Dysphagia Rehabilitation Research Articles

Does What I Say Matter? Influence of Verbal Instruction on Bolus Size: Pilot Data

<h3>Research Objectives</h3> To evaluate the effects, if any, verbal instructions and delivery method may have on bolus size with self-administration of thin liquids. <h3>Design</h3> Prospective, randomized, repeated measure study. <h3>Setting</h3> Freestanding rehabilitation hospital. <h3>Participants</h3> Convenience sample of healthy adults with no history of dysphagia. <h3>Interventions</h3> Subjects were randomized into either the cup or straw group. Each subject consumed eight boluses of water under four different instructions: 1) Take a drink; 2) Take a comfortable sip; 3) Take a small sip: 4) Take a small sip like it is hot coffee. Order of instructions was randomized. Each subject had eight cups prepared (4 cups 60-ml water in 120-ml cup; 4 cups120-ml water in 240-ml cup). Subjects received new cup for each drink instruction. Ratio of liquid to cup size was the same between two cup sizes. <h3>Main Outcome Measures</h3> Bolus size extrapolated from weight of cup / water before and after each administration. <h3>Results</h3> Ten healthy subjects (5 men; 5 women), age range 22-58 years, mean age 39.3 years (SD=11.4 years) participated in the study. Overall, the differences between the mean volume consumed using various instructions were statistically significant (take a drink=28.80 ml; comfortable sip=14.35 ml; small sip=5.3 ml; small sip like it is hot coffee=3.01 ml; F=22.51, p≥.0001). Differences in mean volume consumed by cup size (i.e., 4-ounce cup vs. 8-ounce cup) were not statistically significant (p=.581). Differences in mean volume consumed by straw or cup presentation were not statistically significant (p=.914). <h3>Conclusions</h3> Results suggest verbal instruction has an influence upon bolus size with healthy adults with the semantic cue instruction (hot coffee) resulting in the lowest volume consumed. No differences were observed in amount consumed by cup size or straw vs. cup presentation. Reducing bolus size is a common clinical strategy to eliminate or reduce aspiration. It is important for the dysphagia rehabilitation team to understand the influence verbal instructions may have upon bolus size to facilitate a safe swallow. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interests to disclose.

Sensory neuromuscular electrical stimulation for dysphagia rehabilitation: A literature review.

Dysphagia is a common disorder following a cerebrovascular accident. It can cause detrimental effects on patient's quality of life and nutrition intake, especially in older adults. Neuromuscular electrical stimulation has been one of the management strategies for acceleration of the recovery. This review summarises the current evidence on sensory threshold stimulation of the procedure. This review compiled data from the Internet database PubMed, Cochrane Library and Scopus using combination of MeSH thesaurus: 'Sensory threshold', 'electrical stimulation', 'neuromuscular stimulation', 'Deglutition', 'Dysphagia'. Eleven studies were intergraded into the review. Most of the studies show significant improvement to the outcomes of sensory neuromuscular electrical stimulation treatment. In many cases, the results of the treatment are comparable or superior to motor threshold stimulation and conventional therapy. However, the study design and parameters of the procedure varied greatly without conclusive standardised guidelines. The sensory neuromuscular electrical stimulation (SNMES) is a viable treatment option for treating oropharyngeal dysphagia. The most suggested application parameters are an intensity at sensory threshold, a frequency of 80 Hz, an impulse time of 700 μs, a combined total duration of 20 h of stimulation in a 2-week period, and placing the electrodes in the submental area of the neck. However, further research is necessary to construct a definitive guideline for clinicians.

The Feasibility of Home-Based Treatment Using Vibratory Stimulation in Chronic Severe Dysphagia.

