Dysphagia Rehabilitation Research Articles

Face recognition-driven video game for dysphagia rehabilitation in stroke patients: a pilot randomized controlled trial

ObjectiveTo explore the feasibility and effectiveness of face recognition-driven video game (FR-VG) swallowing training for stroke patients with dysphagia. DesignA single-blind pilot randomized controlled trial. SettingA rehabilitation center. ParticipantsStroke patients with dysphagia (N=26). InterventionsParticipants in the intervention group were trained using FR-VG, while the control group used the conventional method (i.e. lip exercise, tongue exercise, and lower jaw exercise). The training was conducted five days a week over four weeks. Outcome MeasuresThe swallowing function and swallowing-related quality of life between the two groups were observed before and after the intervention. The acceptance of FR-VG in the intervention group and the adherence of the patients in the two groups after the intervention were analyzed. ResultsA total of 26 stroke patients with dysphagia were included. The results showed that after the intervention, both groups exhibited significant improvements in swallowing function and swallowing-related quality of life compared to the pre-intervention (p < 0.05). Patients in the intervention group demonstrated better swallowing function than the control group on the Gugging swallowing screen (p = 0.015) and functional oral intake scale (p = 0.004). The intervention group had high acceptance of the FR-VG training and had significantly better adherence compared to the control group (p = 0.032). ConclusionsFR-VG rehabilitation training can help improve swallowing function, swallowing-related quality of life, and training adherence in stroke patients with dysphagia. Patients have a high acceptance of FR-VG rehabilitation training, which can be used as an adjunctive method to conventional rehabilitation.

Perioperative intervention of dysphagia rehabilitation team is effective in older adults with gastric cancer: An inverse probability weighting analysis

IntroductionThis study aimed to evaluate the efficacy of perioperative dysphagia rehabilitation in older adult patients diagnosed with gastric cancer who underwent gastrectomy. Materials and methodsThis retrospective study included 149 patients over 80 years who underwent gastrectomies between January 2000 and December 2020. The patients were divided into two groups based on the intervention of the dysphagia rehabilitation team (DRT group: n = 101) and the non-intervention control group (C group: n = 48). Inverse probability weighting (IPW) analysis was used to reduce bias caused by potential confounding. ResultsThe incidence of overall complications was significantly lower in the DRT group (odds ratio [OR]; 0.27[0.08–0.93]), among which the incidence of postoperative pneumonia (OR; 0.07[0.01–0.43]) and aspiration pneumonia (OR; 0.05[0.01–0.44] was significantly reduced. Ten patients developed postoperative pneumonia; seven were in the C group, and three were in DRT group. Sixty percent of these patients had preoperative comorbidities related to the respiratory system. Regarding the time of onset of aspiration pneumonia, two patterns were observed: onset within a short period after surgery and onset after the start of eating. In contrast, five patients underwent preoperative dysphagia rehabilitation in the DRT group. Among them, postoperative aspiration pneumonia was prevented in four patients, and the others were prevented from severe pneumonitis by the intervention of the dysphagia rehabilitation team. DiscussionPerioperative intervention in dysphagia rehabilitation is not only associated with reduced postoperative pneumonia but also creates awareness in the medical staff and promotes careful observation of swallowing in patients, thereby controlling the incidence of postoperative pneumonia. The perioperative intervention of the dysphagia rehabilitation team is useful for older adult patients with gastric cancer.

Long-Term Outcomes of Dysphagia Rehabilitation With an Adjustable Resistance Training Device in LaryngectomizedIndividuals.

This study investigated long-term outcomes of dysphagia rehabilitation with an adjustable resistance training device (Swallowing Exercise Aid, SEA2.0) in laryngectomized individuals. Seventeen laryngectomized participants who participated in a Clinical Phase II Trial were reevaluated at T3 (approximately 6 months after T2), including an interview, PROMS, oral intake, and swallowing capacity. Results of T3 were compared with the earlier time points T0 (baseline), T1 (after 6 weeks of training), and T2 (after 8 weeks of rest). All outcomes at T3 remained improved compared to T0. Compared to findings at T2, participants reported some deterioration in swallowing at T3. Swallowing capacity and oral intake slightly decreased. Swallowing-related quality of life slightly improved. Benefits of swallowing rehabilitation with the SEA2.0 in laryngectomized individuals are still noticeable long term. The need for continued exercising to fully maintain improved function is likely, but the required intensity and extent should be determined in further research.

