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Dysphagia : an international multidisciplinary journal devoted to swallowing and its disorders (2022). doi:10.1007/s00455-022-10517-2, Published by Springer, New York, NY

Zusammenfassung Hintergrund Die fiberendoskopische Schluckuntersuchung („fiberoptic endoscopic evaluation of swallowing“, FEES) gilt als ein unverzichtbares instrumentelles Verfahren im Management schluckgestörter Patienten. Das eingeführte Ausbildungscurriculum hat das Ziel, die Qualitätsstandards zu erhöhen und zu einer Aufwertung des Verfahrens beizutragen. Fragestellung Die Studie untersucht, inwieweit eine standardisierte Durchführung, Auswertung und Dokumentation der FEES in Deutschland nach Einführung des Curriculums stattfindet. Material und Methoden Insgesamt 603 neurologische und geriatrische Kliniken in Deutschland wurden mithilfe eines Onlinefragebogens bezüglich struktureller Merkmale und deren Ablauf der Untersuchung befragt. Ergebnisse Insgesamt 190 Institutionen führten die Befragung vollständig durch. 43,31 % der Institutionen haben erst seit der Publikation des Curriculums die FEES implementiert. Die praktische Anwendung findet vermehrt durch Mediziner statt (59 %), das Schreiben des Befundes und die Kostempfehlung durch Logopäden (62 % und 83 %). Mit erhöhtem Ausbildungsgrad steigt die praktische Anwendung durch Logopäden. Die Durchführung weist trotz der Orientierung am Standardprotokoll nach Langmore besonders in Bezug auf die Durchführung der anatomisch-physiologischen Untersuchung, die verabreichten Konsistenzen und Nahrungsmittel und das Scoring schluckrelevanter Parameter Unterschiedlichkeiten auf. Diskussion Die Einführung des Curriculums hat zur Aufwertung der FEES und zu einer Stärkung der Logopädie als durchführende Berufsgruppe geführt. Zum jetzigen Stand liegt ein in wesentlichen Aspekten homogener Ablauf der Untersuchung vor, der jedoch Bedarf nach weiterer Vereinheitlichung zeigt. Das FEES-Curriculum könnte als Steuerungsinstrument zur weiteren Standardisierung verwendet werden.

Background In Germany at least 8000 people suffer from clinically manifest HD, ultimately resulting in patients dependent on care. There are no defined pathways for multidisciplinary HD care in Germany. While slowing down the progression of HD may be available in the future, optimized care is needed now. Aims Jointly defined activities aim to provide a comprehensive multidisciplinary treatment concept covering all HD patients’ stations. Therefore, different stakeholders collaborate: patients, families, patient organization, various medical and therapeutic specialties as well as researchers. Methods In 2020 interdisciplinary advisory boards were initiated by Deutsche Huntington-Hilfe and Roche Pharma AG to identify the most urgent topics needing attention in HD. The following areas were identified and working groups with additional people in specific roles implemented: 1. Disease Awareness & Stigmatization, 2. Networking, 3. Multidisciplinary therapy, 4. Trainings, 5. Capacity for Intrathecal Injections, 6. Publication of a statement paper and 7. Development of a HD educational book for professionals. It is special and unique that all working group members are co-creating voluntarily because they all have the common purpose to improve HD families’ conditions. Outcome First results were the drafting of the ‘statement paper’, in which further recommendations for the multidisciplinary care approach in HD are defined, various disease awareness activities and publication of HD educational book for professionals. Conclusions The collaborative working groups completed first projects and further promising steps are on the way to improve the situation of HD families in Germany. Acknowledgment We thank Roche Pharma AG for their continued support of the described activities.

European journal of neurology 28(9), 2855-2862 (2021). doi:10.1111/ene.14953, Published by Wiley-Blackwell, Oxford [u.a.]

Dysphagia is a common complication following anterior cervical spine surgery and may occur in over 70% of patients. There is an emerging evidence that dysphagia also appears after posterior cervical spine surgery. Nevertheless, hardly any study is focusing on changes in swallowing physiology with regard to surgical approach. Aim of this study: To investigate changes in swallowing physiology following: 1. anterior cervical spine surgery, and 2. posterior cervical spine surgery. Methods: A standardized videofluoroscopic swallowing study (VFSS) was performed in 28 patients who underwent cervical spine surgery (anterior approach n = 19, Mage 56±14; posterior approach n = 9, Mage 58±17) one day before surgery and after surgery (mean 4 days). Data were analyzed retrospectively with the Modified Barium Swallow Impairment Profile (MBSImPTM©). Results: 1. In the anterior group, pharyngeal sum score was significantly higher after surgery (p < .001). Significant changes were found in 4 out of 8 analyzed pharyngeal components. 2. In the posterior group, pharyngeal sum score was significantly higher after surgery (p = .015). No significant changes were found in the oral or pharyngeal components. Conclusions: Whereas more changes in swallowing physiology occurred following anterior surgery, there were also overall changes in the posterior group. Understanding the swallowing pathophysiology associated with cervical spine surgery is indispensable to decrease the rate of secondary complications and improve quality of life for this patients.

