Functional Oral Intake Research Articles

Validation of the Polish version of the Functional Oral Intake Scale against flexible endoscopic evaluation of swallowing and the International Dysphagia Diet Standardization Initiative Functional Diet Scale

IntroductionThe Functional Oral Intake Scale (FOIS) is a widely used instrument for assessing oral intake in dysphagic patients. Despite its frequent use, a validated version for the Polish population has been lacking.MethodsThis study aimed to validate the Polish adaptation of FOIS (FOIS-PL) by examining its concordance with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) outcomes and the International Dysphagia Diet Standardization Initiative Functional Diet Scale (IDDSI-FDS) scores across patients with diverse clinical profiles. The primary outcome measures included the Penetration-Aspiration Scale (PAS) score from FEES, pharyngeal residue quantification, and IDDSI-FDS scores. A total of 302 participants with varying clinical conditions were recruited. The cohort included individuals with head and neck malignancies, cerebrovascular incidents, neuromuscular disorders, and other dysphagia aetiologies.ResultsPatients with gastroesophageal reflux disease and those post-thyroidectomy consistently exhibited oral food intake with a FOIS-PL score of ≥5. A strong inverse correlation was found between FOIS-PL scores and PAS scores (rho = −0.739; p < 0.001), indicating that reduced oral intake was associated with increased penetration or aspiration risk. Significant differences in FOIS-PL scores were evident across patient subgroups stratified by PAS severity (PAS ≤ 2, PAS 3–5, PAS > 5) and IDDSI levels. Lower FOIS-PL scores corresponded with more impaired swallowing safety (PAS > 5). The median FOISPL score was 5 for individuals with pharyngeal residue and 6 for those without (p < 0.001). Inter-rater reliability between evaluations conducted by a dietitian (FOIS I) and a speech-language pathologist (FOIS II) demonstrated high consistency (tau = 0.995; p < 0.001). Convergent validity was supported by strong correlations between FOIS-PL and IDDSI-FDS scores (FOIS I vs. IDDSI-FDS I: tau = 0.819; p < 0.001; FOIS II vs. IDDSI-FDS II: tau = 0.815; p < 0.001).ConclusionThe Polish version of the Functional Oral Intake Scale (FOIS-PL) is a valid and reliable tool for assessing oral intake in dysphagia. The findings demonstrate high accuracy, reliability, and validity, supporting its use across diverse clinical conditions.

Effect of artificial intelligence-based video-game system on dysphagia in patients with stroke: A randomized controlled trial.

Post-stroke dysphagia is highly prevalent and causes complication. While video games have demonstrated potential to increase patient engagement in rehabilitation, their efficacy in stroke patients with dysphagia remains unclear. This aim of this study was to explore the effectiveness of the artificial intelligence-based video-game (AI-VG) intervention in improving swallowing function among stroke patients with dysphagia. A prospective, single blinded, randomized controlled trial (RCT) was conducted in a rehabilitation hospital from October 2023 to July 2024. Participants were randomly assigned to either the AI-VG system group or the usual care group. All participants received training for 30min per session per day, five times per week for 4 weeks. The primary outcome was change in swallowing function from baseline (T0) to post-intervention (T1) and 1 month follow-up (T2). Secondary outcomes included changes in laryngeal function, oral intake function, nutritional status, and swallowing-related quality of life. The adherence, satisfaction, and acceptance of the two groups were evaluated. Changes in outcomes over time were compared using generalized estimating equation modeling. A total of 84 participants (AI-VG group=42, age=65.00±9.70 years, 57.10% male; usual care group=42, age=66.40±13.10 years, 69.00% male) were included in this study. Compared with the usual care group, the AI-VG group showed significantly improved swallowing function, with a mean group difference of 4.02 (95% CI=from-6.16 to-1.89, P<0.001) at T1 and 4.14 (95% CI=from-6.16 to 2.12, P<0.001) at T2. Oral intake function, nutritional status, and swallowing-related quality of life improved significantly (P<0.001 for overall group×time interaction). Adherence was significantly higher in the intervention group than in the control group (median [IQR], 18.00 [17.00-20.00] vs. 16.00 [15.00-17.00], P<0.001). The intervention group had higher levels of acceptance and satisfaction of AI-VG (103.00 [100.50-104.00] and 73.00 [72.00-74.00], respectively). No significant difference was observed in laryngeal function (P>0.05). The AI-VG intervention is an effective method for enhancing swallowing function in patients with post-stroke dysphagia. Future validation through multicenter, large-sample RCTs are warranted to confirm the findings and explore broader clinical applications. ClinicalTrials. Gov Identifier: NCT05978700, https://clinicaltrials.gov/study/NCT05978700.

