish a sustainable and culturally responsive SLP profession in Cambodia. Although there is no Cambodian university training program, there is a growing momentum and local commitment to establishing a workforce to support Cambodians with communication and/or swallowing difficulties. This commentary paper focuses on good health and well-being (SDG 3), decent work and economic growth (SDG 8), reduced inequalities (SDG 10), and also addresses no poverty (SDG 1), quality education (SDG 4) and partnerships for the goals (SDG 17). [ABSTRACT FROM AUTHOR]

Communication is central to the accomplishment of each of the United Nations' 17 Sustainable Development Goals (SDGs) and is a fundamental human right. This special issue of the International Journal of Speech-Language Pathology (IJSLP, vol. 25, no. 1) is dedicated to communication, swallowing and the SDGs; particularly focussing on people with communication and/or swallowing disability and those who support them. The papers in the special issue of IJSLP demonstrate that successful communication is necessary for realisation of all 17 SDGs at both a global and an individual level and advance the international call for SDG 18: Communication for All. The 36 papers address all 17 goals, focussing on poverty, hunger, health, education, work, innovation, climate, cities, land, oceans, justice, and partnerships. Authors worked and undertook their research in Australia, Austria, Benin, Cambodia, Cameroon, Canada, China, Columbia, Denmark, Egypt, Ethiopia, Ghana, Greece, Iceland, India, Iraq, Ireland, Italy, Jordan, Kenya, Lebanon, Maldives, Mozambique, Nepal, New Zealand, Nigeria, State of Palestine, Peru, Philippines, Rwanda, Serbia, South Africa, Uganda, UK, USA, Vietnam. Communication for all is essential for the achievement of the SDGs, "peace and prosperity for people and the planet" (United Nations, 2015a). Achievement of the SDGs is the role of all; including communication specialists, people with communication/swallowing disability, their families and communities. [ABSTRACT FROM AUTHOR]

Tracheostomy and dysphagia are independently associated with increased complications and poorer functional outcome after acquired brain injury (ABI). The aim of this study was to identify and evaluate rehabilitation to restore functional swallowing ability and respiratory capacity during tracheal tube weaning. The review was conducted according to PRISMA guidelines. Any study design with adult patients with ABI and tracheostomy was eligible. The primary outcome was decannulation. A total of 2647 records were identified and eight papers included. Four studies investigated pharyngeal electrical stimulation (PES), two explored Facial Oral Tract Therapy (F.O.T.T.), one respiratory physiotherapy (RPT), and one study investigated external subglottic air flow (ESAF). Two RCTs found a significant difference between intervention and control on successful decannulation and readiness for decannulation in favour of PES. Time from rehabilitation admission and tracheostomy to decannulation was significantly reduced after implementing an F.O.T.T.-based protocol. Four interventions were identified, PES, F.O.T.T., RPT, and ESAF, all aimed at increasing oropharyngeal sensory input through stimulation. Due to heterogeneity of interventions, designs and outcome measures, effect could not be estimated. This review highlights the limited research on rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation. Rehabilitation for early decannulation after brain injury Dysphagia and tracheostomy often coexist in neurocritical care and early rehabilitation. Four rehabilitative interventions were identified—pharyngeal electrical stimulation, external subglottic airflow, respiratory physiotherapy and facial-oral tract therapy. Interventions points to a consensus that sensory stimulation of the oropharynx can increase excitability of the swallowing network and support pharyngeal sensorimotor cortex reorganisation. This review highlights the limited research on therapeutic rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation. [ABSTRACT FROM AUTHOR]

Sepsis is a major global health problem with an estimated 49 million cases globally each year causing as many as 11 million deaths. The primary objective of this commentary is to describe the impacts of sepsis and critical illness on communication and swallowing function, and to discuss management strategies considering the Sustainable Development Goals (SDGs). Communication and swallowing disabilities can occur with sepsis and critical illness. A holistic framework to optimise function, recovery, and future research priorities across the lifespan can be developed through the SDGs. Communication and swallowing disabilities following critical illness associated with sepsis have global impacts. Early multidisciplinary engagement is key to optimising individuals' function. Collaborative research, education, and public awareness is urgently needed to increase equity in health outcomes across populations. This commentary paper supports progress towards good health and well-being (SDG 3), quality education (SDG 4) and reduced inequalities (SDG 10). [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this scoping review were to summarize, understand, and disseminate findings from a broad body of literature on rehabilitation interventions used with survivors of head and neck cancer. Method: Searches were conducted in six databases. Inclusion criteria were studies of adult head and neck cancer survivors with a predefined primary rehabilitation outcome as a result of an intervention. Excluded were studies not written in English, opinion papers, or studies where the intervention was not carried out by a rehabilitation healthcare service. A second level, full-text review of the studies was conducted. A thematic analysis was used to examine and combine study findings. Results: A total of 3804 results were retrieved from all sources resulting in 39 papers that were analyzed. The thematic analysis of the included papers represented interventions focusing on swallowing and nutrition, speech, physical therapy, assistive devices, complementary and alternative modalities, comprehensive interdisciplinary programs, and preventive rehabilitation programs. Conclusion: This review has provided an overview of the scope of rehabilitation interventions available for survivors of head and neck cancer and preliminary information about their efficacy. This is foundational information for the development and refinement of rehabilitation interventions and programs for head and neck cancer survivors. The existing evidence suggests that survivors of head and neck cancer can benefit from early screening of potential rehabilitation needs and being involved in preventive rehabilitation programs pre-surgery when possible. Rehabilitation programs should consider swallowing interventions for patients as evidence reports improved swallowing function, decreased pain and discomfort, and reduced duration of feeding tube use. Rehabilitation programs should consider nutritional interventions after radiotherapy: Patients benefited from stabilized weights, improved nutritional status, and an improved quality of life. Physical exercise interventions demonstrated improvements in physical function, muscular endurance, range of motion, overall quality of life, and showed reductions in pain, and fatigue. [ABSTRACT FROM AUTHOR]

Purpose: Between 55–65% of residents living in residential aged care facilities (RACFs) experience dysphagia and are prescribed texture-modified diets by a speech-language pathologist (SLP). The aim of this study was to assess current adherence to prescribed texture modification for people with dysphagia; and explore barriers to implementation in a rural aged care setting. Method: Meal texture audits (N = 42) were completed with residents with dysphagia in a rural RACF who were prescribed texture-modified diets or fluids by a SLP. Semi-structured focus groups were conducted with nursing and food preparation staff (N = 11) to identify barriers to implementation. Result: Mealtime texture audits identified that 54.8% (n = 23) of residents' food modification requirements were incorrectly documented in the manual entry database (kitchen form) and 64.3% (n = 27) of meal trays contained foods that did not meet residents' dysphagia management plans. Focus group data revealed seven main themes impacting on the ability of staff to implement prescribed texture-modified diets. Complicated processes and communication between nursing, food services and SLP staff were identified as major barriers. These were complicated further by time pressures experienced by staff as well as staffing issues, resourcing of the kitchen, accommodating individual dietary preferences and the variety/presentation of dietary options at the aged care facility. Conclusion: There was low adherence to SLP prescribed texture-modified diets and fluids in the participating rural RACF. This study identified major barriers to implementing SLP prescribed texture-modified diets including complicated processes, communication breakdowns, time pressures and limited staffing. Implementation of an online menu management system and regular dysphagia-specific training may address barriers to communication and complicated paper-based menu systems and should be a priority for health services to ensure adequate dysphagia management. [ABSTRACT FROM AUTHOR]