Efficacy of swallowing rehabilitative therapies for adults with dysphagia: a network meta-analysis of randomized controlled trials.

Dysphagia leads to poor swallowing function and high risk of aspiration; swallowing rehabilitative therapies including jaw exercises, tongue exercises, chin tuck against resistance (CTAR), Shaker exercises, effortful swallow training (EST), traditional dysphagia therapy (TDT), and respiratory muscle training (RMT) including inspiratory muscle strength training (IMST) and expiratory muscle strength training (EMST) are a crucial part of dysphagia rehabilitation. However, limited evidence exists on the comparative efficacy of swallowing rehabilitative therapies in adults with dysphagia. This is the first network meta-analysis (NMA) to investigate the comparative efficacy of swallowing rehabilitative therapies for adults with dysphagia. Web of Science, Embase, CINAHL, Cochrane Library, and PubMed were comprehensively searched until September, 2024. The Frequentist NMA model was performed in R-Software presenting standardized mean differences with corresponding 95% confidence interval (95% CI) for swallowing function and aspiration. Cochrane Q, τ2, and I2 statistics estimated heterogeneity and full design-by-treatment interaction random-effects and node-splitting models determined transitivity. Ranking of the swallowing rehabilitative therapies used the netrank function. The search yielded 7697 studies from which 25 randomized controlled trials with 1020 adults with dysphagia were included. The study findings revealed that CTAR + TDT (SMD = 3.44 [95% CI 2.42, 4.47]), EMST + TDT (SMD = 2.92 [95% CI 1.59, 4.25]), Shaker + TDT (SMD = 2.83 [95% CI 1.81, 3.84]), JE + TDT (SMD = 2.52 [95% CI 1.21, 3.83]), TE + TDT (SMD = 2.19 [95% CI 1.26, 3.12]), RMT + TDT (SMD = 2.14 [95% CI 1.36, 2.93]), and TDT (SMD = 1.92 [95% CI 1.42, 2.42]) showed very-large to huge effect in improving swallowing function. CTAR + TDT (0.93) demonstrated superior improvements for better swallowing function. Additionally, CTAR + TDT (SMD = - 1.82 [95% CI - 2.89, - 0.75]), Shaker + TDT (SMD = - 1.32 [95% CI - 2.36, - 0.27]), EMST (SMD = - 1.23 [95% CI, - 2.01, - 0.45]), and EMST + TDT (SMD = - 1.10 [95% CI - 2.15, - 0.04]) revealed very-large to large effect in preventing aspiration. CTAR + TDT (0.96) and Shaker + TDT (0.76) demonstrated superior improvements for reduced aspiration. The combination of swallowing rehabilitative therapies including CTAR + TDT and Shaker + TDT offers a more comprehensive approach for dysphagia management in adults. Study registration is PROSPERO: CRD42022321345.

Head and Neck Cancer Survivors' Assessment of Mealtimes: Translation and Validation : Assessment and Rehabilitation of Dysphagia in Head and Neck Cancer Patients.

