Admission systemic inflammation predicts swallowing decline in older adults with pulmonary tuberculosis.

Introduction: The aim of this study was to determine the associations of time spent away from bed with whole-body muscle mass and swallowing function in older adults with low activities of daily living (ADL). Methods: This cross-sectional study was conducted at Tokyo Medical and Dental University and included adults over 65 years of age who underwent a medical intervention at their residence. Data regarding age, sex, body height and weight, activity status, medical history, time spent away from bed, and Functional Oral Intake Scale (FOIS) were collected. We calculated the body mass index, Charlson Comorbidity Index, whole-body muscle mass, the appendicular skeletal muscle mass index (ASMI), and the trunk muscle mass index (TMI). According to the time spent away from bed, the subjects were grouped as follows: <4 but ≥0 h (S), <6 but ≥4 h (M), and ≥6 h (L). These variables were analyzed using the one-way analysis of variance, the Kruskal-Wallis test, and the χ2 test, then differences among the three groups were examined. To adjust for confounding factors, we performed multiple regression analysis with ASMI and TMI as the dependent variables and ordinal logistic regression analysis with FOIS as the objective variable. Results: Ninety subjects (male: n = 42; female: n = 48; mean age = 82.9 ± 8.8 years, and groups S: n = 23; M: n = 30; L: n = 37) were analyzed. Group L had a significantly higher ASMI, TMI, and FOIS score than groups S and M, while group M had a significantly higher ASMI and FOIS score than group S. After adjusting for confounding factors, the significant explanatory factors for ASMI were sex, activity status, time spent away from bed, and TMI. The factors for TMI were activity status, time spent away from bed, ASMI, and FOIS. The factors for FOIS were time spent away from bed and TMI. Conclusion: Spending 4 or more hours away from the bed is related to appendicular skeletal muscle mass and FOIS, while spending 6 or more hours is related to appendicular skeletal muscle mass, trunk muscle mass, and FOIS in this population. These findings highlight factors that can prevent a decline in swallowing function in the daily life of older adults with low ADL who have difficulty performing exercises to preserve swallowing function.

Dysphagia and malnutrition combinations in hospitalized patients with acute heart failure (AHF) may affect activities of daily living (ADL) after hospital discharge more than dysphagia or malnutrition alone. The aim of the present study to clarify the impact of the combination of dysphagia and malnutrition on ADL in hospitalized patients with acute phase heart failure who have undergone cardiac rehabilitation (CR). Prospective cohort study. Acute care hospital. Participants were 224 AHF patients undergoing CR. Barthel index (BI), functional oral intake scale (FOIS), controlling nutritional status (CONUT), short physical performance battery (SPPB), and mini-mental state examination were evaluated at baseline. We examined primary effects of predictors (CONUT) and the moderator (FOIS) and the interaction effect of FOIS and CONUT (FOIS × CONUT) using hierarchical linear regressionmodel and simple-slope tests. The ADL independence dropped in 29.5% of the patients on hospitalization; however, 82.6% of the patients successfully regained their independence at discharge. Based on the FOIS score and nutritional status on admission, 58.5% of the patients were classified into the non-dysphagia and non-malnutrition categories, 21.0% into non-dysphagia and malnutrition, 15.2% into dysphagia and non-malnutrition, and 5.3% into dysphagia and malnutrition. Lower FOIS and SPPB scores as well as the FOIS × CONUT interaction predicted a significantly lower BI but not CONUT. Simple slope test revealed a negative association between CONUT and BI with low-level FOIS (B = - 2.917, P < .001) but not with high-level FOIS (B = .476, P = .512). Thus, patients with dysphagia and malnutrition in combination had a greater risk of failed recovery of ADL after cardiac rehabilitation than those without this combination. In hospitalized AHF patients, FOIS and CONUT had an interactive effect on BI at hospital discharge in cases with low-level FOIS. Early detection of dysphagia might improve the accurate identification of hospitalized AHF patients at higher risk of ADL dependence at discharge.

Patients with advanced oral or oropharyngeal cancer sometimes require surgery and adjuvant postoperative radiotherapy (PORT), which may cause dysphagia. However, the efficacy of rehabilitation treatment for PORT-induced dysphagia remains unclear. This study aimed to determine whether rehabilitation treatment during PORT after surgery is effective for dysphagia. We retrospectively studied 55 patients with oral or oropharyngeal cancer who received PORT. Of these, 25 received rehabilitation treatment for swallowing during PORT. The Functional Oral Intake Scale (FOIS) score at 6 months after treatment was used as the swallowing outcome. We performed multivariate linear regression and stratified analyses using the FOIS score (poor oral intake group: FOIS score <5, good oral intake group: FOIS score ≧5) before PORT. The median (interquartile range) FOIS scores at 6 months post-PORT were 6 (5-6) and 6 (4-7) in the non-rehabilitation and rehabilitation groups, respectively. Multivariate linear regression revealed that rehabilitation treatment was a significant independent factor for a better FOIS score. Stratified analysis of the changes in the FOIS score from pre-PORT values to those obtained 6 months after treatment showed a significant difference in the good oral intake group between the rehabilitation and non-rehabilitation groups. There was no significant difference in the FOIS score from pre-PORT values to those obtained 6 months after treatment between the rehabilitation and non-rehabilitation groups in the poor oral intake group. Rehabilitation treatment during PORT may achieve better swallowing outcomes in patients with advanced oral or oropharyngeal cancer.