Background At present, the flexible endoscopic evaluation of swallowing (FEES) is one of the most commonly used methods for the objective assessment of swallowing. This multicenter trial prospectively collected data on the safety of FEES and also assessed the impact of this procedure on clinical dysphagia management. Methods Patients were recruited in 23 hospitals in Germany and Switzerland from September 2014 to May 2017. Patient characteristics, professional affiliation of the FEES examiners (physicians or speech and language therapists), side-effects and cardiorespiratory parameters, severity of dysphagia and clinical consequences of FEES were documented. Results 2401 patients, mean age 69.8 (14.6) years, 42.3% women, were included in the FEES-registry. The most common main diagnosis was stroke (61%), followed by Parkinson’s disease (6.5%). FEES was well tolerated by patients. Complications were reported in 2% of examinations, were all self-limited and resolved without sequelae and showed no correlation to the endoscopist’s previous experience. In more than 50% of investigations FEES led to changes of feeding strategies, in the majority of cases an upgrade of oral diet was possible. Discussion This study confirmed that FEES, even when performed by less experienced clinicians is a safe and well tolerated procedure and significantly impacts on the patients’ clinical course. Implementation of a FEES-service in different clinical settings may improve dysphagia care. Trial registration ClinicalTrials.gov NCT03037762, registered January 31st 2017.

Auch wenn Dysphagien haufig vorkommen, werden sie oft nicht erkannt — mit zum Teil lebensbedrohlichen Folgen. Der Pflege kommt eine wichtige Rolle bei der Fruherkennung zu. Doch trotz Therapiebedarf sind viele Patienten mit chronischer Dysphagie logopadisch unterversorgt. Obwohl die Informationsweitergabe zwischen stationaren und ambulanten Behandlern meist luckenhaft ist, gibt es bereits einige gute Konzepte zur Verbesserung der Transparenz. Wunschenswert ist der Ausbau weiterer interdisziplinarer Dysphagie-Zentren in Deutschland.

Schon normale physiologische Alterungsprozesse beeinflussen die verschiedenen Phasen des Schluckens. Krankheitsbedingte Storungen verscharfen das Problem. Die wichtigste Regel fur den pflegerischen Umgang mit alten Menschen, die an Dysphagie leiden, ist ein hohes Mas an Aufmerksamkeit.

Background Dysphagia is a common problem in HD, frequently leading to aspiration pneumonia and consecutive mortality. Objective estimates of prevalence using instrumental diagnostics and data on neuronal correlates of dysphagia in HD are scarce. Similarly, its correlation with other clinical markers is unknown. Thus, we aimed at defining clinical risk factors and neural correlated for HD-associated dysphagia more precisely. Methods/techniques 21 subjects (12 w, 9 m, Shoulson-Fahn stadium I-IV) underwent a full clinical-neurological exam including the UHDRS motor score and cognitive data from neuropsychological tests. A clinical swallowing examination was performed by a trained SLT, as well as videoendoscopic swallow examination (FEES). Patients additionally underwent an MRI scan (T1, 3 Tesla MRI Siemens Prisma). We then correlated validated scores of dysphagia with motor and cognitive scores as well as measures of atrophy from MRI. Results/outcome Mean UHDRS motor score was 33.6 (SD 15.3), mean UHDRS cognition score 158.6 (SD 64.3). In 20 patients, FEES showed penetration or aspiration in 80%. No significant correlations were found between dysphagia severity and any of the clinical markers (motor score, cognition, functional assessment, age, CAG). Voxel based morphometry confirmed atrophy patterns in known swallowing-network areas rather than motor function, e.g. striatum, when comparing patients with no/mild vs. moderate/severe dysphagia. Conclusions Our results so far suggest that dysphagia is not predicted sufficiently well by clinical markers, as aspiration can occur even in early stage of HD, thus necessitating early instrumental assessments in the course of the disease. Arguably, dysphagia should not be referred to as a ‘prevalent motor symptom’, but rather as a distinct entity.

