Course Of Dysphagia Research Articles

Prevalence and characteristics of the course of dysphagia in hospitalized older adults

Prevalence and characteristics of the course of dysphagia in hospitalized older adults

Oropharyngeal Dysphagia in Hospitalized Older Adults with Dementia: A Prospective Cohort Study

ObjectiveOropharyngeal dysphagia (dysphagia) is highly prevalent (up to 86%) in hospitalized patients with Alzheimer disease and related dementias (ADRD). This study aims to describe the management and clinical course of dysphagia in hospitalized patients with ADRD. DesignProspective observational cohort study. Setting and ParticipantsThe study was conducted across 10 hospitals within a large health system in New York. Participants were older adults with ADRD admitted to the medicine service and diagnosed with dysphagia to liquids on speech-language pathologist (SLP) assessment and were recruited between January and June 2023. MethodsBaseline characteristics [eg, dementia Functional Assessment Staging Tool (FAST)], dysphagia management (eg, prescribed diet), and clinical course (eg, dysphagia improvement, respiratory complications) were collected. ResultsOf patients with ADRD and dysphagia (n = 62), the average age was 86.5 and 66.1% were FAST Stage 7. On admission, 48.4% had pneumonia, 79.0% had delirium, and 69.4% were made nil per os (NPO) for aspiration risk. Of those who received SLP reassessment after diet initiation (n = 25), 76% demonstrated dysphagia improvement; 75% of patients with FAST stage 7 demonstrated improvement. Respiratory complications occurred in 21.0% of patients on the following diets: NPO, nasogastric tube feeding, dysphagia diets, and comfort feeds. In univariate analyses, hospital-acquired dehydration, no dysphagia improvement, and delirium were associated with respiratory complications. Conclusions and ImplicationsThe potential for dysphagia improvement in hospitalized patients with ADRD (even those with advanced dementia) highlights the critical need for standardizing reassessment. Further studies are needed to evaluate factors associated with respiratory complications in this population.

Transient postictal dysphagia in older adults with focal structural epilepsy.

Seizures can cause transient neurological symptoms, such as hemiparesis and aphasia. However, temporary swallowing changes leading to postictal dysphagia have not been previously described. Therefore, this study evaluated the presence of swallowing disorders following seizure. In addition, dysphagia severity and duration of any recovery from dysphagic symptoms were investigated. The local clinical database of all fiberoptic endoscopic evaluation of swallowing (FEES) examinations performed from 2008 to 2019 was screened for patients diagnosed with seizures, but excluding patients with intensive care unit admission or intubation >24 h. Patient charts were evaluated to identify preexisting dysphagia or potential concurrent medical causes for dysphagia, including hyponatremia, increased intracranial pressure, sepsis, or other encephalopathies associated with infections, or other possible causes at the time of admission. Patients receiving >.5 defined daily doses of benzodiazepines or neuroleptics were also excluded. Age, sex, seizure semiology and etiology, comorbidities, concurrent pneumonia, and dysphagia course during hospitalization were evaluated as predictors of the occurrence of dysphagia or its potential duration. We identified 41 patients with dysphagia following a seizure, without evidence of any concurrent cause of swallowing dysfunction. These patients all presented with focal structural epilepsy, they had a mean age of 79 ± 11.3 years (range = 44-95 years), and 21 were women. The mean Elixhauser Comorbidity Score was 4.8. Hospital-acquired pneumonia was detected in 21 patients (51.2%). FEES diagnosed mild and severe dysphagia in 21 (51.2%) and 20 (48.8%) patients, respectively. Dysphagia improved significantly (p = .001) during hospitalization, persisting for an average of 3.9 days (median = 3 days, SD = 2.07 days, range = 1-8 days). Dysphagia is a potential transient neurological deficit following seizure. Our findings suggest that older patients, with focal structural epilepsy, are at risk for postictal dysphagia. Further studies are needed to ascertain the prevalence, complications, and predictors of postictal dysphagia. Dysphagia screening may improve early detection in patients with relevant risk factors, as well as reduce the occurrence of aspiration pneumonia.