To establish a generally accepted Danish definition of dysphagia to enhance collaboration across sectors and professions. The study was initiated by a multi-professional group of experienced researchers and board members of the Danish Society for Dysphagia. We used a modified Delphi methodology to achieve consensus among experienced health care professionals from different professions and contexts. The initial stage consisted of a literature search leading to the draft of different definitions followed by two Delphi rounds between professionals and a stakeholder consultation round. We conducted two Delphi rounds until one definition was clearly preferred. A total of 194 participants responded in round one, and 279 in round two. Both rounds had a broad representation of sectors and geography and most participants had worked with dysphagia for more than four years. The preferred definition was 'Dysphagia is a functional impairment that either prevents or limits the intake of food and fluids, and which makes swallowing unsafe, inefficient, uncomfortable or affects quality of life'. The definition was widely accepted among different health professional groups, patients and across sectors. [ABSTRACT FROM AUTHOR]

Background: Central pontine myelinolysis is a rare condition that can result in debilitating symptoms. Recent evidence suggests a shift in hypothesized prognosis for individuals with this diagnosis and implies a valuable role for rehabilitation to address prevention of secondary complications and functional recovery. This paper describes a 30 year-old female with central pontine myelinolysis presenting with incomplete locked-in syndrome and chronicles her rehabilitative journey at a comprehensive post-acute rehabilitation center. We present discipline specific interventions and discuss the interactions of the rehabilitation team as it relates to this patient's care and progression of training. Methods: Retrospective review of medical records and face-to-face interview were use to compile data for this case report. Results: The patient demonstrated improvements in function in all areas of mobility, swallowing, communication, and self-care over the course of 6 weeks of interdisciplinary training. Conclusion: This report illustrates the critical role of a patient-centered and goal-driven interdisciplinary team approach in the rehabilitation of persons with central pontine myelinolysis. Central Pontine Myelinolysis can result in profound acute disability, including incomplete locked-in syndrome. Interdisciplinary post-acute rehabilitation is beneficial in maximizing functional recovery and minimizing secondary complications for individuals with Central Pontine Myelinolysis. Ongoing clinical assessment and team collaboration contribute to progressive and comprehensive plan of care development in post-acute rehabilitation. A patient-centered and goal-driven interdisciplinary team approach facilitates improvement in outcomes across clinical domains. Recovery potential and therapeutic interventions for individuals with Central Pontine Myelinolysis need to be further explored. [ABSTRACT FROM AUTHOR]

Purpose: Treatment in intensive care units (ICUs) often results in swallowing dysfunction. Recent longitudinal studies have described the recovery of critically ill people, but we are not aware of studies of the recovery of swallowing function in patients with ICU-acquired muscle weakness. This paper aims to describe the time course of regaining water swallowing function in patients with ICU-acquired weakness in the post-acute phase and to describe the risks of regaining water swallowing function and the risk factors involved. Methods: This cohort study included patients with ICU-acquired muscle weakness in our post-acute department, who were unable to swallow. We monitored the process of regaining water swallowing function using the 3-ounce water swallowing test. Results: We included 108 patients with ICU-acquired muscle weakness. Water swallowing function was regained after a median of 12 days (interquartile range =17) from inclusion in the study and after a median of 59 days (interquartile range= 36) from the onset of the primary illness. Our multivariate Cox Proportional Hazard model yielded two main risk factors for regaining water swallowing function: the number of medical tubes such as catheters at admission to the post-acute department (adjusted hazard ratio [HR] = 1.282; 95% confidence interval [CI]: 1.099-1.495) and the time until weaning from the respirator in days (adjusted HR =1.02 per day; 95%CI: 0.998 to 1.008). Conclusion: We describe a time course for regaining water swallowing function based on daily tests in the post-acute phase of critically ill patients. Risk factors associated with regaining water swallowing function in rehabilitation are the number of medical tubes and the duration of weaning from the respirator. Implications for rehabilitation: Little guidance is available for the management of swallowing dysfunction in the rehabilitation of critically ill patients with intensive-care-units acquired muscle weakness. There is a time dependent pattern of recovery from swallowing dysfunction with daily water swallowing tests in the post-acute phase of critically ill patients. Daily water swallowing tests can be used to test swallowing dysfunction in the post-acute phase of critically ill patients The amount of medical tubes and the duration of weaning from respirator are associated risk factors for recovery of swallowing dysfunction. [ABSTRACT FROM AUTHOR]

Post-stroke dysphagia (PSD) is a widely prevalent and possibly life-threatening consequence that may lead to aspiration pneumonia, malnutrition, dehydration, and higher mortality risk. Recommending thickened fluids (TF) is a longstanding practice in the management of dysphagia. Augmenting liquid viscosity with a xanthan gum-based thickener benefits patients with PSD by aiding in the enhancement of bolus control, facilitating improved coordination in the swallowing mechanism, and lowering the risk of aspiration. Despite the widespread use of TF, limited high-quality evidence supports its benefits in PSD. This manuscript presents the clinical experience with four varied cases of PSD. A comprehensive approach to management with TF decreased the risk of aspiration pneumonia and facilitated effective management of dietary recommendations both during hospitalization and after discharge (all Cases). In addition, TF maintained nutrition and hydration in patients with multiple hospital admissions (Case 2), maintained hydration in those unable to engage in swallow rehabilitation due to complex medical conditions (Cases 2, 3, and 4), and those who needed slow and longer recovery due to long-term risk of silent aspiration (Cases 2, 3, and 4). In one case (Case 4), the use of TF was extended for more than two years post-stroke with no reported incidence of chest infection. In routine clinical practice, a comprehensive management approach with xanthan gum-based TFs reduces the risk of aspiration and aspiration pneumonia in patients with PSD while maintaining nutritional and hydration and improving swallowing function based on formal instrumental assessments. This clinical experience highlights the pivotal role of instrumental assessment, patient education, and informed decision-making to optimize outcomes with TF. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented in which the authors discuss various articles published within the issue on such topics as anatomical visualisation, swallowing simulation and visualisation, and knee joint contact biomechanics in walking.