Volume-viscosity swallow test to facilitate individualized dietary modifications for dysphagia following intracerebral hemorrhage.

This study examined the effects of individualized dietary modifications based on the volume-viscosity swallow test (V-VST) on functional oral intake, incidence of pneumonia, and swallowing-related quality of life in individuals with intracerebral hemorrhage. One hundred and seven participants with signs of dysphagia in the acute and early subacute phases of stroke following intracerebral hemorrhage were randomly assigned into an experimental group for individualized dietary modifications based on V-VST plus routine standard care (n = 53), and a control group for routine care alone (n = 54). Incidence of pneumonia, functional oral intake scale (FOIS) ratings and Eating Assessment Tool (EAT-10) scores before and after intervention were evaluated. A significantly lower incidence of pneumonia was found in the experimental group than in the control group (p < 0.05). Significant group differences were found in functional oral intake and in quality of life, with significantly higher FOIS ratings and significantly lower EAT-10 scores in the experimental group post-intervention (p < 0.001). These findings suggested that despite being a noninstrumental screening tool, V-VST could facilitate individualized dietary modifications and could be an effective clinical option for reducing the risk of pneumonia, improving functional oral intake and enhancing quality of life in individuals with dysphagia following intracerebral hemorrhage. Future studies should explore how dietary modifications could be more precisely implemented based on the International Dysphagia Diet Standardization Initiative framework.

Can invasive interventions be avoided with a holistic swallowing therapy program in older patients in intensive care units: percutaneous endoscopic gastrostomy tubes or oral intake?

The use of percutaneous endoscopic gastrostomy (PEG) tubes in older patients did not show any benefits in terms of survival, improvement in quality of life, or reduction in aspiration pneumonia. Significant gaps exist regarding the evidence for the evaluation and management of dysphagia in older patients. This study aimed to diagnose swallowing disorders and highlight the importance of swallowing therapy in older patients in intensive care units (ICUs). Twenty-five older patients (12 men, 13 women, mean age 67.22 ± 24.03 years) hospitalized in the ICUs with complaints of dysphagia were analyzed prospectively. The 12 weeks (14-16 sessions) of swallowing therapy were administered to patients with dysphagia who signed the (voluntary) consent form. The bedside water swallowing test (BWSS), Functional Oral Intake Scale (FOIS) Score, Clinical Swallowing Evaluation, Mini Nutritional Assessment Test (MNAT), Eating Assessment Tool (EAT-10), the Turkish version of the World Health Organisation Quality of Life Scale Elderly Module, and the Swallowing Therapy Programme Protocol were applied. Pretherapy stage (T1) and post-therapy stage (T2) results were compared with videofluoroscopy swallowing study (VFSS) recordings with thin liquids, moderately thick liquids, extremely thick liquids, and crackers (International Dysphagia Diet Standardization Initiative [IDDSI] Levels 0, 3, 4, and 7, respectively). The World Health Organisation Quality of Life Scale Elderly Module (WHOQOL-OLD) raw scores significantly improved from T1 (38.63 ± 7.05) to T2 (73.07 ± 4.82). The bedside water swallowing test results demonstrated statistically significant differences in therapy timings among older patients (p < 0.001). There were significant improvements in swallowing physiology, as represented by the improved oral and pharyngeal composite scores of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scala (PAS) levels. Before therapy, all patients exhibited high rates of oropharyngeal residue with thin liquids and spoon-thick pudding viscosities (MNA ≤ 17). The results reported in the present study show that malnutrition risk is linked to a poorer QoL in older patients on admission to ICUs. Statistical analyses revealed the dominant effects of functional status and eating-related factors on QoL in this group. Early dysphagia diagnosis of older patients and subsequent application of exercise-based swallowing therapy increase the quality of life of patients. In this study, exercise-based swallowing therapy was developed in Turkey and can be used in older patients as part of a holistic cognitive-communication-swallowing intervention program. Results prove the effectiveness of the developed exercise-based swallowing therapy on the cognitive-communication-swallowing skills of older patients. The present findings reinforce the role of nutrition as a priority for improving patients' perceptions of QoL. Further studies are required to investigate and identify the interventions that improve QoL in older patients. More studies with better research designs are required to establish whether nutritional intervention is effective in enhancing QoL in this vulnerable group.