Previously, externally placed vibratory laryngeal stimulation increased rates of swallowing in persons with and without dysphagia. This study examined the feasibility of using a vibratory device on the skin over the thyroid cartilage for home-based swallowing rehabilitation in long-standing dysphagia. Only participants with long-standing dysphagia (> 6 months) following cerebrovascular accident or head/neck cancer who had not previously benefited from dysphagia therapy participated. The device had two modes used daily for 90 days. In automatic mode, participants wore the device when awake, which vibrated for 4-8 s every 5 min to trigger a volitional swallow. In manual mode, participants practiced by activating vibration while swallowing rapidly. Study-related adverse events, such as pneumonia, and device-recorded adherence were tracked. Swallowing function on a modified barium swallow study was assessed at baseline and after 3 months of device use. Outcome measures included the Dysphagia Outcome and Severity Scale (DOSS), Penetration-Aspiration Scale (PAS), and swallowing timing measures. Participants' perceptions of the vibratory device and training were obtained. The intent to treat analysis showed seven of 11 participants completed the study, all with severe chronic dysphagia. Of those seven participants completing the study, two developed respiratory complications (possibly due to pneumonia) that cleared after antibiotic intervention. For prescribed practice trials, adherence was 80% or greater in four of seven participants (57%) whereas prescribed automatic stimulations were met in only two of seven participants (29%). Three participants (43%) had a modest benefit on DOSS. The time to vestibule closure after the bolus passed the ramus was reduced in five participants (71%) on the modified barium swallow study. Overall, the results have indicated that intensive home-based practice with stimulation may provide limited functional benefits in severe chronic dysphagia. https://doi.org/10.23641/asha.21498591.

Application of Meta-Therapy to Dysphagia Rehabilitation

Purpose: Metatherapy is an important tool for practicing clinicians to implement when conducting dysphagia rehabilitation. Yet, few clinicians receive explicit training regarding how to implement metatherapy effectively with patients. As such, metatherapy skills are typically developed implicitly over time with experience. This tutorial will provide an overview of what metatherapy is and will provide instructions regarding how to implement metatherapeutic techniques for dysphagia rehabilitation by providing readers with a rehabilitation framework, case study examples, and techniques for conducting effective metatherapy. Conclusion: Dysphagia practitioners may use the framework and techniques provided in this tutorial to effectively implement metatherapy into dysphagia rehabilitation to enhance patient engagement in the therapy process and to improve patient outcomes and quality of life.

Nutritional Management in Adult Patients With Dysphagia: Position Paper From Japanese Working Group on Integrated Nutrition for Dysphagic People.

This position paper prepared by the Japanese Working Group on Integrated Nutrition for Dysphagic People (JWIND) aims to summarize the need for nutritional management in adult patients with dysphagia, the issues that nutrition professionals should address, and the promising approaches as well as to propose a vision for the future of nutritional care for adult patients with dysphagia. JWIND is a joint certification system recognized by the Japan Dietetic Association and the Japanese Society of Dysphagia Rehabilitation; its members are mostly experts known as "Certified Specialist of Registered Dietitian for Dysphagia Rehabilitation." Malnutrition and dysphagia are associated with each other. Therefore, malnutrition detection and intervention are essential for patients with dysphagia. However, evidence on the usefulness nutritional assessment and intervention to ensure appropriate nutritional care remains insufficient. Here, we present current knowledge of the relationship between primary diseases causing dysphagia and malnutrition, the indicators used for nutritional assessment, and nutritional interventions such as texture-modified diet (TMD) quality improvement, oral nutritional supplementation, and comprehensive intervention. We also discuss the current status and issues in nutritional care for adult patients with dysphagia. Furthermore, we have proposed measures that nutrition professionals should consider based on 3 perspectives: nutritional assessment, TMD, and nutritional intervention. Individualized and specialized nutritional management by registered dietitians (RDs) through appropriate assessment of the nutritional status of adult patients with dysphagia is needed. To maintain and improve swallowing function and nutritional status, RDs should intervene from the state of risk or early dysphagia onset, providing individualized care per their expertise as part of a multidisciplinary team. However, systematic clinical practice and research regarding the association of nutrition with dysphagia are currently insufficient. Therefore, further clinical practice and evidence building, including the verification of the efficacy on nutritional support through intervention research, are needed.