Purpose:Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer new tools for its assessment but little guidance is available for its management. This paper aims to provide a step-by-step algorithm to facilitate clinical decisions regarding dysphagia management in this patient population. Methods:This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available. Results:Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated. Conclusions: There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population.Implications for RehabilitationLittle guidance is available for the management of dysphagia in Duchenne dystrophy.Food can penetrate the vestibule, accumulate as residue or cause aspiration.We propose recommendations and an algorithm to guide management of dysphagia.Penetration/residue accumulation: prohibit solid food and promote intake of fluids.Aspiration: if cough augmentation techniques are ineffective, consider tracheostomy. [ABSTRACT FROM AUTHOR]

The Valsalva maneuver and its modifications have been utilized across several conditions in medicine; however, there have been difficulties in its application. Thus, at the University of Texas Health Science Center in San Antonio, we designed and patented an affordable and accessible device that mimics Valsalva called "Forced Inspiratory Suction and Swallow Tool (FISST). In this review, we discuss the premise for the design of FISST, based on applications of the law of conservation energy, the continuity equation, and Bernoulli's principle. We then detail the mechanism by which FISST stimulates hiccup cessation by increasing negative inspiratory pressure when drinking through the apparatus, causing diaphragmatic contraction and disruption of the hiccup reflex. We then detail the efficacy and future applications of FISST in addressing other pathologies. FISST has been used to address hiccups by utilizing its reverse-Valsalva effect to increase parasympathetic stimulation by increasing vagal tone. In a prospective study that we conducted on a cohort of 249 hiccup subjects worldwide, this tool achieved 92% effectiveness. Additionally, several cases, including a published case report, have found FISST successful in terminating supraventricular tachycardias (SVT). FISST may be further utilized in diagnosing or addressing various upper airway pathologies and should be explored further. [ABSTRACT FROM AUTHOR]

Bulbar motor deterioration due to amyotrophic lateral sclerosis (ALS) leads to the eventual impairment of speech and swallowing functions. Despite these devastating consequences, no standardized diagnostic procedure for assessing bulbar dysfunction in ALS exists and adequate objective markers of bulbar deterioration have not been identified. In this paper, we consider objective measures of speech motor function, which show promise for forming the basis of a comprehensive, quantitative bulbar motor assessment in ALS. These measures are based on the assessment of four speech subsystems: respiratory, phonatory, articulatory, and resonatory. The goal of this research is to design a non-invasive, comprehensive bulbar motor assessment instrument intended for early detection, monitoring of disease progression, and clinical trial application. Preliminary data from an ongoing study of bulbar motor decline are presented, which demonstrate the potential clinical efficacy of the speech subsystem approach. [ABSTRACT FROM AUTHOR]

A dynamical systems approach to infant feeding problems is presented. A theoretically motivated analysis of coordination among sucking, swallowing, and breathing is at the heart of the approach. Current views in neonatology and allied medical disciplines begin their analysis of feeding problems with reference to descriptive phases of moving fluid from the mouth to the gut. By contrast, in a dynamical approach, sucking, swallowing, and breathing are considered as a synergy characterized by more or less stable coordination patterns. Research with healthy and at-risk groups of infants is presented to illustrate how coordination dynamics distinguish safe swallowing from patterns of swallowing and breathing that place premature infants at risk for serious medical problems such as pneumonia. Coordination dynamics is also the basis for a new medical device: a computer-controlled milk bottle that controls milk flow on the basis of the infant's coordination patterns. The device is designed so that infants may gradually take complete control of milk flow as they begin to discover the relation between swallowing and breathing. [ABSTRACT FROM AUTHOR]

Because of its distinct advantage in radiation-free soft tissue imaging, ultrasonography has been widely used to study lingual, pharyngeal, hyoid, laryngeal, and even esophageal action during swallowing in individuals of all ages. Qualitative ultrasonographic observations have made considerable contributions to our understanding of deglutition. Quantitative ultrasonographic swallowing research has also grown by leaps and bounds over the years with advances in imaging technologies and analytical methodologies. As a technical primer for new investigators, this paper reviews the modern methods for quantitative analysis in ultrasonographic swallowing research. The intended outcome is a basic understanding of the application of ultrasonography with various analysis options to the quantitative study of the deglutitive action of selected upper aerodigestive structures. Though proven useful for swallowing research, ultrasonography has inherent limitations and methodological issues. Future technological advancement and sophisticated image processing and analysis algorithms will resolve some of these issues. [ABSTRACT FROM AUTHOR]

Copyright of Acta Oto-Laryngologica is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Acta Oto-Laryngologica is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is building evidence that oesophageal screening (OS) should be considered a critical component of videofluoroscopic swallow studies (VFSS). This study surveyed Australian speech-language pathologists (SLPs) regarding current practices and perceptions of OS in VFSS. A 16–24 item online survey was distributed to Australian SLPs via relevant email forums. One response per site was requested. Survey questions explored experience and training in VFSS, skill and confidence with OS, OS protocol use, and pathways following OS. One hundred and one SLPs across all Australian states and territories responded, with 70% (n = 69/99) from metropolitan hospitals and 74% (n = 75/101) having more than five years' VFSS experience. While 69% (n = 70/101) of SLPs conducted OS, only half (n = 35/70) conducted OS routinely, and only 4% (n = 3/70) always used published OS protocols. Barriers to OS, for some participants, were concerns about scope of practice and confidence. This study confirms higher levels of OS in Australia compared to similar international surveys and provides rich data on the Australian context. Prescriptive clinical guidelines for OS, consensus regarding a preferred OS protocol, and specific OS training may clarify SLP scope of practice and improve SLP confidence and standardisation in OS. [ABSTRACT FROM AUTHOR]

Investigation into dysphagia, dysphonia and laryngeal hypersensitivity after whiplash is limited, offering minimal insight into specific features and impact. This study aimed to explore these symptoms. A qualitative interpretive description design was used. Eleven participants with chronic Whiplash Associated Disorder and self-reported swallowing, voice and/or throat-related problems completed baseline symptom questionnaires and were offered a videofluroscopic swallow study to investigate baseline swallowing biomechanics. Semi-structured interviews were conducted to explore features of swallowing, voice and laryngeal sensory complaints and analysed using thematic analysis. There were high baseline levels of self-reported neck, pain- and throat-related disability and psychological distress. There was no evidence of baseline deficits in swallow biomechanics. Thematic analysis revealed 5 themes: (1) A range of features of dysphagia and dysphonia exist after whiplash with varied clinical course; (2) Activity and participation in swallow and voice activities have changed; (3) There are psychological and emotional impacts; (4) Features of laryngeal hypersensitivity co-exist and (5) There are barriers to management. Swallow, voice and laryngeal sensory problems after whiplash were described, with impacts on quality of life and barriers to management. These insights broaden understanding of post-whiplash sequalae, indicating the need for better detection. Dysphagia, dysphonia and laryngeal hypersensitivity are under-recognised consequences of whiplash. Individuals presenting with dysphagia, dysphonia and laryngeal sensory symptoms after whiplash experience significant implications to wellbeing, activity and participation. Improved understanding of these symptoms may facilitate better detection and subsequent referral to speech-language pathology. Greater understanding into the functional and psychosocial implications of these symptoms may guide more effective post-whiplash assessments and informed rehabilitation. [ABSTRACT FROM AUTHOR]

Communication and swallowing disabilities (CSwD) impact health and well-being (Sustainable Development Goal SDG 3), educational attainment (SDG 4) and employment (SDG 8) and contribute to poverty (SDG 1). In Vietnam, community-based rehabilitation (CBR) workers are often the first point of contact for people with CSwD. This commentary reports research exploring the knowledge, experiences and training needs of CBR workers and their preparedness to provide services to people with CSwD and their families living in a province of Vietnam. Two hundred and five CBR workers completed a written survey and eight participated in a semi-structured interview. Quantitative survey data were analysed using descriptive statistics and content analysis was used to analyse the qualitative data. Most participants were female, aged over 30 and worked in a variety of health settings. Multiple challenges to the delivery of services to people with CSwD were described, including lack of training and limited understanding of CSwD by CBR workers, communities and their leaders. Limited knowledge and preparedness of CBR workers is threatening the achievement of the SDGs for people with CSwD in Vietnam. There is a need for comprehensive education, training and the raising of awareness of the cause and impact of CSwD, and for this to be in partnership with people who experience CSwD and their families, local speech-language pathologists, and international collaborators. Future research exploring the needs of people with CSwD in Vietnam is critical to guiding the development of contextually relevant services and support. This commentary focuses on good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8), reduced inequalities (SDG 10) and partnerships for the goals (SDG 17), and indirectly addresses no poverty (SDG 1). [ABSTRACT FROM AUTHOR]