Nutritional Profiles and Factors Associated with the Intake of Certain Food Types in Patients Undergoing Maxillofacial Prosthetic Rehabilitation: A Cross-Sectional Study.

Background: Malnutrition is a significant concern for head and neck cancer (HNC) patients, as treatment often impairs mastication, causes dysphagia, and alters taste and smell, leading to reduced food intake and a diminished quality of life. Thus, this study aims to compare nutritional intake in HNC survivors using maxillofacial prostheses (MFPs) to healthy reference values and identify the factors influencing their dietary intake. Methods: The study included 56 patients treated for HNC undergoing rehabilitation with comfortable definitive dentures for over a month at the Maxillofacial Prosthetics Clinic of Tokyo Medical and Dental University Hospital. Data were gathered on the demographics, clinical characteristics, malnutrition risk using a malnutrition universal screening tool, dietary intake consistency via a functional oral intake scale, swallowing difficulties with eating assessment tool-10, and nutrient intake through a Brief-type Self-administered Dietary History Questionnaire. Patients' nutrient intakes were compared to the reference values from the BDHQ ad hoc computer algorithm based on the 2015 National Health and Nutrition Survey in Japan. Factors such as maximum mouth opening and the number of functional teeth were also assessed together with the aforementioned factors. Results: There were significant differences between the patient values and reference values, with lower intakes of total dietary fiber, carbohydrates, and β-carotene, while higher intakes of calcium, fats, and certain vitamins were noted in the patients. Food intake consistency, swallowing difficulties, and mouth opening significantly influenced green vegetable intake, whereas sex and the number of functional teeth impacted cereal intake. Conclusions: The HNC survivors were rehabilitated with MFP; however, their nutritional intake differed from that of healthy subjects. The significance of swallowing rehabilitation, appropriate food preparation, exercises to enhance mouth opening, and the preservation of functional teeth has been emphasized as critical factors influencing diet in head and neck cancer (HNC) survivors. Additionally, the importance of a multidisciplinary approach to nutritional care for these individuals is underscored.

Nutritional changes in patients undergoing hemodialysis who develop COVID-19

BackgroundCoronavirus disease 2019 (COVID-19) is known to deteriorate nutrition in the general population. However, the influence of COVID-19 on the nutritional status of patients undergoing maintenance hemodialysis remains unclear.MethodsA retrospective study was conducted in a hospital that had an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. COVID-19 was diagnosed using an antigen test, and the subjects were divided into COVID-19 and control groups. Data on body mass index, biochemistry measurements, geriatric nutritional risk index (GNRI), functional oral intake scale, and nutritional intake were collected from medical records. A generalized linear mixed model was used to analyze the interaction of time × group for these parameters between the two groups.ResultsThe study included 28 participants, 16 of whom belonged to the COVID-19 group. There were no significant differences in baseline characteristics, except for serum creatinine level, among the groups. In the COVID-19 group, 63% exhibited anorexia and 50% experienced vomiting/nausea. Nutritional support or dietary consultations were provided to nine patients. Significant declines were observed in serum albumin level, total iron binding capacity, energy intake, and GNRI in the COVID-19 group, and these nutritional parameters recovered within 1 month following the resolution of the infection.ConclusionsCOVID-19 deteriorated nutritional status in patients undergoing hemodialysis. More proactive nutritional support may help maintain the nutritional status of patients undergoing hemodialysis during COVID-19 infection and could lead to a better prognosis.