Swallowing outcome to speech therapy intervention in resistant hypertensive patients with obstructive sleep apnea.

PurposeTo evaluate (i) the outcome of swallowing therapy program on the rehabilitation of oropharyngeal dysphagia in resistant hypertensive patients with obstructive sleep apnea (OSA) and (ii) the association between the clinical and anthropometric characteristics of these individuals and this outcome.MethodsThis was a prospective interventional study in which resistant hypertensives diagnosed with OSA by polysomnography and dysphagia by fiberoptic endoscopic evaluation of swallowing (FESS) participated. All participants underwent a FEES and assessment of the risk of dysphagia (Eating Assessment Tool, EAT-10) and swallowing-related quality of life (Swal–QoL) before and after the intervention. The therapeutic program was performed daily by the participants, with weekly speech-therapist supervision for eight weeks, including the following strategies: Masako, chin tuck against resistance, and expiratory muscle training.ResultsA total of 26 (78.8%) of the participants exhibited improvement in the degree of dysphagia in the intervention outcome. After the intervention, there was a statistically significant improvement in the level of penetration–aspiration (p = 0.007), the degree of pharyngeal residue (p = 0.001), the site of onset of the pharyngeal phase (p = 0.001), and the severity of dysphagia (p = 0.001) compared to before intervention. The EAT-10 score was 2 (0–6) before and 0 (0–3) after intervention (p = 0.023). Swal–QoL had a score on the symptom frequency domain of 92.8 (75–100) before and 98.2 (87.5–100) after intervention (p = 0.002).ConclusionsResistant hypertensive patients with OSA showed improved swallowing performance after swallowing therapy program.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00405-022-07612-3.

“Response to Treatment” in Dysphagia Rehabilitation: Factors for Consideration in Clinical Practice and Future Research

Purpose: Some patients experience dysphagia that is not responsive to treatment. Despite application of appropriate evidence-based interventions, decreased swallow safety and/or efficiency persists. In order to provide the best opportunity for therapeutic efficacy, it is important to attempt to identify and characterize source of nonresponse. The definition of “nonresponse” will likely vary based on each patient depending on etiology and patient-specific goals. The purpose of this article is to outline some potential sources for patient nonresponse to dysphagia rehabilitation. We also aim to identify gaps in the literature that should be addressed in future research, to both further our understanding of nonresponse to dysphagia therapies and to better understand how to address nonresponse to improve patient outcomes. Method: Several potential sources of nonresponse are described, and specific areas of dysphagia rehabilitation research that require further investigation are discussed. Results: Based on available evidence, several sources of nonresponse to treatment are possible. First, application of interventions that are nonspecific to visualized impairments in swallow physiology could result in lack of treatment response. Patient population and etiology of dysphagia should also be considered when selecting a treatment approach to ensure that the available evidence supports use of that approach within the specific patient group. Patient adherence with rehabilitation protocols may affect response to treatment, although effects of adherence on dysphagia therapy efficacy are not fully understood. Furthermore, optimal dosing protocols to maximize benefit from rehabilitation approaches have not been fully appreciated in the literature. Conclusions: Understanding sources of nonresponse to treatment in dysphagia rehabilitation is multifaceted. Use of current literature to guide practice and therapy planning will help maximize patient benefit. However, in cases where the reason for nonresponse cannot be identified, it may be that the source lies in an area of dysphagia rehabilitation that has yet to be fully explored, including therapy dose and patient adherence among others.

Effect of Peripheral Magnetic Stimulation for Dysphagia Rehabilitation: A Systematic Review.