Dysphagia is a prevalent complication before, during and after treatment for head and neck cancer (HNC). Besides the medical and societal consequences, dysphagia has a negative impact on functioning, activity, participation and quality of life. These aspects are all affected by the environmental factors (EF). However, patient-reported outcome measures (PROMS) such as the Head-and-Neck Cancer Survivors' Assessment of Mealtimes (HNSAM), which thoroughly assess participation and EF in addition to function and activity, are rare. Therefore, this study aimed to translate and validate the HNSAM into Dutch (D-HNSAM). The HNSAM was translated according to the standardized procedure of translation & back-translation and according to the international cross-cultural adaptation process. A pilot study was then conducted with 10 HNC patients to assess the linguistic features and comprehensibility of the test items. Finally, the D-HNSAM was completed by 50 participants who were at least 6months post-treatment for HNC. The Performance Status Scale for Head and Neck cancer patients (PSS-HN)- subscales normalcy of diet and eating in public, the Dysphagia Handicap Index (DHI), the Functional Oral Intake scale (FOIS) and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) were used to examine the psychometric properties of the D-HNSAM. High correlations with related assessment tools and low correlations with unrelated assessment tools were expected. Internal consistency was found to be weak to good. Test-retest reliability, convergent validity and divergent validity were demonstrated except for the EF subscale. The D-HNSAM can detect differences in impact of dysphagia on daily functioning and quality of life. The D-HNSAM is a reliable and clinically valuable PROM for assessing the impact of dysphagia on daily functioning and quality of life in patients with HNC. The unique aspect of this PROM, the subscale EF, has unfortunately weak psychometric properties and requires further refinement.

A survey of dysphagia services practice in China.

Dysphagia services have only recently been formalised within Chinese health services. There has been no comprehensive evaluation of all aspects of dysphagia services practice in China. To provide a profile for the dysphagia practice in China by assessing various facets of dysphagia services. This is a survey study carried out from December 2022 to May 2023 online in China. One hundred fifty-nine respondents comprising doctors, nurses or therapists involved in the field of dysphagia rehabilitation completed a questionnaire via Sojump. The questionnaire included dichotomous (e.g., yes/no) and multiple-choice questions related to participants' general information and their provision of dysphagia management services. Results were analysed descriptively and the differences among different levels of hospitals were analysed. Approximately two-thirds of hospitals (67.9%) started dysphagia services within the last 5 years. A significant difference in the initiation of dysphagia rehabilitation was observed across different hospital levels (χ2=32.70;p<0.001). Routine dysphagia screening was a standard practice in most hospitals (71.7%), with the most frequently employed screening method being the water swallow test (95.6%). Clinical swallowing evaluation emerged as the preferred initial assessment method (80.5%) and the most utilised assessment method (91.8%). Video fluoroscopic swallow study and flexible endoscopic evaluation swallowing were used by 22.7% and 12.6% of respondents. A significant difference was observed in the choice of assessment methods across hospitals of different levels (χ2=43.397; p < 0.001). The majority of respondents (53.5%) primarily employed rehabilitation as the main intervention method (76%-100%). Most respondents indicated that they would reevaluate patients after treatment (74.8%) and reported routine follow-up with patients (60.4%). Despite the relatively recent development of dysphagia management in China, the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. However, the use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. There is a need for policy and resource support in the field of dysphagia rehabilitation in China. What is already known on this subject Assessment and treatment methods for dysphagia are various across different patients, medical facilities and settings. There has been no comprehensive evaluation of all aspects of dysphagia rehabilitation practice in China. What this study adds to existing knowledge The study assessed various facets of dysphagia rehabilitation in China through an online survey. We found that the relatively recent development of dysphagia management in China, but the practice patterns uncovered in this study are broadly consistent with Chinese guidelines and consensus. Variations in practice patterns between hospitals of different levels may be attributed to resource constraints and patient needs. Besides, while rehabilitation exercises are the primary intervention method for dysphagia in China, the assessment largely centres on clinical swallowing evaluation. The use of instrumental assessments remains low, resulting in a lack of objective evaluation of patient conditions and outcomes. What are the clinical implications of this work? The study assessed various facets of dysphagia rehabilitation in China, and the results indicate that the use of instrumental assessments needs to be improved and there is a need for policy and resource support in the field of dysphagia rehabilitation in China.

Framework for Nursing Quality Assessment in Tracheotomy Dysphagia Following Craniocerebral Trauma Using the Structure-Process-Outcome Model.

This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the 'structure-process-outcome' model. A Delphi survey. The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts. The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90-5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators. The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes. This study develops targeted NSQIs to improve dysphagia management in ABI patients' posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training. Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.