Prevalence and Characteristics of the Course of Dysphagia in Hospitalized Older Adults.

Sarcopenic dysphagia (SD) is an emerging concern in geriatric medicine. This study aimed to identify the prevalence, progression, and distinct attributes of SD in patients in the Department of Geriatric Medicine. Older adult patients admitted between 2021 and 2022 were enrolled. The department conducts a comprehensive geriatric assessment (CGA) combined with a multidisciplinary team-based intervention, setting the standard for medical care. We diligently assessed the occurrence and development of dysphagia at both the admission and discharge phases. Of the 180 patients analyzed (38.9% male, mean age 86.0 ± 6.6 years), 22.8% were diagnosed with SD at admission, thrice the rate of other dysphagia variants. Only one patient had new-onset dysphagia during hospitalization, attributed to SD. Patients with SD showed a better recovery rate (18.9%) than those with other dysphagia types. Patients with diminished swallowing capacity had compromised nutritional profiles, diminished energy and protein consumption, and extended fasting durations. Although sarcopenia is a prevalent inducer of dysphagia in older adults, an integrated approach in geriatric medicine involving rehabilitation, nutrition, and dentistry is pivotal. Strategies rooted in CGA promise potential for addressing dysphagia.

Increasing Student Confidence With Medically Complex Infants Through Simulation: A Mixed Methods Investigation.

The purpose of this study was to compare student knowledge and confidence, related to the assessment and management of oral feeding readiness in medically complex infants, following a written case study versus a high-fidelity human patient simulation (HPS). A sequential, two-phase, embedded mixed methods design was conducted. Participants were two sequential cohorts of second-year speech-language pathology graduate students enrolled in a didactic Pediatric Dysphagia course. At the end of the course, students completed the same case scenario presented as a written case study (control group; N = 28) or as an HPS (experimental group; N = 24). Pre- and post-knowledge assessment results and self-assessments of confidence conducted at three time points were compared. All students made gains in knowledge, regardless of intervention (written case study or HPS). Despite different baselines, the percent change in knowledge was significant with the control group improving 33% and the experimental group improving 76% from baseline. Students in the experimental group demonstrated significantly greater gains in confidence with skills enhanced by the hands-on, immersive experience of HPS. Qualitative analysis further identified factors contributing to increased confidence with all students reporting that experience significantly contributes to their confidence in their ability to treat patients. While knowledge outcomes were similar between the groups, the confidence that the experimental group gained through the hands-on experiences of HPS fosters student development as confident professionals in assessing feeding readiness and managing medically complex infants. Results support integration of simulation into the graduate curriculum to support student learning. https://doi.org/10.23641/asha.19233504.

The Impact of Active Learning in a Speech-Language Pathology Swallowing and Dysphagia Course

The signature pedagogy in Speech-Language Pathology (SLP) higher education programs has been criticized for its instructor-centric lecture format and emphasis on the lower tiers of Bloom’s taxonomy (simply memorizing knowledge) at the expense of helping students develop the clinical problem-solving skills required for a lifetime of practice and learning. The purpose of this study was to examine the responses of a cohort of graduate speech-language pathology students to an active learning-oriented swallowing and dysphagia course design. A potential relationship between student perceptions of the active learning pedagogy and academic performance was also explored. The results suggest that active learning positively impacted both student perceptions and performance in the redesigned swallowing and dysphagia course.