Recently, a therapeutic method to stimulate the suprahyoid muscle using peripheral magnetic stimulation for dysphagia rehabilitation has been reported. However, clinical evidence, application protocol, and intervention method remain unclear. Therefore, a systematic review of the published literature is needed. The objective of this study was to systematically review clinical studies of peripheral magnetic stimulation applied for rehabilitation of dysphagia. Issues to be considered in future studies are also suggested. This systematic review performed a literature search of four databases (Medline, Embase, CINAHL, and Web of Science) to identify relevant studies published on the application of repetitive peripheral magnetic stimulation (rPMS) for swallowing-related muscles between 2010 and 2022. Seven studies were reviewed. Randomized controlled trials and one-group pre–post, case study designs were included. In the included studies, rPMS was applied to strengthen the submental suprahyoid muscles. The intervention regime varied. The rPMS was applied at a frequency of 30 Hz for 2 s. Rest time ranged from 8 s to 27–28 s. The number of intervention sessions ranged from 2–3 to 30. The intensity ranged from pain-inducing minimum intensity (90% of maximum stimulus output) to non-painful intensity (70–80% of maximum intensity). The rPMS on the suprahyoid muscles had positive effects on physiological changes in the swallowing function, such as displacement of the hyoid bone, muscle strength (cervical flexor, jaw-opening force), swallowing safety, swallowing performance, and swallowing-related quality of life. Participants also reported little pain and adverse reactions during rPMS. Although rPMS is a therapeutic option that can help improve the swallowing function as a non-invasive stimulation method in the rehabilitation of dysphagia, clinical evidence is needed for the development of clear stimulation protocols and guidelines.

Door-to-oral time and in-hospital outcomes in older adults with aspiration pneumonia undergoing dysphagia rehabilitation

Aspiration pneumonia (AP) is a public health concern among older adults. Previous studies have reported the association between oral intake initiation within 48h after hospital admission and better in-hospital outcomes among patients with AP. We investigated the association between initiation of oral intake within 24h and in-hospital outcomes of older patients with AP undergoing dysphagia rehabilitation. This retrospective cohort study was conducted from April 2015 to September 2020. Door-to-oral time (D2O) was defined as the time from hospital arrival to the first oral intake and was divided into early (within 24h), middle (between 24 and 48h), and late (over 48h). We examined the associations between D2O and in-hospital outcomes: discharge with oral intake (by logistic regression analysis), length of stay, and days from the first oral intake to discharge (by fitting the general linear models with robust variance estimation). Among the 398 patients with AP, 142 (35.7%) were classified into early, 111 (27.9%) into middle, and 145 (36.4%) into late groups. Compared with the late group, we found insufficient evidence that early D2O was associated with a greater likelihood of discharge with oral intake (adjusted odds ratio=1.09; 95% confidence interval [95% CI]: 0.50 to 2.38). The early group was associated with a shorter length of stay (adjusted length difference [aLD]=-7.14 days; 95% CI:-10.80 to-3.42) but not with shorter days from first oral intake to discharge (aLD=-3.34 days; 95% CI:-6.91 to 0.24). While D2O within 24h among patients with AP was not associated with a decreased likelihood of discharge with oral intake, it was associated with a shorter length of stay. To improve outcomes without compromising the quality of AP care, early oral intake should be decided based on careful swallowing function assessment.

Impact of Dysphagia Rehabilitation in Adults on Swallowing Physiology Measured With Videofluoroscopy: A Mapping Review.

The research aims of this review were to (a) map swallowing rehabilitation approaches to specific swallowing impairments using the Modified Barium Swallow Impairment Profile (MBSImP) to develop evidence maps, (b) match desired rehabilitation treatment targets to treatment approaches, and (c) identify gaps in the literature and highlight which rehabilitation approaches require further investigation to support accurate mapping of interventions to physiologic change. A mapping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review extension framework. The databases searched were CINAHL, Ovid Medline, and Ovid Embase. Data extracted included swallowing rehabilitation approach details via the Rehabilitation Treatment Specification System framework, study characteristics, and resulting change in swallowing physiology. The resulting change in swallowing physiology was mapped onto MBSImP components, where applicable, and effect sizes were reported where data were available. Extracted data were summarized in the form of evidence maps. Forty-three unique articles met the inclusion criteria for this review and were divided into single-approach and multi-approach exercise studies. Within single-approach studies, 13 different exercise approaches were investigated, and 117 outcome measures could be mapped to MBSImP components. Within multi-approach studies, 13 different combinations of exercise approaches were investigated and 60 outcome measures could be mapped to MBSImP components. This review supports speech-language pathologists in incorporating current best evidence into their practice, as it found there is potential for improvement in many MBSImP components by using rehabilitative exercises. In the future, more intervention studies are needed to ensure that recommended rehabilitation approaches are beneficial for improving the targeted swallowing physiology.