Purpose: Brain tumour and leukaemia represent the most common childhood cancers and can result in communication and swallowing difficulties. The purpose of this study was to survey health professionals and consumers regarding the management of communication and swallowing difficulties in children with brain tumour or leukaemia (CBTL). Method: In this study participants completed a survey focussing on (1) communication and swallowing assessment and intervention, (2) multidisciplinary team (MDT) practices and (3) risk factors. Quantitative data were reported using descriptive statistics. Qualitative data were analysed using NVivo12 Qualitative Data Analysis Software. Result: Twenty-four participants were included (22 health professionals; two consumers). Most participants (≥80%) agreed that comprehensive and regular communication and swallowing assessments improved outcomes. Communication and swallowing interventions were reported to improve outcomes by 96% of participants. MDT care was considered essential in improving outcomes. Speech-language pathologists were the primary health professional identified in communication management; additional multidisciplinary health professionals were highlighted in swallowing management. Risk factors were identified across three categories: cancer-related, treatment-related and child-factors. Conclusion: This study collates the expertise and experience of multidisciplinary health professionals and consumers which can be used to guide assessment and intervention for communication and swallowing in CBTL. It also provides perspectives on MDT care and consideration of patient values and risk factors. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of cerebellar tDCS on motor learning for swallowing. In a double-blind RCT, 39 healthy adults received either sham, anodal tDCS, or cathodal tDCS in two sessions on two consecutive days. Following 20 min cerebellar tDCS (2 mA) or sham, they underwent swallowing skill training that targeted control of timing and magnitude of submental muscle activation during swallowing. Linear mixed models were used to identify the effects of stimulation on timing and magnitude accuracy as measured by the change in task performance for each training session, and for skill retention on days 3 and 10 post-intervention. Only the sham group had a reduced temporal error from baseline to all following timepoints. When compared to error changes in the sham group, changes from baseline in temporal errors were higher at all timepoints post-intervention for the anodal group, and higher at both retention assessments for the cathodal group. Amplitude errors were smaller for all conditions at all timepoints post-intervention compared to baseline. Cerebellar tDCS was found to inhibit temporal aspects of motor skill learning in swallowing. For the tDCS parameters used in this study, there is no support for use of tDCS to facilitate swallowing rehabilitation. Trial Registry Number (): ACTRN12615000451505. Cerebellar tDCS, in combination with motor skill training, has been demonstrated to increase motor skill learning in healthy individuals and neurologically impaired patients. In this study, cerebellar tDCS applied prior to swallowing skill training adversely affected timing measures of submental muscle activation during swallowing. In contrast to published outcomes in the corticospinal literature, both anodal and cathodal tDCS resulted in a relative inhibitory effect on motor skill learning in swallowing when compared to the sham condition. Swallowing skill training without tDCS produced increased accuracy in outcomes. [ABSTRACT FROM AUTHOR]

Dysphagia is a 'hidden' disorder that can present with a range of consequences including fatality. It is important for intervention to be timeous and adopt a team approach, with each professional displaying understanding of both dysphagia and each other's roles. The nurse is at the epicentre of service provision in hospitals and is ideally positioned to collaborate with the speech-language therapist to manage dysphagia. The state of collaboration, however, is not ideal. Reasons perpetuating this need, to be understood to facilitate improved care by nurses for patients with dysphagia. The aim of the study was to describe the caseload of dysphagia patients seen by nurses, their experiences caring for patients with dysphagia, and nurses' views on inter-professional training. A qualitative, exploratory study was conducted with nurses working at two government hospitals in Johannesburg, South Africa. An open-ended semi-structured interview was conducted with nine nurses working with adult patients. Descriptive and inductive thematic analysis was used, comparisons were made between the responses, and data were categorised according to emerging themes. Results confirmed that while experience improved care, gaps in dysphagia knowledge, inexperience and contextual challenges adversely impacted efficiency of dysphagia care. Inter-professional training and recognition of nurse intervention positively impacted on interactions with dysphagia. Nurses have a central role in dysphagia care in acute settings. The study confirmed that multidisciplinary management, inter-professional training and inter-professional relations contribute to overall improved service delivery in dysphagia in acute settings, with nurses at the epicentre. [ABSTRACT FROM AUTHOR]

The improvement in the nutritional status of older adults with swallowing limitations, as could happen in Alzheimer's, has prompted modified-texture food design, including thick liquids that reduce the risk of aspiration. National Dysphagia Diet and the International Dysphagia Diet Standardization Initiative classified food accordingly with dysphagia severity level by literature sources without considering preparation and service conditions. The rheological and mechanical behavior of 34 liquid, 35 semisolid, and solid food commonly included in elderly menus was categorized by dysphagia severity level, considering preparation conditions and evaluation at service temperature. Data were fitted to the Power Law and Herschel-Bulkley models. Rheological behavior found thixotropic and pseudoplastic fluids in the range of 0.13 < n < 0.69; 0.48 < K < 62081, without elastic limit. Solid and semisolid food were classified by hardness as 4-pureed (H ≤ 15000), 5-Minced & moist, and 6-Soft & bite-sized (15000 ≤ H ≤ 40000), 7-Regular-Easy to chew (H > 40000). Analyzing the rheological and mechanical behavior attributes allowed the categorization by type of dysphagia. Outcomes for food with individualized attributes are useful for older adult caregivers at home and in professional clinical care, emphasizing people with cognitive impairment, including Alzheimer's. [ABSTRACT FROM AUTHOR]

To synthesise the available evidence relating to best practice in training videofluoroscopy and barium swallow analysts. The review was conducted according to the PRISMA statement and registered in PROSPERO (CRD42017053744). Data were extracted from nine databases. Studies were included if they described training approaches for clinicians or students of any profession learning to interpret videofluoroscopic (VFSS) or barium swallow studies and were written in English. The methods were heterogeneous and a metanalysis was not possible; a narrative review is presented. Sixteen studies were eligible, including those designed to evaluate the influence of training as well as those that described training as part of validating an assessment tool or method. The quality of the studies was assessed with the Hawker scale and assigned an NHMRC rating. While the evidence was low quality (NHMRC level IV), training consistently improved the accuracy and reliability of clinicians and students conducting VFSS. No studies reported the outcome of training for barium swallow analysis. There was significant variability in the dose, method, and setting of training. To elucidate best practice in VFSS analysis to ensure training is cost effective and results in accurate diagnosticians requires further research. [ABSTRACT FROM AUTHOR]