Examining Tongue Movement Intentions in EEG-Based BCI with Machine and Deep Learning: An Approach for Dysphagia Rehabilitation

Abstract Dysphagia, a common swallowing disorder particularly prevalent among older adults and often associated with neurological conditions, significantly affects individuals’ quality of life by negatively impacting their eating habits, physical health, and social interactions. This study investigates the potential of brain-computer interface (BCI) technologies in dysphagia rehabilitation, focusing specifically on motor imagery paradigms based on EEG signals and integration with machine learning and deep learning methods for tongue movement. Traditional machine learning classifiers, such as K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Decision Tree, Naive Bayes, Random Forest, AdaBoost, Bagging, and Kernel were employed in discrimination of rest and imagination phases of EEG signals obtained from 30 healthy subjects. Scalogram images obtained using continuous wavelet transform of EEG signals corresponding to the rest and imagination phases of the experiment were used as the input images to the CNN architecture. As a result, KNN (79.4%) and SVM (63.4%) exhibited lower accuracy rates compared to ensemble methods like AdaBoost, Bagging, and Random Forest, all achieving high accuracy rates of 99.8%. These ensemble techniques proved to be highly effective in handling complex EEG datasets, particularly in distinguishing between rest and imagination phases. Furthermore, the deep learning approach, utilizing CNN and Continuous Wavelet Transform (CWT), achieved an accuracy of 83%, highlighting its potential in analyzing motor imagery data. Overall, this study demonstrates the promising role of BCI technologies and advanced machine learning techniques, especially ensemble and deep learning methods, in improving outcomes for dysphagia rehabilitation.

Repetitive transcranial magnetic stimulation as a therapy for post-stroke dysphagia: An overview of systematic reviews and meta-analysis

Objective Post-stroke dysphagia is a common swallowing disorder that occurs after a stroke, leading to an increased risk of aspiration pneumonia and malnutrition. There is a pressing need for effective and safe interventions for its rehabilitation. This review aims to answer two key scientific questions: (1) What is the efficacy of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke dysphagia? (2) Is repetitive transcranial magnetic stimulation a safe intervention for post-stroke dysphagia? Data Sources A comprehensive search was conducted across four electronic databases: PubMed, Cochrane Library, Web of Science, and Embase. The search aimed to identify relevant studies concerning our topic of interest and was completed on 28 May 2024. Review methods In accordance with the PRISMA checklist, a comprehensive search of four databases was conducted, which identified 13 relevant systematic reviews. The inclusion criteria were systematic reviews that evaluated the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. Exclusion criteria were reviews that did not focus on post-stroke dysphagia or did not evaluate repetitive transcranial magnetic stimulation as a therapeutic intervention. The quality, bias, reporting, and overall evidence quality of these reviews were assessed using validated tools, including the AMSTAR 2 tool for assessing the methodological quality of systematic reviews, the ROBIS tool for assessing the risk of bias, and the GRADE approach for evaluating the overall quality of evidence. This rigorous approach ensures that our review provides a comprehensive and reliable overview of the current state of knowledge on the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia. Results The sample sizes for the individual studies included in the systematic reviews/meta-analyses ranged from 66 to 555. The total number of participants across all studies included in the overall analyses was 752. The evidence was limited by the methodological flaws and heterogeneity of the systematic reviews. The quality of the evidence varied from high to low, with most outcomes having moderate quality. Future research should adopt more rigorous, standardized, and comprehensive designs to confirm the efficacy and safety of repetitive transcranial magnetic stimulation for post-stroke dysphagia. The main reason for downgrading the evidence quality was the small sample size and high heterogeneity of the primary studies. Conclusion This overview synthesized research on repetitive transcranial magnetic stimulation for dysphagia, aiming to inform clinical and policy decisions. However, the current evidence does not conclusively establish the safety and efficacy of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The studies reviewed varied in quality, and many were of poor quality. Therefore, while some studies suggest potential benefits of repetitive transcranial magnetic stimulation, these findings should be interpreted with caution. There is a pressing need for more rigorous, high-quality research to validate the use of repetitive transcranial magnetic stimulation for post-stroke dysphagia rehabilitation. The implications of these findings for clinical practice and policy will be clearer once we have more robust, evidence-based recommendations.