Possible Impact of Mylohyoid Muscle Architecture on Reduced Hyolaryngeal Elevation

One of the most important problems in swallowing function is the risk of inadequate airway closure and aspiration. Insufficient hyolaryngeal elevation during swallowing is one of the reasons for this risk. Suprahyoid (SH) muscles are fundamental structures responsible for hyolaryngeal elevation. Inadequate activation of SH muscles causes insufficient and reduced hyolaryngeal elevation. Reduced hyolaryngeal elevation causes insufficient opening of the upper esophageal sphincter (UES), leading an increase in the amount of pharyngeal residue and a risk of aspiration. Superior hyolaryngeal excursion during swallowing contributes to airway protection and prevention of aspiration. Anterior hyolaryngeal excursion is related to the UES opening and its crucial for the safe transition of bolus to esophagus without aspiration. Our study hypothesized that the long sarcomere length of mylohyoid muscle could be a contributing or responsible factor to the reduction in the hyolaryngeal elevation. There is no study on the pathophysiology on sarcomere properties of reduced hyolaryngeal elevation. Reduced hyolaryngeal elevation emerges as a symptom that reveals the cause of aspiration. Explaining the potential mechanism of reduction in hyolaryngeal elevation may contribute to the development of new treatment approaches based on architectural features in dysphagia rehabilitation practices. Furthermore, based on our hypothesis, we recommend new therapy approaches that may contribute to reducing the hyolaryngeal elevation.

Usefulness of Telemedicine for Disabled Children Receiving Feeding Therapy

We performed a retrospective cohort study using medical records of 374 pediatric patients who visited a university dental clinic specializing in dysphagia rehabilitation in Japan between 2019 and 2020 to clarify the usefulness of telemedicine among disabled children receiving feeding therapy. The primary outcome was the feeding developmental stage confirmed at the final evaluation. Propensity score matching was performed between individuals in two treatment groups (in-person and telemedicine) before the final analysis using patients’ age, sex, primary disease, gross motor function, and feeding developmental stage as covariates. A total of 36 patients were enrolled in each of the in-person and telemedicine groups. The initial evaluation for the propensity score matched population using the χ2 test showed no significant difference between the two groups in any parameter. The feeding developmental stage evaluated at the final evaluation using the Wilcoxon signed-rank test significantly improved compared with the stage at the initial evaluation in both groups (in-parson group, p = 0.007; telemedicine group, p = 0.013). The difference in level achieved at the final evaluation revealed that the most common level was “unchanged,” followed by “improvement by one level” in both groups, indicating that there was no significant difference in the efficacy of feeding therapy between the two groups (p = 0.314). Our results show that telemedicine can achieve the same therapeutic outcomes as in-person therapy to improve feeding function in children with disabilities when receiving feeding therapy.

Evaluating the effectiveness of stepwise swallowing training on dysphagia in patients with Alzheimer’s disease: study protocol for a randomized controlled trial