P.15Myopathies featuring early or prominent dysphagia

Dysphagia occurs in a variety of neuromuscular disorders, including motor neuron diseases, myasthenia gravis (MG) and myopathies. Limited data exist regarding myopathies with early/ prominent dysphagia. We conducted a retrospective study over 16 years to identify myopathy patients, in whom dysphagia was the initial symptom or was disproportionately severe compared to limb weakness (evidence of aspiration on swallowing study or requirement of diet modification, procedural intervention or feeding tube while ambulatory).. We identified 29 patients, [inclusion body myositis (IBM) (n=13), immune-mediated necrotizing myopathy (IMNM) with (n=2)/without (n=3) immune checkpoint inhibitor exposture, oculopharyngeal muscular dystrophy (OPMD) (n=4), nonspecific myositis (n=2), mitochondrial myopathy (n=2), and single cases of amyloid myopathy, sporadic late onset nemaline myopathy, and congenital myopathy], dysphagia was the initial symptom in 15. Median age at diagnosis was 65 years (range 36-80). At time of evaluation, 19 required diet alterations, 3 required feeding tubes and 5 had aspiration pneumonia. Twenty eight patients had also weakness of facial (12), neck flexor (11), neck extensor (6) and limb muscles (27). Ten patients (4 IMNM, 4 OPMD, 1 IBM and 1 mitochondrial myopathy) had ophthalmoparesis or ptosis. Median time from dysphagia onset to diagnosis was 36 months, (range 1–240). Dysphagia evolved rapidly within 6 months in 4 patients (3 IMNM and 1 nonspecific myositis). Follow-up data was available in 20 patients: 4 required feeding tube (3 SIBM, 1 nonspecific myositis), 2 SIBM patients had esophageal dilatation and 4 SIBM patients underwent cricopharyngeal myotomy. Eight patients (4 IMNM, 3 IBM, and 1 nonspecific myositis), received immunotherapy resulting in marked improvement only in patients with rapidly progressive dysphagia. This study identifies IBM and IMNM as the 2 most common causes of acquired myopathies with early or prominent dysphagia, accounting for approximately two-thirds of the patients in our cohort. Rapidly progressive course of dysphagia may predict immunotherapy responsiveness

Pharyngeal Dysphagia in Individuals With Cervical Spinal Cord Injury: A Prospective Observational Cohort Study.

Objectives: To identify and describe the types and time course of dysphagia following cervical spinal cord injury (SCI). Methods: This was a prospective cohort study conducted in an SCI inpatient rehabilitation unit. Seventy-six individuals with SCI were enrolled. Inclusion criteria were age 18 years or older, admitted into SCI inpatient rehabilitation unit, and medically stable for participation in bedside swallow evaluation (BSE) and videofluoroscopic swallow study (VFSS). All participants first underwent a BSE, of whom 33 completed a VFSS. A follow-up BSE was conducted on individuals who tested positive on the initial BSE and continued to show signs of dysphagia. Diagnosis and type of dysphagia as well risk factors were collected. Results: Twenty-three out of 76 individuals with cervical SCI were diagnosed with dysphagia using the BSE. All participants with positive BSE and VFSS had pharyngeal dysfunction. For participants with a positive initial BSE and persisting dysphagia (n = 14), a follow-up BSE demonstrated resolution within 34 days. Risk factors associated with dysphagia were older age, nasogastric tube, invasive mechanical ventilation, tracheostomy, and pneumonia. Posterior spinal surgery was associated with a decreased risk of dysphagia. Conclusion: Dysphagia was present in 30% of individuals based on the initial BSE. All individuals with dysphagia demonstrated pharyngeal phase dysfunction on the VFSS. No participants experiencing dysphagia were missed on the BSE as confirmed by VFSS. In the subset of individuals who received a follow-up BSE, the time course of resolution of dysphagia was at most 34 days from initial BSE.

The time course of dysphagia following traumatic cervical spinal cord injury: a prospective cohort study.