Do We Know the Long-Term Effects of the Most Popular Traditional Swallow Maneuvers on the Submental Muscles?

Various trainings focus on the submental muscles (SMs) for dysphagia rehabilitation because of their importance for swallowing safety and efficiency. According to the current literature, swallow-specific tasks may be optimal exercises for dysphagia. The effortful swallow (ES) and the Masako maneuver (MM) are the most commonly used swallow-specific tasks in the clinical settings for dysphagia for years, but long-term effects for these trainings is insufficient. This study aims to investigate and compare the effects of ES and MM on SM activity, strength and thickness. Thirty-seven healthy adults were randomised to ES, MM and control groups, and ES and MM groups completed 6 weeks of swallowing training. Participants in both training groups performed a total of 120 swallows in each session, while control group did not participate in any swallowing training. Surface electromyography was used to evaluate SM activity, digital dynamometer for SM strength and ultrasonography for SM thickness. Both trainings did not change SM activity (p > 0.05), but increased SM strength (p < 0.05). MM increased the thickness of all SM (p < 0.05), and ES increased the thickness of mylohyoid (right, left) and digastric muscle (right) (p < 0.05), and there was no change in all evaluation parameters in the control group (p > 0.05). Also, trainings were not superior to each other in any parameter (p > 0.05). The results of this study provided new evidence to the literature to show that ES and MM trainings are effective for improving SM strength and thickness. Considering that SM is important in terms of swallowing safety and effectiveness, it is thought that both trainings may be promising by increasing the strength and mass of SM, especially in individuals with reduced SM strength and mass.

Correlation Between Swallowing and Cognitive Brain Networks in Older Adults via Functional MRI.

Clinical evidence supports that swallowing function is correlated with cognition, but the neurobiological mechanism associated with cognitive impairment and dysphagia remains unclear. To compare the brain activation patterns of the swallowing and the cognitive tasks and explore neural associations between swallowing and cognitive function via task-related functional magnetic resonance imaging (fMRI). A total of 13 healthy older adults (aged > 60 years) were recruited. Participants underwent the clinical dementia rating (CDR) test and the Montreal Cognitive Assessment (MoCA). A block-designed task-related fMRI study was conducted where each participant completed both swallowing and cognitive tasks within a single session. During the swallowing task, participants swallowed 2 mL of thickened water, while the Stroop Colour Word Test (SCWT) served as the cognitive task. First-level analysis of swallowing time-series images utilised the general linear model (GLM) with Statistical Parametric Mapping (SPM), applying a voxel threshold of p < 0.001 for significance. Common activations in brain regions during swallowing and cognitive tasks were extracted at the group level, with significance set at p < 0.05, corrected for multiple comparisons using the false discovery rate (FDR), with a minimum cluster size of 20 voxels. Correlation analysis between behavioural measurements and imaging signals was also conducted. Some regions were commonly activated in both task networks; these regions were the bilateral occipital lobe, cerebellum, lingual gyrus, fusiform, middle frontal gyrus, precentral and postcentral gyrus, right supramarginal and inferior parietal lobe. Most importantly, the average beta value of cognitive and swallowing tasks in these areas are both significantly negative related to the MoCA score. Furthermore, opposite signal changes were seen in the bilateral prefrontal lobes during the swallowing task, while positive activation in the bilateral prefrontal lobes was observed during the SCWT. Postcentral gyrus activation was more extensive than precentral gyrus activation in the swallowing task. The common activation of swallowing and cognitive tasks had multiple foci. The activity of cognitive and swallowing task in these areas is significantly negative correlated with the MoCA score. These findings may help to illustrate the association between dysphagia and cognitive impairment due to the common brain regions involved in cognition and swallowing and may provide a reference for further rehabilitation of dysphagia. Clinical Trial: (Chinese Clinical Trial Registry): ChiCTR1900021795.

Evidence summary on the rehabilitative management of dysphagia during radiotherapy for head and neck cancer patients.