BackgroundThe high prevalence of dysphagia among Alzheimer’s disease (AD) patients has become a public health and economic concern. Therefore, effective and accessible dysphagia treatments are needed. As a fundamental rehabilitation of dysphagia, swallowing muscle exercises have received increased attention. Stepwise swallowing training (SST), integrated with all swallowing organs movement, is expected to improve swallowing dysfunction among AD patients. By using a randomized controlled trial design, we propose a multi-center research to evaluate the effectiveness of SST program among AD patients.MethodsA multi-center exploratory randomized controlled trial, with a 4-week follow-up period, will be conducted in three major public psychiatric hospitals in Guangdong, China. Participants in the control group will be assigned to routine dysphagia care, while participants in the intervention group will undergo the same nursing care and additionally receive the SST program. The SST program includes five sections of swallowing organs training: lip movement, facial movement, tongue movement, mandibular movement, and neck movement. Primary outcomes evaluate the swallowing function, namely, Water Swallowing Test (WTS) and Standard Swallowing Assessment (SSA). Secondary outcomes aim at measuring the improvement of negative impacts of dysphagia, namely eating behavior, ability of daily activity, and nutritional status. Data will be collected at baseline (T1), at 2 weeks (T2, intervention), and 4 weeks after intervention (T3, follow-up).DiscussionThis study will offer trial-based evidence of the effectiveness of SST in relieving dysphagia among AD patients. SST program is expected to improve both the swallowing function and reduce the negative impacts of dysphagia, with an exploration of acceptability in the SST program.Trial registrationChinese Clinical Trial Registry, ChiCTR2200056481. Prospectively registered on 6 February 2022.

Comparing amplitudes of transcranial direct current stimulation (tDCS) to the sensorimotor cortex during swallowing.

Transcranial direct current stimulation (tDCS) can alter cortical excitability, making it a useful tool for promoting neuroplasticity in dysphagia rehabilitation. Clinical trials show functional improvements in swallowing following anodal tDCS despite varying dosing parameters and outcomes. The aim of the current study was to determine the most effective amplitude criterion (e.g., 0mA [sham/control], 1mA, 2mA) of anodal tDCS for upregulating the swallowing sensorimotor cortex. As a novel paradigm, tDCS, functional near-infrared spectroscopy (fNIRS), and surface electromyography (sEMG) were simultaneously administered while participants completed a swallowing task. This allowed for measurement of the cortical hemodynamic response and submental muscle contraction before, during, and after tDCS. At the conclusion of the study, participants were asked to rate their level of discomfort associated with tDCS using a visual analog scale. There was no significant difference in the hemodynamic response by time or amplitude. However, post-hoc analyses indicated that in the post-stimulation period, changes to the hemodynamic response in the left (stimulated) hemisphere were significantly different for the groups receiving 1mA and 2mA of tDCS compared to baseline. Participants receiving 1mA of tDCS demonstrated reduced hemodynamic response. There was no significant difference in submental muscle contraction during or after tDCS regardless of amplitude. Anodal tDCS was well tolerated in healthy adults with no difference among participant discomfort scores across tDCS amplitude. During a swallowing task, healthy volunteers receiving 1mA of anodal tDCS demonstrated a suppressed hemodynamic response during and after stimulation whereas those receiving 2mA of anodal tDCS had an increase in the hemodynamic response. tDCS remains a promising tool in dysphagia rehabilitation, but dosing parameters require further clarification.

Clinical Statistics of Dysphagia Rehabilitation Provided on Dental Visits to a Partner Hospital.

Maintaining oral hygiene is an important yet often neglected aspect of rehabilitation medicine. Our visiting dental team, which provides dental treatments and swallowing rehabilitation, partnered with a medical hospital that had no dental department and began visiting and treating inpatients at this hospital. This study is aimed at evaluating the effects of dysphagia rehabilitation, and this was jointly conducted by medical and dental hospitals. The survey was conducted between May 2017 and March 2018. We retrospectively examined dysphagia rehabilitation provided to 25 patients (12 men and 13 women) aged 40–92 years (mean age: 77.1 ± 12.3 years). The largest number of requests for dental treatment was received from the internal medicine department (13 requests, 52.0%). A total of 39 videofluoroscopic or videoendoscopic examinations of swallowing interventions for dysphagia rehabilitation were conducted. All patients' oral and swallowing functions were evaluated using the functional oral intake scale (FOIS). At initial assessment, 9, 13, and 0 patients were at FOIS levels 1, 2, and 3 (use of tube feeding), respectively, and 1, 2, and 0 patients were at FOIS levels 4, 5, and 6 (only oral feeding), respectively. At the final assessment, 6, 10, and 4 patients were at FOIS levels 1, 2, and 3, respectively, and 0, 2, and 3 patients were at FOIS levels 4, 5, and 6, respectively. Oral and swallowing functions differed significantly between the first and final visits (p = 0.02). Visits conducted by a team of oral health practitioners to a medical hospital without a dental department appear to have a major impact and will become even more important in the future.