To establish normative data of crackers common in the Scandinavian and international markets for use in the Test of Masticating and Swallowing Solids (TOMASS), and to investigate possible sex and age effects on masticatory performances. 234 healthy participants (>20 years of age) were asked to either ingest the Göteborgskex Guld Marie™ cracker (n = 234) or to ingest both a Guld Marie cracker and a Tuc Original™ cracker (n = 115). Quantifiable measures of masticatory performance (number of bites, number of chewing cycles, number of swallows, and total time) were observed during TOMASS for each participant, directly on-site or by video recording. There were no significant differences in masticatory performances between the crackers. Significant age effects were observed for all masticatory measurements, except for the number of swallows. The results showed insufficient support for an effect of sex, and that results obtained on-site and from video recordings were highly correlated. These findings suggest that similar masticatory performance is to be expected when performing TOMASS using the evaluated crackers. The age of the participant affects TOMASS performance, but the effect of sex is considerably smaller. [ABSTRACT FROM AUTHOR]

Keywords: Instrumentation; reproducibility; tongue; range of motion; deglutition EN Instrumentation reproducibility tongue range of motion deglutition 76 98 23 08/25/21 20210601 NES 210601 Oral motor skills play a critical role in speech and feeding processes (McMurray et al., [25]). The IOPI is one of the most widely used instruments which measures the strength of the tongue and lips in kPa; it also measures the endurance of the tongue and lips in Sec. The IOPI, JMS tongue pressure measurement device, lip & tongue pressure gauge, and a variety of dynamometers are commercialized and available in portable form. The TOMS aimed to objectively quantify tongue strength and endurance, the strain-gauged cantilever beam to measure maximal upper and lower lip closing forces, the multidirectional lip-closing force measurement system to quantify the directional specificity of the lip-closing forces, the lip & tongue pressure gauge to measure tongue and lip strength, the Forling portable instrument to measure tongue force, the lip force-meter LF100 to measure lip force, the CITEC digital dynamometer to measure tongue strength, a button and elastic band to measure lip strength, and the electronic dynamometer to measure maximum force of the tongue, lips, cheek, and bite. [Extracted from the article]

Polypharmacy and specific medication classes are prevalent in older adults. Their relationships with swallowing disorders are not well explored, which would best be managed holistically, with consideration of medication profiles. This study aimed to establish profiles of polypharmacy in older adults and investigate the associations of polypharmacy and medication class with signs of aspiration during swallowing. This was a secondary retrospective analysis of data from 291 adults aged 60 years and older. Polypharmacy was profiled numerically and described. Multivariate logistic regression was used to identify associations between medication classes with signs of aspiration, while controlling for independent variables of demographics, functional status, and medical history. Three distinct profiles of polypharmacy were described. Higher numbers of medications were associated with higher age, lower functional status, nursing home residency, multimorbidity, and showing signs of aspiration. Thirty-four classes of medications were found in this study, benzodiazepines were the only class independently associated with signs of aspiration. Different profiles of polypharmacy can be observed in older adults, but none were independently associated with signs of aspiration. In addition to known demographic and functional status variables, benzodiazepine-use was found to be independently associated with signs of aspiration (p =.005, B = 7.94). [ABSTRACT FROM AUTHOR]

A correction is presented to an article "Numerical visualisation of physical values during human swallowing using a three-dimensional swallowing simulator ‘Swallow Vision' based on the moving particle simulation method" which was published in the issue of the perodical.

Literature to date describing the lived experience of dysphagia has predominantly focussed on the clinical populations of stroke and head and neck cancer. The current study aimed to understand the experience of people with dysphagia of varying aetiologies living at home in the community. Using a qualitative descriptive approach grounded in phenomenology, individuals with dysphagia were interviewed (n = 15) about their experiences living with and managing dysphagia at home. Thematic analysis revealed an overarching theme of "Journey of discovery – learning to live with dysphagia," which described the process of managing dysphagia at home. This theme was characterised by three subthemes: (1) The story of dysphagia; (2) Engaging with support networks; and (3) Limited community awareness of dysphagia. This study highlights a range of psychosocial impacts individuals with dysphagia living at home may experience. Participants described how managing other health conditions alongside dysphagia influenced their perspectives about dysphagia. speech-language pathologists must consider individual client health priorities and provide support for not just the physical but also the psychosocial needs of clients. The reduced profile of dysphagia in our communities continues to be an ongoing barrier for clients with dysphagia and their families. [ABSTRACT FROM AUTHOR]

Conducting and interpreting videofluoroscopic swallow studies (VFSS) is a complex, multi-dimensional task, requiring post-qualification training to develop knowledge, skill and competence. Speech-language pathology (SLP) managers must continually ensure staffs are adequately trained to deliver safe and effective VFSS services. However, VFSS training is resource intensive, variable in content and not consistently accessed universally. This study examined managers' perceptions of a new VFSS eLearning programme and its impact on VFSS training and service delivery. The eLearning programme incorporated theoretical and procedural aspects of VFSS, accessed free of charge by speech-language pathologists working in a large public health service in Queensland, Australia. Twenty-two SLP managers participated in semi-structured interviews, which were evaluated using inductive content analysis. Four themes were identified relating to eLearning benefits: (1) design and content facilitated widespread uptake, (2) enhanced training opportunities, (3) increased clinical skill and workforce capacity and (4) benefits and efficiencies for SLP services. A fifth theme described contextual considerations for using the programme. This study contributes information about the benefits of eLearning for delivering consistent, accessible VFSS training, in a resource-efficient manner. Managers perceived the eLearning programme as a valuable resource to supplement practical VFSS training, to ultimately support VFSS service provision. [ABSTRACT FROM AUTHOR]

Patients suffering from dysphagia have trouble in swallowing conventional oral dosage forms and there is also risk of choking, which may cause patient noncompliance. This study aimed to develop an orodispersible film (ODF) containing cefixime trihydrate (CFX) to cope with the above-mentioned problems as well as to enhance water solubility and masking the bitter taste of the drug. The freeze-drying and kneading methods were used for the formation of inclusion complexes. The physicochemical evaluation revealed that T7 was the best film for the incorporation of pure drug and inclusion complexes. Films were further characterized for physical and mechanical properties. Drug content, dissolving time of the film and drug release tests were performed. In vivo taste and disintegration time studies were also conducted in healthy human volunteers. FTIR spectra of the individual ingredients and prepared formulations have confirmed the chemical compatibilities of the ingredients. The solubility of CFX was increased by complexation with β-CD and optimized freeze-dried inclusion complex (FD1) was selected for the formation of ODF. C4 was selected as an optimized film for the delivery of CFX as this film has released 95.52% drug at the end of 10 min. Dissolution kinetics of FD1 showed that it followed zero-order kinetics while drug release from films, exhibits first-order kinetics; however, both showed non-Fickian transport. In vivo taste evaluation revealed that taste was masked by inclusion complexation with β-CD. However, selected ingredients and employed methodology enabled to formulate film, capable of delivering taste-masked CFX with improved solubility and better patient compliance. [ABSTRACT FROM AUTHOR]