To retrieve, extract, integrate and evaluate evidence on the rehabilitation of dysphagia in patients undergoing radiotherapy for head and neck cancer (HNC), and to provide a basis for the development of a rehabilitation management protocol for dysphagia in patients undergoing radiotherapy for HNC. An evidence-based systematic search of the literature related to the rehabilitation of dysphagia in patients with HNC during radiotherapy was conducted from January 2013 to March 2023, and the corresponding evaluation tools were selected according to the different types of literature for quality evaluation. "The Joanna Briggs Institute (JBI) evidence pre-grading system was used to evaluate the quality of the evidence. A total of 17 articles were included, including 3 guidelines, 5 expert articles, 1 clinical decision, 1 practice recommendation, 2 evidence summaries and 5 systematic evaluations. A final total of 28 pieces of evidence were summarised, including 6 areas of swallowing disorder screening and assessment, physiotherapy, preventive swallowing function training, feeding management, pain control, and oral care. This study forms a multidisciplinary collaborative evidence summary for the rehabilitation management of dysphagia in patients undergoing radiotherapy for HNC, but the application of some of the evidence needs to be carried out in the context of the clinical setting and patient-specific circumstances for the rehabilitation evidence selected for patients' dysphagia to improve their swallowing function and their swallowing-related quality of life and reduce the occurrence of related complications.

Caregiver burden and eating-related guilt during dysphagia rehabilitation: A descriptive cross-sectional time series study.

Caregivers of patients with chronic dysphasia experience stress and guilt regarding their eating behaviors. Dysphagia rehabilitation, including minimal oral intake with tube feeding, may be vital for caregivers. This study investigated the effects of dysphagia rehabilitation on caregiver well-being and attitudes toward eating assistance. This cross-sectional questionnaire study was conducted at two dental university hospitals on caregivers of homebound patients with dysphagia undergoing rehabilitation. Caregivers' experiences, with an emphasis on guilt and psychological status, were assessed using the Apathy Scale and Patient Health Questionnaire-5 Depression Scale. Patients were evaluated at the time of the survey and rehabilitation commencement using the Barthel Index and Functional Oral Intake Scale (FOIS). Changes in FOIS scores and caregiver guilt were assessed using the Wilcoxon signed rank test and McNemar test, respectively. The impact of oral intake changes on caregiving motivation was assessed using the Fisher exact test. Between August 2019 and January 2021, 55 of 100 targeted caregivers responded (median age=64.5 years). A significant difference in FOIS scores was found (median rehabilitation duration=9.7 months). Despite 25 pneumonia cases, 65% of the caregivers continued to encourage oral intake. Guilt decreased from 48% during peak dysphagia to 22% at survey time (odds ratio=0.2, 95% CI=0.04-0.70; P < 0.01). No association was found between caregiving motivation and improved oral intake. Severe dysphagia impacted caregiver well-being, indicating preferences for patients' oral intake. To support caregivers, healthcare professionals should explore and integrate new multidisciplinary approaches into dysphagia rehabilitation strategies.

A prospective cohort study on factors related to dental care and continuation of care for older adults receiving home medical care.

Information on the effects of dental treatment must be identified and factors that hinder the continuation of dental treatment must be identified to provide appropriate domiciliary dental care (DDC). This study aimed to clarify the treatment outcomes of DDC for older adults and the factors that impede the continuation of such care. This prospective study was conducted at a Japanese clinic specializing in dental care for older adults. The functional status, nutritional status, oral assessment, details of the dental treatment, and outcomes after 6months of older adults receiving DDC were surveyed. The Oral Health Assessment Tool (OHAT) was used for oral assessment. Cox proportional hazards analysis was used to analyze the factors at the first visit that were associated with treatment continuation. A total of 72 participants (mean age, 85.8 ± 6.9) were included. Twenty-three participants (31.9%) could not continue treatment after 6months. The most frequently performed procedures were oral care and dysphagia rehabilitation, followed by prosthetic treatment, then tooth extraction. The percentage of participants with teeth that required extraction after 6months and the total OHAT score decreased significantly. The Barthel Index, Mini Nutritional Assessment Short-Form, and rinsing ability were significantly associated with treatment continuation. Furthermore, instrumental activities of daily living (ADL) and the OHAT "tongue" sub-item were correlated with treatment continuation. In conclusion, DDC improved the oral health status of older adults after 6months. Factors that impeded treatment continuation were decreased ADL, decreased nutritional status, difficulty in rinsing, and changes in the tongue such as tongue coating.