Suicide is a leading cause of death in Huntington’s disease (HD), following pneumonia. Up to one-fifth of individuals with HD report suicidal ideation. Identifying the risk factors of suicidal ideation in this clinical population is thus pivotal. Here, we review the literature on prevalence rates and risk factors of suicidal ideation in premanifest and manifest patients and re-evaluate them using the largest currently existing clinical dataset from the ongoing observational study “Enroll-HD” (N = 5709). Large scale studies yielded important insights regarding suicidal ideation in HD. However, estimated prevalence rates vary among studies and risk factors are still poorly understood. According to the Enroll-HD data, pre- and manifest disease stages are associated with current (5.8–10%) and a history of suicidal ideation (18.6–30.9%). Throughout the course of HD, a history of suicidal ideation and the presence of depressive symptoms were strongly associated with current suicidal ideation. However, while for premanifest individuals, socio-demographics and activities of daily living appear to be important, in manifest patients, suicidal ideation is more closely linked to anxiety, irritability, psychosis, and apathy. These results highlight the importance of treating depressive symptoms in patients with HD and addressing potential suicidal ideation during clinical monitoring. The relevance of risk factors may differ among premanifest and manifest patients.

When interacting with a robot, the level of mental workload, comfort and trust during the interaction are decisive factors for an effective interaction. Hence, current research focuses on the concept, whether ascribing gantry robot in assembly with anthropomorphic movements can lead to a better anticipation of its behavior by the human operator. Therefore, in an empirical study the effect of different degrees of anthropomorphism should be compared. This is based on the scientific research concerning the neural activity of the human brain when watching someone performing an action. Within the study videos of a virtual gantry robot and a digital human model during placing movements were designed to use in the functional magnetic resonance imaging (fMRI). The aim is to investigate the underlying brain mechanism during observing the movements of the two models.

Patients with Parkinson’s disease (PD) have progressive and pervasive disorders of airway protection. Recent work has highlighted the relationship between reflex and voluntary cough and swallowing safety. The goal of this study was to test the sensitivity and specificity of several airway protective and disease-specific factors for predicting swallowing safety outcomes in PD. Sixty-four participants (44 males) completed measures of voluntary and reflex cough, and swallowing safety. Clinical predictors included disease severity and duration, and cough airflow and sensitivity measures. ROC and Chi-square analyses identified predictors of swallowing safety (penetration–aspiration score) in PD. Disease duration significantly discriminated between patients with normal and abnormal swallowing safety (p = 0.027, sensitivity: 71 %, specificity: 55.4 %). Cough reflex sensitivity significantly discriminated between patients who penetrated above the level of the vocal folds and those with more severe penetration/aspiration (p = 0.021, sensitivity: 71.0 %, specificity 57.6 %). Urge-to-cough sensitivity (log–log linear slope) was the only variable which significantly discriminated between patients with penetration versus aspiration (p = 0.017, sensitivity: 85.7 %, specificity 73.2 %). It is important to identify the factors which influence airway protective outcomes in PD especially given that aspiration pneumonia is a leading cause of death. Results from this study highlight the ecological validity of reflex cough in the study of airway protection and this study further identifies important factors to consider in the screening of airway protective deficits in PD.

Background Dysphagia is a common problem in HD. 1,2,3 Swallowing function becomes increasingly impaired, increasing the risk of aspiration and pneumonia, the most common cause of mortality. 3 An evidence-based rationale for the development and evaluation of timely and complex SLT interventions is required to confirm that swallow training is beneficial in HD and at what disease stages interventions are most likely to be beneficial. This also helps to choose reliable and feasible outcome-measures, including instrumental assessments visualising the structure and function of different stages of swallow. Aims collect longitudinal data to assess the features of the dysphagia in HD identify possible risk factors for severity of the dysphagia and aspiration evaluate a range of dysphagia related outcome measures Methods We investigated 61 patients retrospectively and 25 patients prospectively to describe features of the swallowing disorder (such as residues, leaking, penetration/aspiration) dependent on consistencies and their correlation with the motor stage of HD. For clinical swallowing examination we used the NOD-Stepwise Concept. 4 Instrumental assessment to visualise the structure and functions of the different stages of swallowing and to identify the risk of aspiration was Fiberoptic Endoscopic Evaluation of Swallowing (FEES). The examination was complemented by the Swallowing Quality of life survey (SWAL-QOL). 5 Results Subclinical Dysphagia was found in HD patients at all stages of the disease. Clinical predictors like dysarthria and dysphonia for the risk of aspiration as well as effective compensatory strategies were identified. References Heemskerk AW, Roos RAC, ASHA Perspectives on Swallowing and Swallowing disorders, Review 2012; 21 (4):126–134 Hamilton, et al. Oral feeding in Huntington’s Disease: a guideline document for speech and language therapists. Neurodegen. Dis Manage 2012; 2 (1):45–53 Heemskerk AW, Roos RAC. Aspiration Pneumonia and death in Huntington’s Disease. PLoS currents HD 2012 Ickenstein GW, Hofmayer A, Lindner-Pfleghar B, Pluschinski B, Riecker A, Schelling A, Prosiegel M. Standardisierung des Schluckablaufs bei neurogener oropharyngealer Dysphagie. Neurologie und Rehabilitation (2009) McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, Bricker DE. The SWAL-QOL and SWAL-CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia 2002; 17 (2):97–114