To investigate the construct validity of the Functional Oral Intake Scale (FOIS) as a proxy measure for dysphagia, through associations with swallowing prerequisites, orofacial functions, age, and diagnosis; and to investigate content validity through distributions of FOIS ratings. A cohort of 1,876 patients with severe acquired brain injury. Early Functional Abilities items were applied as measures of swallowing prerequisites and orofacial functions. Clustered logistic regression model with 6,052 cross-sectional observations. Disturbance in swallowing 10.55 OR (95%CI:7.90;14.09), oro-facial stimulation 3.04 OR (95%CI:2.41;3.83), and head control 2.86 OR (95%CI:2.25;3.62) were robustly associated with tube feeding (FOIS 1–3). Disturbance in trunk control, wakefulness, tongue movement/chewing, older age, and a non-stroke diagnosis were also associated with tube feeding. BMI did not attenuate associations in sensitivity analyses. FOIS ratings had greatest density in FOIS level 1 and level 7, with 25% and 40% of registrations, respectively. Level 4 was rated in only 1% of 6,052 registrations. The FOIS was robustly associated with indicators of dysphagia. However, associations with postural control, wakefulness, age and diagnosis highlights that tube feeding may be attributed to other issues than dysphagia. It should be further investigated whether FOIS level 4 is meaningful in neurorehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To inform service provision, this study explored feeding and swallowing difficulties in children within the context of South Africa's quadruple burden of disease (BOD) (i.e. conditions characterised as communicable, non-communicable, maternal and/or perinatal and trauma). Method: A retrospective chart review of 1432 paediatric inpatients (under 12 years of age) who met the inclusion criteria of presenting with dysphagia and being referred for speech-language pathology services was conducted. Result: Participants with diagnoses within the maternal and/or perinatal BOD category were noted most frequently (61.2%), followed by non-communicable (59.7%), communicable (43.4%) and trauma (4.2%). The majority of participants were under 1 year of age (82.2%) and 56.2% presented with comorbidities in multiple BOD categories. Mortality was 5.9%, with a higher rate (67.7%) in more complex cases. Mortality was associated with non-communicable BOD (p = 0.001), and maternal and/or perinatal BOD (p = 0.003). Pharyngeal phase swallowing difficulties were a significant risk for mortality (OR = 2.96; 95% CI: 1.01–8.65, p = 0.047). Conclusion: The majority of children with dysphagia presented with multiple comorbidities and were at high risk for mortality. Education and service delivery models should be designed to improve health outcomes and reduce mortality rates. [ABSTRACT FROM AUTHOR]

Choking occurs more frequently in children and senior citizens than in other groups. Obstruction materials are varied, including food or foreign bodies such as toys and coins. The number of choking accidents has not decreased because its mechanism remains unclear; the manner in which such accidents occur cannot be observed. The purpose of this study is to visualize choking on toys by using a computer simulation, Swallow Vision®, after creating a new child model of swallowing. An organ model for the simulation was created from the CT of a 9-month-old boy and videofluorographic images during swallowing for a 9-month-old girl. The organ models were defined as hyperelastic and contained particles that moved by forced displacement. The toy models were spheres with diameters of 10 and 15 mm and different coefficients of friction and restitution. The applied calculation method was the Hamiltonian Moving Particle Simulation. The results demonstrated that the simulation could visualize how a toy model obstructed the upper airway in the pharynx and larynx. Moreover, the ball size and the coefficients of friction and restitution affected the site obstructed. As choking accidents were successfully visualized using the Swallow Vision®, The computer simulation is expected to advance research on understanding the choking mechanism. [ABSTRACT FROM AUTHOR]

Purpose: There are no examples in the literature of successful long-term hospital-wide implementation of nurse-led dysphagia screening. This article aims to describe strategies used to implement hospital-wide dysphagia screening in a large acute tertiary teaching hospital in Australia. It reports on compliance, accuracy and nursing staff satisfaction using the validated Royal Brisbane and Women's Hospital Dysphagia Screening Tool (RBWH DST). Method: A retrospective observational study of audit data was conducted to examine hospital-wide compliance and accuracy of dysphagia screen completion. A nursing staff survey measured staff satisfaction. Implementation included: (1) utilisation of validated tool (RBWH DST); (2) key stakeholder engagement and strong governance; (3) policy development; (4) education; and (5) review and monitoring processes. Result: Audits conducted over a 9-year period (n = 3726) showed an average hospital-wide compliance rate of 74% and an accuracy rate of 82%. A nurse satisfaction survey (n = 109) showed high levels of satisfaction associated with using the RBWH DST. Conclusion: The RBWH DST was implemented in a large acute tertiary teaching hospital with acceptable compliance and accuracy rates and favourable nursing staff satisfaction. Further study is required to objectively evaluate patient health and cost benefits associated with using the RBWH DST. [ABSTRACT FROM AUTHOR]

During a fiberoptic endoscopic evaluation of swallowing (FEES) the study of the oesophagus, complete with tests with bolus (oesophageal FEES, E-FEES) is a procedure rarely used in a phoniatric setting, with patients complaining of swallowing and voice alterations. This extension of FEES toward the oesophagus by a transnasal approach is a procedure used for decades in the instrumental evaluation of patients with ENT complaints. E-FEES is used on out-patients without premedication or local anaesthesia. The patient is sitting upright and a 70 cm flexible endoscope, 3.5 cm diameter, is used. During the procedure the patients undergo tests with bolus. 20 patients (13M/7F, range 19–78 years, mean age 50, 51 years), taken from 437 consecutive outpatients seen in our Department from August to December 2011, underwent E-FEES (retrospective analysis). Patients were selected based on a reflux finding index (RFI) > 13, Reflux finding score (RFS) > 7 and FEES alterations (penetration/aspiration, spillage, residues). E-FEES findings were: 10 esophagitis, 1 gastroesophageal junction incontinence, 2 hiatal hernia, 4 motility alterations, 2 diverticula, 1 carcinoma. oesophageal alterations are not rare in patients with deglutition and voice disorders. E-FEES is a safe, reliable and cost-effective technique, worthy of being implemented in a phoniatric setting. The main steps and characteristic of the procedure are proposed. [ABSTRACT FROM AUTHOR]

Purpose: The New Zealand Secretion Scale (NZSS) has been developed for comprehensive assessment of accumulated secretions during endoscopy. The scale rates secretion severity under the subcategories location, amount and response. This study describes the scale's development and reliability when used by experts and untrained raters. Method: One expert scored 254 endoscopy videos using the NZSS and performed repeat measures on 100 randomly selected videos one month later. These 100 videos were scored by a second expert in a randomised order. In a second arm of the study, 28 raters scored 10 endoscopy videos, without training on the NZSS. Seventeen had experience in endoscopy (mean 1.8 years, SD = 1.0). Reliability was calculated across the entire cohort and as a function of experience interpreting endoscopy. Result: Strong internal consistency (Cronbach's α = 0.88), and high inter-item (>0.60) and corrected item-total correlations (>0.70) were established. Inter-rater (ICC = 0.99) and intra-rater reliability (ICC = 0.95) of the experts was excellent. Inter-rater reliability of the untrained raters ranged from ICC = 0.65–0.79, with no significant influence of experience on reliability. Conclusion: The NZSS is a reliable assessment of secretion severity during endoscopy and can be used without training. This comprehensive scale will support research evaluating the predictive value of accumulated secretions. [ABSTRACT FROM AUTHOR]