Effects of vitamin C stimulation on rehabilitation of dysphagia after stroke: a randomized trial.

Stroke is a clinical syndrome of localized or global brain dysfunction caused by cerebrovascular disease. The aim of this study was to explore the effect of vitamin C acid stimulation on the rehabilitation process, Nourishment State Index and immune function indicators of stroke patients with dysphagia. This is a prospective cohort study. This study was conducted at our hospital. We analyzed stroke patients with dysphagia. A total of 120 stroke patients with dysphagia were randomly divided into a routine group and a test group, with 60 cases in each group. Routine swallowing training was performed in the routine group, and the test group was stimulated with vitamin C acid. The water swallow test (WST) and video fluoroscopic swallowing study (VFSS) were used to compare the rehabilitation of dysphagia in the two groups. Nourishment State Index was evaluated by BMI, serum albumin, total serum protein and hemoglobin. Immune Function Index was evaluated by IgA, IgM and IgG. Compared with the control group, the WST level of patients treated with vitamin C acid stimulation intervention were significantly reduced, and the VFSS score were significantly increased. Serum levels of hemoglobin, albumin, total protein, IgA, IgM and IgG in the vitamin C acid stimulation group were remarkably increased than those in the control group. Vitamin C acid stimulation exhibits a good application effect in patients with dysphagia after stroke. Moreover, vitamin C acid stimulation can further improve the nutritional status and immune function after stroke and promote postoperative recovery of patients. Therefore, we believe that vitamin C stimulation therapy can be widely used in stroke rehabilitation management. Vitamin C acid stimulation significantly improves rehabilitation of stroke patients with dysphagia and ameliorates the nutritional status and immune function of patients.

Reliability of the Penetration-Aspiration Scale and Temporal and Clearance Measures in Poststroke Dysphagia: Videofluoroscopic Analysis From the Swallowing Treatment using Electrical Pharyngeal Stimulation Trial.

Information on reliability of outcome measures used to assess the effectiveness of interventions in dysphagia rehabilitation is lacking, particularly when used by different research groups. Here, we report on reliability of the penetration-aspiration scale (PAS) and temporal and clearance measures, determined using videofluoroscopy. Secondary analysis used videofluoroscopies from the Swallowing Treatment using Electrical Pharyngeal Stimulation trial in subacute stroke. PAS scores (719 scores from 18 participants) were evaluated and compared to the original PAS scores from the trial. Five conditions were assessed, including reliability for every swallow and overall mean of the worst PAS score. Operational rules for assessing temporal and clearance measures were also developed using the same data, and reliability of these rules was assessed. Reliability of component-level and derivative-level scores was assessed using the intraclass correlation coefficient (ICC) and weighted kappa. Image quality was variable. Interrater reliability for the overall mean of the worst PAS score was excellent (ICC = .914, 95% confidence interval [CI] [.853, .951]) but moderate for every swallow in the bolus (ICC = .743, 95% CI [.708, .775]). Intrarater reliability for PAS was excellent (all conditions). Excellent reliability (both inter- and intrarater > .90) was seen for temporal measures of stage transition duration (ICC = .998, 95% CI [.993, .999] and ICC = .995, 95% CI [.987, .998], respectively) as well as initiation of laryngeal closure and pharyngeal transit time and all individual swallow events. Strong scores were obtained for some clearance measures; others were moderate or weak. Interrater reliability for PAS is acceptable but depends on how the PAS scores are handled in the analysis. Interrater reliability for most temporal measures was high, although some measures required additional training. No clearance measures had excellent reliability. https://doi.org/10.23641/asha.19090088.