Prospective cohort study. To elucidate serial changes in dysphagia and elucidate the critical period for dysphagia following acute traumatic cervical spinal cord injury (CSCI). Spinal Injuries Center, Fukuoka, Japan. We prospectively examined individuals with acute traumatic CSCI admitted within 2 weeks after injury. Severity of dysphagia was evaluated using both the dysphagia severity scale (DSS) and functional oral intake scale (FOIS) at 2 weeks, 1 month, 2 months, and 3 months after injury. Condition of oral intake before injury was assessed by history taking. American Spinal Injury Association (ASIA) impairment scale grade and motor scores were also assessed at the same timepoints, and the correlation between dysphagia and paresis was analyzed. Sixty-five individuals with CSCI were assessed consecutively for 3 months after injury. Swallowing function, evaluated using both the DSS and FOIS, was significantly decreased at 2 weeks after injury, but significantly improved thereafter. Significant correlations between severity of dysphagia (DSS and FOIS scores) and motor scores were found at 2 weeks after injury (rs = 0.66 and 0.61; p < 0.001 and p < 0.001, respectively), indicating that individuals with lower motor scores had more severe swallowing dysfunction. Dysphagia occurred immediately after injury, but gradually improved over time. Individuals with more severe paralysis had significantly more severe dysphagia. Special attention for dysphagia should be paid to individuals with severe paralysis in acute phase.

Characteristics and Clinical Course of Dysphagia Caused by Anterior Cervical Osteophyte.

ObjectiveTo investigate swallowing characteristics of patients with dysphagia caused by anterior cervical osteophytes (ACOs) and compare clinical courses according to treatment options.MethodsA retrospective analysis of 1,866 videofluoroscopic swallowing studies (VFSS) of patients with ACOs from electronic medical records was performed. Patients with other diseases that could explain the dysphagia were excluded. Dysphagia characteristics and severity and clinical and radiological characteristics of subjects with ACOs were evaluated. Dysphagia characteristics and clinical course were compared among three treatment groups: surgical treatment, swallowing rehabilitation, and conservative treatment.ResultsSubjects were 22 men and 1 woman with a mean age of 78.69±8.01 years. The mean osteophyte thickness was 9.07±3.84 mm. It was significantly thicker in the surgical group than that in other groups (p=0.01). ACOs were most frequently found at C5 level. This level also had the thickest osteophytes. However, videofluoroscopic dysphagia scales (VDS) were not significantly different among the three treatment groups. The pharyngeal phase score of the VDS was significantly higher in the surgical group (p=0.041). Dysphagia severity was decreased significantly in the surgical group at 3 months after the initial VFSS (p=0.004).ConclusionThe main swallowing characteristics in patients with ACOs were dysphagia features of the pharyngeal phase, including inappropriate airway protection, decreased laryngeal elevation, and reduced epiglottis inversion. When determining treatment options, it may be helpful to consider dysphagia severity at pharyngeal phase and osteophyte thickness.

Changes in Speech-Language Pathology Students' Attitudes Toward Breastfeeding During a Pediatric Dysphagia Course.

Speech-language pathologists provide infant feeding assessment and intervention; their training in breastfeeding management is highly variable. Research aim: The purpose of this study was to evaluate student attitudes toward breastfeeding and self-identified factors in attitude change. Before and after their course in pediatric dysphagia, two cohorts of graduate students in speech-language pathology ( N = 36) completed an assignment designed to capture qualitative and quantitative data on changes in their attitudes toward breastfeeding. Students rated their reactions to two hypothetical breastfeeding scenarios before and after the class, which included multiple sources of information on the importance of human milk and on breastfeeding management. Additionally, they completed a postclass reflection describing the nature of any changes in their attitudes toward breastfeeding and their ideas about the factors that were responsible for these changes. Nonparametric statistical tests were used to assess quantitative results; the qualitative data were evaluated via content analysis to identify themes. Significant positive changes in student attitudes were measured at the completion of the course. Students identified parents' stories as a particularly compelling component of their increased openness to breastfeeding. Attitudes toward breastfeeding may improve significantly over a relatively short period of time following a targeted intervention. Implications for lactation consultants and continuing education providers are discussed.