Osteosarcopenia is a combination of sarcopenia and osteoporosis that increases mortality rates among older people compared with either alone. This study aimed to identify the contribution of osteosarcopenia to the development and severity of dysphagia. We retrospectively reviewed the medical charts of 211 patients aged ≥ 65 years who were referred to the dysphagia rehabilitation team. Based on Functional Oral Intake Scale (FOIS) scores, we classified the patients with (FOIS scores 1-5) and without (FOIS scores 6, 7) dysphagia as Type A and those with (FOIS scores 1, 2) and without (FOIS score 3-7) enteral feeding as Type B. Based on chest computed tomography (CT) findings we then defined patients with T4 (MI) and pectoralis (PMI) muscle indexes, L1 attenuation, and T4MI, PMI, and L1 attenuation below the cutoff values as having sarcopenia, osteoporosis, and osteosarcopenia, respectively. The FOIS scores were significantly lower among patients with osteosarcopenia than among those without sarcopenia or osteoporosis. Moreover, PMI and FOIS scores significantly and positively correlated, and PMI was significantly lower in the group with, than without, enteral feeding. Osteoporosis and osteosarcopenia were significant in the patients who were fed enterally (p = 0.032 and 0.047, respectively). Patients with sarcopenia and osteoporosis undergoing swallowing rehabilitation tended to have severe dysphagia that required much medical attention.

Physical performance improvement through whole-body exercise may have a positive impact on dysphagia via improvement of maximum tongue pressure (MTP). The present study aimed to quantitatively analyze whether improvement in physical performance reduces dysphagia by improving MTP in patients with acute heart failure (AHF). A total of 146 patients with AHF and dysphagia were included. Dysphagia was defined as a functional oral intake scale (FOIS) score < 6. The short physical performance battery (SPPB) indexed physical performance. A two-wave cross-lagged mediation model was used to examine whether an improvement in SPPB results improves the FOIS score via an improvement in MTP. The SPPB, MTP, and FOIS scores (T1: baseline, T2: hospital discharge) were included in the model. A total of 146 patients were included in the final analysis. The SPPB result at T1 positively affected MTP (β = 0.150, P = 0.030) and the FOIS score (β = 0.249, P = 0.002) at T2. MTP at T1 also positively affected the FOIS score at T2 (β = 0.189, P = 0.026). Furthermore, the SPPB result indirectly affected the FOIS score by affecting the MTP (indirect effect = 0.028; 95% CI = 0.010, 0.078). This study contributes to the knowledge base regarding the potential of exercise therapy as a new treatment strategy for dysphagia in patients with AHF. An improvement in SPPB results improved the FOIS score by improving the MTP in patients with AHF.

BackgroundCaregiver burden, or the impact of caregiving, commonly occurs in caregivers of persons with dementia (PWD); however, prior research focused on caregiver burden in this population has not considered the impact of dysphagia. Therefore, the purpose of this study was to measure dysphagia‐specific burden in caregivers of PWD and examine its relationship to general caregiver burden, as well as the PWD’s current diet level and dementia severity.MethodData were collected from PWD‐caregiver dyads participating in a prospective, dysphagia‐focused clinical trial at the initial study visit. The Clinical Dementia Rating (CDR) scale was administered to dyads to determine dementia severity. The Zarit Burden Interview (Zarit) and Caregiver Analysis of Reported Experiences with Swallowing Disorders (CARES) were administered to caregivers. Functional Oral Intake Scale (FOIS) scores were recorded for the PWD.ResultTwenty‐nine dyads were included. Caregivers were 93% female with a mean age of 65 years. PWD were 21% female with a mean age of 80 years. The mean CARES score was 2.86 (range = 0‐26; SD = 3.43) and the mean Zarit score was 28.1 (range = 5‐65; SD = 16.64). The median FOIS score for PWD was 7 (range = 5‐7). The highest CARES values were reported for the following experiences: being worried about the future, fear of their care recipient choking, and feeling “anxious.” A one‐way analysis of variance revealed no differences in CARES scores based on CDR stage. A Kendall tau rank correlation coefficient revealed a significant moderate, negative association between FOIS and CARES scores (r = ‐0.52; p&lt;.002); while the moderate, positive association Pearson correlation between CARES and Zarit scores (r = .40; p = .03) was also significant.ConclusionFindings revealed that dysphagia‐associated caregiver burden may trend similarly as general burden (Zarit) but is generally low in earlier stages of dementia. However, the more restrictive the PWD’s diet (lower FOIS scores), the greater the dysphagia‐related burden reported by caregivers. Higher ratings on specific CARES items can guide clinical decision‐making regarding support needed by caregivers of PWD with early‐stage disease. The relationship between dysphagia‐related burden and general burden may change with disease progression, warranting continued investigation.