Effectiveness of repetitive transcranial magnetic stimulation on poststroke dysphagia: a meta-analysis of randomized-controlled trials.

Dysphagia is a common functional impairment after stroke, resulting in aspiration of liquids, ingested foods, or oral secretions and influencing the quality of life. Noninvasive repetitive transcranial magnetic stimulation has been widely used for rehabilitation of dysphagia. The purpose of this meta-analysis was to investigate the efficacy of repetitive transcranial magnetic stimulation on poststroke swallowing impairment. Four databases were systematically searched for eligible studies from their inception to 31 September 2021. Review Manager 5.4 software was used for this meta-analysis. The bias of included randomized controlled trials was assessed using the version 2 of the Cochrane risk-of-bias tool for randomized trials. Nine randomized controlled trials involving 393 patients were included according to the selection criteria. The results revealed significant benefit of repetitive transcranial magnetic stimulation as a treatment of dysphagia following the onset of stroke, when compared with intervention without repetitive transcranial magnetic stimulation. Applying repetitive transcranial magnetic stimulation on different stimulation sites effectively improved the dysphagia of poststroke patients, and no significant difference was observed among the different stimulation sites subgroups. Our findings support repetitive transcranial magnetic stimulation as an effectively treatment of the poststroke dysphagia, especially in unilateral hemispheric stroke patients.

Clinical profile and recovery pattern of dysphagia in the COVID-19 patient: A prospective observational cohort within NSW

BackgroundThe impact of COVID-19 on swallowing function is not well understood. Despite low hospital admission rates in Australia, the virus and subsequent treatment affects swallow function in those requiring intensive care unit (ICU) treatment. As such, the current pandemic provides a unique opportunity to describe swallowing function and outline dysphagia characteristics and trajectory of recovery for a series of cases across NSW. AimThe aims of this study were to describe (i) physiological characteristics of swallowing dysfunction and (ii) pattern of swallowing recovery and outcomes, in ICU patients with COVID-19. MethodsAll patients admitted to 17 participating NSW Health ICU sites over a 12-month period (March 2020–March 2021), diagnosed with COVID-19, treated with the aim for survival, and seen by a speech pathologist for clinical swallowing examination during hospital admission were considered for inclusion. Demographic, critical care airway management, speech pathology treatment, and swallowing outcome data were collected. ResultsTwenty-seven patients (22 male; 5 female) with a median age of 65 years (interquartile range [IQR] = 15.5) were recruited. All required mechanical ventilation. Almost 90% of the total cohort had pre-existing comorbidities, with the two most frequently observed being diabetes (63%, 95% confidence interval = 44%–78%) and cardiac disease (59%, 95% confidence interval = 40%–75%) in origin. Prevalence of dysphagia was 93%, with the majority (44%) exhibiting profound dysphagia at the initial assessment. Median duration to initiate oral feeding was 38.5 days (IQR = 31.25) from ICU admission, and 33% received dysphagia rehabilitation. Dysphagia recovery was observed in 81% with a median duration of 44 days (IQR = 29). Positive linear associations were identified between duration of intubation, mechanical ventilation, hospital and ICU length of stay, and the duration to speech pathology assessment (p < 0.005), dysphagia severity (p < 0.002), commencing oral intake (p < 0.02), dysphagia recovery (p < 0.004), and enteral feeding (p < 0.024). ConclusionCOVID-19 considerably impacted swallowing function in the current study. Although many patients recovered within an acceptable timeframe, some experienced persistent severe dysphagia and a protracted recovery with dependence on enteral nutrition.

Dysphagia rehabilitation in post-COVID patients: Review of the literature

Dysphagia rehabilitation in post-COVID patients: Review of the literature