The aim of this study is to visualise changes in physical values of food bolus during swallowing to correlate the movement of human organs and bolus flow configuration using Swallow Vision®, a three-dimensional human swallowing simulator. Swallow Vision was developed using realistic human organ models, food bolus models, and the meshless three-dimensional moving particle simulation (MPS) method. The human organ model used to create Swallow Vision was reconstructed using computed tomography and video-fluorography images of a healthy volunteer. The extracted physical values, such as velocity, shear rate and viscosity were correlated with the movement of human organs and bolus flow configuration. The velocity and the shear rate were in good agreement with other researchers' results, and the simulation results are hence considered adequate. Swallow Vision will be helpful for understanding swallowing biomechanics, as well as for identifying appropriate foods for people with swallowing difficulties or dysphagia. [ABSTRACT FROM AUTHOR]

Purpose:Limited data exist that support the reproducibility of cervical auscultation (CA) use in children. This study aimed to determine the reliability of CA in detecting oropharyngeal aspiration (OPA) in children within a controlled environment. Method:This observational study included eight speech-language pathologists who rated clips of 40 normal and 40 OPA swallowing sounds on two separate occasions (i.e.160 sound clips rated by each speech-language pathologist) to comprise a total of 1280 swallow clips rated. Swallowing sound clips were collected from (1) a volunteer sample of 20 healthy children from the general community (mean 16.2 ± 10.7 months; 65% female); (2) a referred sample of 19 children with demonstrated OPA (mean 22.8 ± 25.5 months; 36.8% female), as determined on videofluoroscopic swallow studies (VFSS) using the Penetration-Aspiration Scale (PAS) (≥6 score). Result:Inter-rater reliability was very good (kappa =0.81, 95%CI 0.79–0.84). Intra-rater reliability for each rater was good to very good (kappa range 0.72–0.98). Overall sensitivity was 93.9% (95%CI 91.8–95.6) and specificity was 94.5% (95%CI 92.5–96.2). High reliability values were found for the detection of OPA versus normal swallows using CA alone. Conclusion:Future research should investigate the use of CA in a variety of clinical settings with less environmental control before CA can be advocated for use in routine clinical practice. [ABSTRACT FROM PUBLISHER]

Purpose:While the presence of dysphagia following partial glossectomy has been widely reported, there is insufficient quality evidence to guide clinical decision making about the treatment of this disorder. This study investigated a novel dysphagia rehabilitation approach using ultrasound tongue imaging for patient training. Method:Initially, a pilot study was conducted to investigate the feasibility of ultrasound visual feedback during swallow tasks. The protocol was then replicated using a single-case experimental designed study to investigate therapeutic effect. Swallow, speech, and oromotor functions were measured across multiple baselines using an A-B-A intervention study design. Results:During intervention, both participants were able to interpret ultrasound tongue images during swallow tasks. Following intervention, positive therapeutic effect was achieved with reduced frequency of aspiration and self-initiated swallow strategies. Generalization of intervention was evidenced by reduced bolus transit duration on videofluoroscopy and improved functional oral intake scores. Speech and oromotor functions remained stable throughout the study demonstrating experimental control. Conclusions:This study establishes that ultrasound visual feedback is feasible in dysphagia rehabilitation following partial glossectomy. In addition, the predicted therapeutic effect specifically to swallow but not speech or oromotor functions were demonstrated.Implications for RehabilitationPartial glossectomy results in altered tongue shape, movement, and function which negatively impact on speech and swallowingThere is limited research evidence to support previously used speech pathology interventions (in particular, tongue range of movement exercises) to rehabilitate dysphagia following tongue cancer surgeryThe tongue, and hence oral phase of swallowing, can be viewed by placing an ultrasound probe under the chinUltrasound scanning of the tongue is not invasive, can be repeated without dosage side effect. It’s also comfortable for the patient and if a portable probe and monitor are used, can be performed within a variety of clinical settings for assessment or therapyThis study shows specific therapeutic benefit following ultrasound visual feedback along with a motor learning approach to rehabilitate swallow function following partial glossectomyVisual and verbal feedback that focus specifically on the motor movements undergoing adaptation (e.g., tongue wave movement, tongue elevation, bolus clearance) following partial glossectomy are recommendedPatients who are able to see the ultrasound monitor, hear the feedback given, are cognitively able to self-evaluate tongue movement, and remember intervention goals will most benefit from ultrasound tongue visual feedback in therapyClinicians also benefit from visualizing the tongue with ultrasound during assessment and therapy as a direct view reduces the subjectivity of rating task performance [ABSTRACT FROM AUTHOR]

Purpose:Following repeated weaning failures in acute care services, spinal cord injury (SCI) patients who require prolonged mechanical ventilation and tracheostomy are discharged to their homes or skilled nursing facilities, with a portable mechanical ventilator (MV) and/or tracheostomy tube (TT) with excess risk of complications, high cost and low quality of life. We hypothesized that many difficult-to-wean patients with cervical SCI can be successfully managed in a rehabilitation clinic. The aim of our study was to develop a respiratory rehabilitation, MV weaning and TT decannulation protocol and to evaluate the effectiveness of this protocol in tetraplegic patients. Methods:A multidisciplinary and multifaceted protocol, including respiratory assessment and management themes, was developed and performed based on the findings from other studies in the literature. Tetraplegic patients with the diagnosis of difficult-to-wean, who were admitted to the rehabilitation clinic after having been discharged from the intensive care unit to their home with home-type MV and/or TT, were included in this prospective observational study. Results:The respiratory rehabilitation protocol was applied to 35 tetraplegic patients (10 home-type MV and tracheostomy-dependent, and 25 tracheostomized patients) with C1-C7 ASIA impairment scale grade A, B, and C injuries. Seven out of 10 patients successfully weaned from MV and 30 of 35 patients were decannulated. Four patients were referred for diaphragm pace stimulation and tracheal stenosis surgery. The mean durations of MV weaning and decannulation were 37 and 31 days, respectively. Conclusions:A multifaceted, multidisciplinary respiratory management program can change the process of care used for difficult-to-wean patients with SCI. Implications for rehabilitationFindings from this study indicate the significance of a multidimensional evaluation of any reversible factors for prolonged MV- and/or TT-dependent SCI patients. Thus, rehabilitation specialists should take this into consideration and should provide the appropriate amount of time to these patients.The proposed protocol of respiratory rehabilitation for MV- and/or TT-dependent SCI patients shows promising results in terms of changing the care used for these patients.Successful implementation of a respiratory rehabilitation and weaning protocol is dependent on careful planning and detailed communication between the rehabilitation specialist and intensivist during the respiratory rehabilitation process.Because many of the so-called difficult- or impossible-to-wean patients were successfully weaned from MV and TT in the PMR clinic, the need for such an outlet for countries without specialized centers is supported. [ABSTRACT FROM PUBLISHER]

Sensory properties of food drive our food choices and it is generally accepted that lipids greatly contribute to the sensory properties of many foods and consequently to eating pleasure. Many studies have investigated the mechanisms of the fat perception. Unfortunately they used a variety of methods and products, thereby making generalization very difficult. The mechanism of fat perception in oral cavity is combined of several processes. Lipid composition and its properties strongly influence food structure. During consumption food is exposed to a range of in-mouth processing steps. Oral sensation of fat texture changes with time, from a first bite to chewing, while mixing with saliva, up to swallowing and even after swallowing. The present work reviews many aspects of fat texture perception from physical chemistry to physiology. Understanding the underlying mechanisms of in-mouth lipid processing would provide new concepts to produce low-fat food products with full-fat perception. [ABSTRACT FROM AUTHOR]