Evidence surrounding swallowing impairment in sporadic inclusion body myositis (IBM) is based on nonstandardized and nonvalidated assessment methods. We investigated (a) IBM's impact on swallowing function and oral intake status using well-tested assessment frameworks; (b) changes in swallowing over time; and (c) age, sex, and swallowing impairment severity's influence on oral intake status. We conducted a secondary analysis of Modified Barium Swallow Impairment Profile (MBSImP) and Functional Oral Intake Scale (FOIS) data from 13 patients with IBM (seven females; Mage = 60.2 [±13.6] years) and 13 age- and sex-matched healthy controls. We compared MBSImP Overall Impression (OI), Oral Total (OT), Pharyngeal Total (PT), and FOIS scores between groups. Specific to the IBM cohort, we analyzed repeated OT and PT scores and calculated whether age, sex, and OT and PT scores predicted FOIS scores. The IBM cohort demonstrated poorer OI scores across six swallowing components than healthy controls (each p < .05). Unlike OT scores (p = .84), PT (p = .033) and FOIS (p < .001) scores were worse in the IBM cohort. Repeated OI scores revealed changes in three swallowing components (each p < .05), but repeated OT (p = .16) and PT (p = .30) scores did not significantly change. Age, sex, and OT and PT scores did not influence FOIS scores (each p > .05). Pharyngeal impairments were most prominent in the IBM cohort, and their oral intake status was adversely affected. Our preliminary data showcase the application of robust assessment methods to investigate swallowing function in IBM, enhancing standardization and comparability across studies. https://doi.org/10.23641/asha.27165450.

Dysphagia in patients with heart failure leads to poorer outcomes during hospitalization and after discharge. Therefore, addressing dysphagia is critical for improving patient prognosis. This retrospective observational study aimed to evaluate associations between improvements in swallowing dysfunction at the time of hospital discharge and the physical function, cognitive function, nutritional status, and maximum tongue pressure (MTP). Overall, 111 patients who underwent cardiac rehabilitation and were deemed to have oral intake impairment were included. The exclusion criteria comprised the following: pre-admission diagnosis of dysphagia, in-hospital death, and missing data. Patients were categorized based on whether they did (n = 65) or did not (n = 46) exhibit improvements in oral intake impairment, which were determined from the functional oral intake scale (FOIS) score at discharge. Associations between potential explanatory variables and the FOIS score at discharge were assessed using a linear regression model. After adjusting for covariates, such as age, sex, heart failure severity, short physical performance battery score, Mini-Mental State Examination score, transthyretin level, and provision of swallowing therapy, the FOIS score at discharge was significantly associated with the MTP (P = 0.024, confidence interval: 0.006–0.046). In conclusion, the MTP was independently associated with improvements in FOIS in patients with heart failure.

Swallowing Training Combined With Game-Based Biofeedback in Poststroke Dysphagia

Effect of swallowing rehabilitation using traditional therapy, kinesiology taping and neuromuscular electrical stimulation on dysphagia in post-stroke patients: A randomized clinical trial

BackgroundTo date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles.ObjectiveTo evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES.MethodsIn this prospective randomized case–control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2–3 weeks (minimal session: 7 times, treatment duration: 300–800 min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale.ResultsThe sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores.ConclusionsThe sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia.Trial registration: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1.