Application of nursing intervention based on International Classification of Functioning, Disability and Health in the course of dysphagia for stroke patients

Objective To observe the influence of nursing intervention based on International Classification of Functioning, Disability and Health (ICF) in the course of dysphagia for stroke patients. Methods A total of 60 stroke patients were chosen with dysphagia in the Second Affiliated Hospital of Xi'an Jiaotong University for the study. These patients were randomly divided into the control group and the intervention group with 30 cases in each group, two groups were directly treated with routine training, oral care, menthol popsicle stimulation, balloon dilatation treatment, swallowing electrical stimulation, basic training of swallowing and health education. The intervention group was assessed and intervened based on 34-item dysphagia ICF core project which Dongyi refined in addition to conventinal nursing. The grade was measured by the Kubota Toshio′s drinking test, and the Surface Electromyography (sEMG) was performed to compare the swallowing duration and maximum amplitude in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention, after 4 weeks and after 8 weeks. Results The average grade in Kubota Toshio′s drinking test before intervention, after 4 weeks and after 8 weeks in the control group and the intervention group were 4.12±0.23, 3.34±0.57, 2.76±0.46 and 4.29±0.25,2.82±0.39,1.81±0.41, intra group comparison was statistically significant (F=67.19, 368.56, P<0.01). Comparison between two groups in 4 weeks, 8 weeks after intervention was statistically significant (t=4.81, 7.22, P<0.01). In the control group, intra group comparison of swallowing duration in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention, after 4 weeks and after 8 weeks was statistically significant (F=18.40-34.65, P<0.01). In the intervention group, intra group comparison of swallowing duration in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention, after 4 weeks and after 8 weeks was statistically significant (F=127.82-174.93, P<0.01) . There were significant differences in swallowing duration in the masseter, the orbicularis oris, submental, and the lower hyoid muscles in 4 weeks, 8 weeks after intervention between the two groups (t=-5.32-10.14, P<0.01) .In the control group, intra group comparison of maximum amplitude in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention, after 4 weeks and after 8 weeks was statistically significant (F=28.11-90.54, P<0.01) . In the intervention group, intra group comparison of the maximum amplitude in the masseter, the orbicularis oris, submental, and the lower hyoid muscles before intervention, after 4 weeks and after 8 weeks was statistically significant (F=60.91-178.31, P<0.01) . There were significant differences in the maximum amplitude in 4 weeks, 8 weeks after intervention between the two groups(t=-8.82--4.06, P<0.01) . Conclusions Nursing intervention based on ICF has obvious curative effect on stroke patients with dysphagia. Key words: International classification of functioning, disability and health; Nursing care; Intervention; Dysphagia

The Graduate Dysphagia Course: Opening the Door to New Frontiers

A graduate-level course in dysphagia is an integral part of the graduate curriculum in speech-language pathology. There are many challenges to meeting the needs of current graduate student clinicians, thus requiring the instructor to explore alternatives. These challenges, suggested paradigm shifts, and potential available solutions are explored. Current trends, lack of evidence for current methods, and the variety of approaches to teaching the dysphagia course are presented.

The variety of dysphagia progression in amyotrophic lateral sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by onset within the upper limb, lower limb, or bulbar musculature. Regardless of site of onset, dysphagia inevitably occurs. This study aimed to examine the course of dysphagia in ALS, and to investigate whether the progression of dysphagia differs by site of onset. Thirty ALS patients were included. For each patient, we collected information on site of disease onset (bulbar or limb onset), duration to initiation of gastrostomy feeding from disease onset, dysphagia onset, course of dysphagia, and course of the respiratory function after dysphagia onset. Patients were divided into two groups based on the site of onset: the bulbar onset group (the BO group, i.e., clinical onset was characterized by dysarthria and/or dysphagia) and the limb onset group (the LO group, i.e., limb weakness was the first symptom). Each survey item was compared between two groups. There were no significant differences in time to initiation of gastrostomy feeding from disease onset between groups (p=0.45). On the other hand, there were significant differences in dysphagia onset, course of dysphagia, and course of the respiratory function after dysphagia onset (p=0.0008, p=0.007, p=0.0002, respectively).Our result suggest that the progression of dysphagia in ALS may differ by site of onset. Compared with bulbar onset ALS patients, progression of dysphagia may be faster in limb onset patients. Moreover, the decline in respiratory function is likely to influence the progression of dysphagia.

Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS)

Purpose: The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia.Method: University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students’ perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients.Result: Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician.Conclusion: This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

Przewlekłe zanikowe zapalenie gardła jako problem geriatryczny

Chronic atrophic pharyngitis is a special form of chronic inflammation of the throat, which coexist change production and mirrors. The disease most often refers to older people, especially women. It results from the progressive age-circulatory disorders and secretory function of the glands of the mucous membranes. This causes severe pain and general discomfort which reduces the quality of life of geriatric patients who have intensified the course of dysphagia, typical for this age group. Various methods of treatment of symptomatic, documented in the literature for decades, characterized by low efficiency. Present on the market of plant-based preparations, which have anti-inflammatory, analgesic and stimulating the natural processes of growth and renewal of tissues seem to be particularly appropriate for use in chronic atrophic pharyngitis. This paper presents a formulation containing sea buckthorn oil, marigold and bergamot, which is sold in the Polish market as Larimax T.

Integrating Academic and Clinical Learning Using a Clinical Swallowing Assessment

This article describes an experiential learning activity designed to integrate classroom knowledge and a clinical swallowing assessment. Twenty master’s-level graduate students in a dysphagia course conducted a clinical swallowing assessment with a resident of an independent retirement community. The exercise was designed to allow students an opportunity to obtain a case history and assess the oral motor and swallowing abilities of older adults without clinical dysphagia. The students’ favorable responses from evaluating the experience suggested that it is a beneficial activity to bridge academic knowledge and emerging clinical skills. The areas the students considered most beneficial were the following: asking questions during the case history interview, providing clear explanations and directions during tasks, practicing the clinical task and observing a normal swallow, and increased confidence and competence to perform a clinical swallowing assessment. This activity could be used in academic training programs regardless of location and availability of clients.

Natural course of dysphagia in Parkinson's disease: Clinical and videofluoroscopical data

Natural course of dysphagia in Parkinson's disease: Clinical and videofluoroscopical data

Swallowing dysfunction in cancer patients.

PurposeDysphagia (swallowing dysfunction) is a debilitating, depressing, and potentially life-threatening complication in cancer patients that is likely underreported. The present paper is aimed to review relevant dysphagia literature between 1990 and 2010 with a focus on assessment tools, prevalence, complications, and impact on quality of life in patients with a variety of different cancers, particularly in those treated with curative chemoradiation for head and neck cancer.MethodsThe literature search was limited to the English language and included both MEDLINE/PubMed and EMBASE. The search focused on papers reporting dysphagia as a side effect of cancer and cancer therapy. We identified relevant literature through the primary literature search and by articles identified in references.ResultsA wide range of assessment tools for dysphagia was identified. Dysphagia is related to a number of factors such as direct impact of the tumor, cancer resection, chemotherapy, and radiotherapy and to newer therapies such as epidermal growth factor receptor inhibitors. Concomitant oral complications such as xerostomia may exacerbate subjective dysphagia. Most literature focuses on head and neck cancer, but dysphagia is also common in other types of cancer.ConclusionsSwallowing impairment is a clinically relevant acute and long-term complication in patients with a wide variety of cancers. More prospective studies on the course of dysphagia and impact on quality of life from baseline to long-term follow-up after various treatment modalities, including targeted therapies, are needed.

Getting to the Scholarship of Teaching and Learning: Professional Development in University Faculty

Getting to the Scholarship of Teaching and Learning: Professional Development in University Faculty