Conclusion:The sensitive sonotubometry and MATLAB provide a new tool to study the eustachian tube (ET) function and contribute more to reliable data and precise analysis. The levator veli palatini muscle (mLVP) and the salpingopharyngeus muscle (mSP) may, respectively, be the most important and least important muscle for ET function. Objectives:The ET lumen dilation is a result of the contraction of the paratubal muscles, the tensor veli palatini muscle (mTVP), mLVP and mSP. To trace the dynamic ET muscle/lumen activities, the present study aimed to optimize sonotubometry and achieve cross-platform data integration of electromyography (EMG) and sonotubometry using MATLAB (matrix laboratory). Method:Seventeen healthy volunteers (34 ears) were chosen for the concurrent recordings of the paratubal EMG and sonotubogram under dry and water swallowing. Results:The optimized sonotubometry based on computer sound card showed satisfied sensitivity. For both EMGs and sonotubogram, dry swallowing generated significantly greater amplitude and longer duration compared to water swallowing. Moreover, statistically significant differences (p < 0.05) were detected in the comparison of the amplitude, duration, and latency for the mTVP, mLVP, and mSP. The mSP activity was the weakest and even inactive in some cases, the mLVP presented the most powerful and long lasting activity during ET-opening. [ABSTRACT FROM PUBLISHER]

The Montgomery T-tube is used as a combined tracheal stent and airway after laryngotracheoplasty, to keep the lumen open and prevent mucosal laceration from scarring. It is valuable in the management of upper and mid-tracheal lesions, while invaluable in long and multisegmental stenting lesions. Numerical simulations based on real-patient-tracheal geometry, experimental tissue characterization, and previous numerical estimation of the physiological swallowing force are performed to estimate the consequences of Montgomery T-tube implantation on swallowing and assisted ventilation: structural analysis of swallowing is performed to evaluate patient swallowing capacity, and computational fluid dynamics simulation is carried out to analyze related mechanical ventilation. With an inserted Montgomery T-tube, vertical displacement (Z-axis) reaches 8.01 mm, whereas in theY-axis, it reaches 6.63 mm. The maximal principal stress obtained during swallowing was 1.6 MPa surrounding the hole and in the upper contact with the tracheal wall. Fluid flow simulation of the mechanical ventilation revealed positive pressure for both inhalation and exhalation, being higher for inspiration. The muscular deflections, considerable during normal breathing, are nonphysiological, and this aspect results in a constant overload of the tracheal muscle. During swallowing, the trachea ascends producing a nonhomogeneous elongation. This movement can be compromised when prosthesis is inserted, which explains the high incidence of glottis close inefficiency. Fluid simulations showed that nonphysiological pressure is established inside the trachea due to mechanical ventilation. This may lead to an overload of the tracheal muscle, explaining several related problems as muscle thinning or decrease in contractile function. [ABSTRACT FROM AUTHOR]

Purpose: This review critiques the benefit of commonly used rehabilitative exercises for dysphagia. Method: Common goals of rehabilitation for dysphagia and principles of neuroplasticity are introduced as they apply to swallowing and non-swallowing exercises. A critique of published studies is offered regarding their evidence for showing benefit from the exercise. Result: One of five swallow exercises had preliminary evidence for long-term benefit and two of four non-swallow exercises have strong evidence for long-term benefit. Conclusion: Only a minority of exercises prescribed for patients with dysphagia have sufficient evidence for long-term improvement in swallowing. [ABSTRACT FROM AUTHOR]

Research indicates that patients with Chronic Obstructive Pulmonary Disease (COPD) have increased aspiration risk. Several factors may pre-dispose a patient to aspiration including a reduction in laryngopharyngeal sensitivity (LPS). Reduced LPS has been associated with increased aspiration risk in pathologies including stroke; however, this has not been examined in COPD. This study aims to explore possible associations between LPS and swallowing function in COPD patients, and determine whether a LPS predictive value may be used as a method of evaluating dysphagia risk in this patient population. Twenty participants with COPD underwent LPS discrimination testing, respiratory function testing, self-reporting swallowing questionnaire, clinical swallowing examination, and fibre-optic endoscopic evaluation of swallowing (FEES). Participants with COPD demonstrated impaired LPS defined by elevated laryngeal adductor reflex thresholds and high incidence of pharyngeal residue on FEES. Positive correlations were identified between their clinical swallowing examination and FEES results for the presence of laryngeal penetration/aspiration ( p < 0.04), vallecular residue ( p < 0.01), and piriform residue ( p < 0.01). In conclusion, COPD patients have reduced laryngopharyngeal mechanosensitivity and impaired swallowing function characterized primarily by pharyngeal stasis. The combination of these deficits may place patients with COPD at increased aspiration risk due to lack of detection of pharyngeal residue and subsequent inhalation of pharyngeal contents. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate swallowing function using a videofluoroscopic swallow study (VFSS), and to identify factors related to long-term swallowing function in children with swallowing dysfunction. Methods: Ninety children, aged 1-120 months (mean 27.5 months) were randomly selected from among children referred for the evaluation of swallowing dysfunction. We retrospectively reviewed the charts, and long-term outcomes were tracked up to 5 years. Results: Baseline American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale was 3.4 ± 2.5. Supraglottic penetration and subglottic aspiration comfirmed by VFSS were detected in 30 children. After follow-up, oral feeding was possible in 74 patients, and the ASHA NOMS swallowing scale improved significantly, from 3.4 ± 2.5 to 5.8 ± 2.0. Baseline VFSS severity, serum albumin concentration, baseline weight percentile and neurologic conditions were significantly correlated with long-term swallowing function. Conclusions: The long-term outcomes in children with swallowing dysfunction were favorable, and baseline videofluoroscopic severity was significantly correlated with long-term swallowing function. [ABSTRACT FROM AUTHOR]

This prospective, single-blinded study investigated the validity and reliability of cervical auscultation (CA) under two conditions; (1) CA-only, using isolated swallow-sound clips, and (2) CSE + CA, using extra clinical swallow examination (CSE) information such as patient case history, oromotor assessment, and the same swallow-sound clips as condition one. The two CA conditions were compared against a fibre-optic endoscopic evaluation of swallowing (FEES) reference test. Each CA condition consisted of 18 swallows samples compiled from 12 adult patients consecutively referred to the FEES clinic. Patients' swallow sounds were simultaneously recorded during FEES via a Littmann E3200 electronic stethoscope. These 18 swallow samples were sent to 13 experienced dysphagia clinicians recruited from the UK and Australia who were blinded to the FEES results. Samples were rated in terms of (1) if dysphagic, (2) if the patient was safe on consistency trialled, and (3) dysphagia severity. Sensitivity measures ranged from 83-95%, specificity measures from 50-92% across the conditions. Intra-rater agreement ranged from 69-97% total agreement. Inter-rater reliability for dysphagia severity showed substantial agreement (rs = 0.68 and 0.74). Results show good rater reliability for CA-trained speech-language pathologists. Sensitivity and specificity for both CA conditions in this study are comparable to and often better than other well-established CSE components. [ABSTRACT FROM AUTHOR]