Impact and management of integrated dysphagia rehabilitation within cardiac care programs for older patients with cardiovascular disease.

This study assessed the characteristics, management, and outcomes of dysphagia rehabilitation in older patients withCVD in a super-aged society, highlighting the need for comprehensive management strategies in community hospital settings. It aimed to uncover valuable insights into the benefits of integrating dysphagia rehabilitation with cardiac care in patient management. We conducted a retrospective review of patients with CVD aged ≥ 65years who were admitted to Niigata Minami Hospital between January 2019 and December 2021. We focused on patients requiring dysphagia rehabilitation and assessing the effects of these interventions on recovery. The study included 732 participants with an average age of 86.0 ± 7.8years, of whom 41.9% were male. Approximately 55.1% required dysphagia rehabilitation. Dysphagia rehabilitation significantly improved oral caloric intake and BMI in patients who underwent rehabilitation, and these improvements were comparable to those in patients who did not require dysphagia rehabilitation. Significant enhancement in the ADL of patients was observed at discharge. Patients who required dysphagia rehabilitation also had longer hospital stays and were more likely to be discharged to nursing facilities. Dysphagia is common in older patients with CVD, and dysphagia rehabilitation positively affects the maintenance of nutritional status and helps patients achieve ADL independence at discharge. This study highlights the importance of integrating dysphagia rehabilitation into ordinary cardiac rehabilitation programs for older patients with CVD to improve their QOL.

Stochastic electrical stimulation of the thoracic or cervical regions with surface electrodes facilitates swallow in rats.

Aspiration pneumonia, a leading cause of mortality, poses an urgent challenge in contemporary society. Neuromuscular electrical stimulation (NMES) has been commonly used in dysphagia rehabilitation. However, given that NMES at motor threshold targets only specific muscles, it carries a potential risk of further compromising functions related to swallowing, respiration, and airway protection. Considering that the swallow motor pattern is orchestrated by the entire swallow pattern generator (the neural mechanism governing a sequence of swallow actions), a rehabilitation approach that centrally facilitates the entire circuit through sensory nerve stimulation is desirable. In this context, we propose a novel stimulation method using surface electrodes placed on the back to promote swallowing. The efficacy of the proposed method in promoting swallowing was evaluated by electrically stimulating sensory nerves in the back or neck. Probabilistic stimulus was applied to either the back or neck of male and female rats. Swallows were evoked by an oral water stimulus, and electromyographic (EMG) activity of the mylohyoid, thyroarytenoid, and thyropharyngeus muscles served as the primary outcome measure. Gaussian frequency stimulation applied to the skin surface of the thoracic back elicited significant increases in EMG amplitude of all three swallow-related muscles. Neck stimulation elicited a significant increase in EMG amplitude of the thyroarytenoid during swallow, but not the mylohyoid or thyropharyngeus muscles. While the targeted thoracic spinal segments T9-T10 have been investigated for enhancing respiration, the promotion of swallowing through back stimulation has not been previously studied. Furthermore, this study introduces a new probabilistic stimulus based on Gaussian distribution. Probabilistic stimuli have been reported to excel in nerve stimulation in previous research. The results demonstrate that back stimulation effectively facilitated swallow more than neck stimulation and suggest potential applications for swallowing rehabilitation.