The aim of this study was to compare the efficacy of neuromuscular electrical stimulation (NMES) in addition to traditional dysphagia therapy (TDT) including progressive resistance training (PRT) with that of TDT/PRT alone during inpatient rehabilitation for treatment of feeding tube-dependent dysphagia in patients who have had an acute stroke. This study is an inpatient rehabilitation case-control study involving 92 patients who have had an acute stroke with initial Functional Oral Intake Scale (FOIS) scores of 3 or lower and profound to severe feeding tube-dependent dysphagia. Sixty-five patients, the NMES group, received NMES with TDT/PRT, and 27 patients, the case-control group, received only TDT/PRT. Treatment occurred in hourly sessions daily for a mean ± SD of 18 ± 3 days. χ(2) Analyses/t tests revealed no significant statistical differences between the groups for age (t = -0.85; P = 0.40), sex (χ(2) = 0.05; P = 0.94), and stroke location (χ(2) = 4.2; P = 0.24). A Mann-Whitney U test revealed a statistically significant difference between the groups for the initial FOIS score (z = -2.4; P = 0.015), with the NMES group having worse initial scores with a mean rank of 42.64 and the case-control TDT/PRT group having a mean rank of 55.8. The main outcome measure was the comparison of the FOIS scores after treatment. The mean ± SD FOIS score after NMES with TDT/PRT treatment was 5.1 ± 1.8 compared with 3.3 ± 2.2 in the case-control TDT/PRT group. The mean gain for the NMES group was 4.4 points; and for the case-control group, 2.4 points. Significant improvement in swallowing performance was found for the NMES group compared with the TDT/PRT group (z = 3.64; P < 0.001). Within the NMES group, 46% (30 of 65) of the patients had minimal or no swallowing restrictions (FOIS score of 5-7) after treatment, whereas 26% (7 of 27) of those in the case-control group improved to FOIS scores of 5-7, a statistically significant difference (χ(2) = 6.0; P = 0.01). This study suggests that NMES with TDT/PRT is significantly more effective than TDT/PRT alone during inpatient rehabilitation in reducing feeding tube-dependent dysphagia in patients who have had an acute stroke.

IntroductionDysphagia following a stroke is a common complication that significantly impacts patients’ daily living abilities. Acupuncture has been reported to effectively alleviate post-stroke dysphagia and enhance patients’ quality of life. This study aims to compare the effects of purpose-directed acupuncture (PDA) schemes and conventional acupuncture schemes on post-stroke dysphagia using surface electromyography.MethodsA randomized single-blind controlled study design was employed, where eligible post-stroke dysphagia patients were randomly assigned to the treatment group and control group. Both groups received 4 weeks of treatment based on either PDA or conventional acupuncture in addition to regular dysphagia rehabilitation training. After treatment, patients’ Functional Oral Intake Scale (FOIS) scores, Standardized Swallowing Assessment (SSA) scores, and surface electromyography of swallowing muscles were assessed.ResultsThe study included a total of 58 subjects, with 29 in each treatment group and control group. Compared to the control group, the treatment group showed a significant increase in FOIS scores and a decrease in SSA scores. Surface electromyography results indicated that patients in the treatment group had significantly increased Aemg and Iemg values in the submental muscle group compared to the control group.ConclusionPDA schemes may serve as a more effective treatment approach for post-stroke dysphagia, particularly showing advantages in improving submental muscle strength.Clinical trial registrationThe protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2100053597).

The aim of this study was to investigate the effects of game-based electromyography (EMG)-biofeedback therapy on swallowing functions and quality of life in patients with post-stroke dysphagia. This prospective, assessor-blind, randomized controlled trial included 33 patients with post-stroke dysphagia. The study group performed the Mendelsohn maneuver and effortful swallow using game-based EMG-biofeedback, while the control group performed the same tasks with only verbal feedback for 30 min across a total of 15 sessions. In addition, both groups received oral motor exercises and thermal-tactile stimulation for equal durations. Patients were evaluated immediately before and after the treatment using clinical swallowing assessments, including the Functional Oral Intake Scale (FOIS), Penetration-Aspiration Scale (PAS), Dysphagia Outcome and Severity Scale (DOSS), and Dysphagia Handicap Index (DHI). Statistically significant improvements were observed in FOIS scores (p = 0.038), PAS-Liquid scores (p = 0.026), and DOSS scores (p = 0.003) in the study group, while no significant changes were noted in the control group. PAS-Semisolid scores improved in both groups (study group, p = 0.002; control group, p = 0.023); however, post-treatment scores were significantly higher in the study group compared to the control group (p = 0.031). Although significant improvements in DHI total, physical, emotional, and functional scores were observed in both groups at the end of treatment (all p < 0.05), post-treatment DHI scores were significantly higher in the study group compared to the control group (all p < 0.05). The addition of game-based EMG-biofeedback to conventional therapy improved clinical and radiological outcomes, as evidenced by improvements in FOIS, PAS-Liquid, and DOSS scores, and led to statistically significant improvements in PAS-Semisolid and DHI scores. In conclusion, the inclusion of game-based EMG-biofeedback therapy in swallowing rehabilitation programs may have a positive impact on treatment outcomes.

The Effects of Deep Transcranial Magnetic Stimulation Targeting the Insular Cortex in Patients with Infratentorial Stroke and Aspiration: A Randomized Controlled Trial.