Awareness of Rehabilitation Services Related to Dysphagia among Speech-language Pathologist

Abstract Background: Feeding is the process which includes preparation of food in the mouth, sucking, munching, and swallowing. Dysphagia is a difficulty in swallowing. Speech-language pathologist (SLP) has an important role in the evaluation and rehabilitation of dysphagia. Objective: The objective of the study was to carry out the survey on awareness of rehabilitation services related to dysphagia among SLPs. Methodology: Fifty SLPs who have completed postgradation and have minimum 1 year of experience were selected for the study. A questionnaire having 10 closed-ended questions related to dysphagia was given to the participants. Responses were collected and analyzed. Results: SLPs were working in the different setups and have seen different types of cases. They have used a variety of instruments and techniques for the assessment and management of dysphagia. Conclusion: SLPs are there to help in dysphagia rehabilitation that addresses the requirement of dysphagia management. Management of dysphagia is a developing trend in states and SLPs accept this new trend and accountability of rehabilitation with this population.

Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review.

The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS on both motor and other symptoms in stroke rehabilitation, its impact on functional ability, and potential side effects (PROSPERO number: CRD42022365697). A systematic electronic database search was performed by using PubMed Central (PMC), EMBASE, and Web of Science, with a cutoff date of November 2023. Data extracted included study details, NIBS methodology, outcome measures, and results. The risk of bias in eligible studies was also assessed. Twenty-two clinical studies involving 1016 participants were finally included, with a focus on outcomes related to post-stroke motor recovery (gait and balance, muscle spasticity, and upper limb dexterity) and other functions (dysphagia and aphasia). Positive effects were observed, especially on motor functions like gait and balance. Some efficiency was also observed in dysphagia rehabilitation. However, findings on language recovery were preliminary and inconsistent. A slight improvement in functional ability was noted, with no serious adverse effects reported. Further studies are needed to explore the effects of cerebellar NIBS on post-stroke non-motor deficits and to understand how cerebellar engagement can facilitate more precise treatment strategies for stroke rehabilitation.

Effects of effortful swallowing against kinesiology taping resistance on the swallowing function in patients with poststroke dysphagia: A randomized controlled trial.

A dysphagia rehabilitation method using kinesiology taping (KT) was recently introduced, and its potential for clinical efficacy was demonstrated by evaluating muscle activity and thickness. However, its effect on the swallowing function in patients with dysphagia remains unclear. This study aimed to investigate the effects of effortful swallowing against KT resistance on the swallowing function in patients with post stroke dysphagia. Thirty patients with poststroke dysphagia were recruited and randomly assigned to the experimental and placebo groups. In the experimental group, the KT was attached to the front of the neck (the hyoid bone between the sternum) with a tension of approximately 70% to 80%, and effortful swallowing was performed against the KT tension. In contrast, the placebo group performed effortful swallowing with KT applied at the same location without tension. The intervention was performed 30 times/day, 5 days/week for 6 weeks. The videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study were used to analyze oropharyngeal swallowing function. The experimental group showed statistically significant improvements in the oral and pharyngeal phases of the VDS (P = .029 and .007, respectively) and PAS (P = .034) compared with the placebo group. Effect sizes were observed for the oral (0.3) and pharyngeal phases (0.5) of the VDS and PAS (1.1). This study demonstrated that effortful swallowing against resistance to KT is an effective therapeutic exercise for improving the swallowing function in patients with poststroke dysphagia.

Effect of oral intake initiation-establishment interval on hospital stay after oral cancer surgery.

To clarify the effect of the period between initiation of oral intake (IOI) and establishment of oral intake (EOI) on length of hospital stay. This retrospective study included postoperative oral cancer patients. The number of days from surgery to IOI and EOI and between IOI and EOI were recorded. We performed intergroup comparisons and Cox regression analysis using the number of days until discharge, representing hospital stay length as the dependent variable. The median number of days between IOI and EOI was 3 days for eligible patients and 4.5 and 1.5 for older and younger patients, respectively. The median number of days from surgery to IOI was 15 days. There was a significant correlation between the period between IOI and EOI and the length of hospital stay (r = 0.40, p < 0.01). The period between IOI and EOI was a significant independent variable for the length of hospital stay (HR [95% confidence interval] = 0.45 [0.28-0.72]). Shortening the IOI to EOI intervals was identified as an independently associated factor for shortening hospital stay, even in older postoperative patients with dysphagia who struggled with early oral intake initiation. Professional, step-by-step dysphagia rehabilitation tailored to the patient's condition yields beneficial outcomes.