Effect of pre-hospital living setting on nutritional intake route upon discharge in older adults with aspiration pneumonia: a prospective cohort study

BackgroundAspiration pneumonia, which often recurs due to dysphagia, worsens as patients move between homes, facilities, and hospitals. The impact of pre-hospital living setting on oral intake at discharge remains unclear. The purpose of this study was to identify the effects of the pre-hospital living setting on the nutritional intake route upon discharge in older patients with aspiration pneumonia.MethodsThis prospective cohort study included patients aged ≥ 65 years who were admitted to an acute care hospital and diagnosed with aspiration pneumonia. Patients were followed up until discharge or death during hospitalisation. Patient demographic information, pre-hospital living setting (home or nursing facility), functional oral intake scale (FOIS) score, pneumonia severity index, clinical frailty scale score, history of aspiration pneumonia, and pneumonia recurrence during hospitalisation were recorded. Binary logistic regression was used to assess the impact of the pre-hospital living setting on oral intake at discharge as the primary outcome.ResultsAmong the 89 included patients (52 males (58.4%); mean age, 84.8 ± 7.9 years), 39.3% (n = 35) had pneumonia recurrence during hospitalisation. The average follow-up period was 44.0 ± 36.6 days. The pre-hospital living setting was independently associated with the nutritional intake route upon discharge (odds ratio = 7.72, 95% confidence interval (95%CI) = 1.70–35.1, p = 0.008).ConclusionsThe pre-hospital living setting could serve as a good indicator of the nutritional intake route upon discharge. It is essential to optimize care in both nursing facilities and hospital settings when caring for older patients with aspiration pneumonia.

Submandibular Gland Flap Reconstruction for Oropharyngeal Defects After Transoral Robotic Surgery (TORS)

ABSTRACTBackgroundTo describe utilization and outcomes of submandibular gland flap (SGF) reconstruction after transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC).MethodsA multi‐institutional retrospective case series of patients who underwent TORS for OPSCC followed by SGF reconstruction with harvest via transcervical approach from 1/1/2016 to 4/1/2023.ResultsIn total, 14 patients underwent SGF reconstruction after TORS for OPSCC. All patients had HPV‐positive disease, predominantly in early local (N = 10 with pT1/pT2 disease, 71%) and regional stages (N = 11 with pN0/pN1 disease, 79%). Most patients received adjuvant radiation treatment (N = 9, 64%). Median hospital LOS after surgery was 4 days (IQR 2 days) with median functional oral intake scale (FOIS) score of 5 (IQR 0.8) at 1–3 weeks after surgery.ConclusionsSGF reconstruction is a useful technique for closure of appropriately selected TORS defects requiring reconstruction beyond healing by secondary intention and mobilization of adjacent tissue but not large enough to warrant free flap reconstruction.

Nutritional Status, Frailty, Oral Health, and Oral Motor Functions in Long-Term Care Residents with Swallowing Dysfunction.

Background: Swallowing dysfunction is a prevalent but often overlooked problem in long-term care facilities. This study investigated the relationships between nutritional deficits, frailty, oral health, and swallowing dysfunction. Additionally, we explored the associations between oral muscle weakness, frailty markers, and swallowing dysfunction. Methods: We recruited 373 participants from seven long-term care facilities across Taiwan. Swallowing function, frailty, nutrition status, and oral health were assessed by research staff. Oral muscle function was evaluated through tongue strength measurements, cheek bulging function tests, the Repetitive Saliva Swallowing Test (RSST), and a diadochokinetic task. Frailty was assessed through grip strength as well as mid-upper arm and calf circumference measurements. Results: The Functional Oral Intake Scale revealed that 97 participants (26%) had swallowing dysfunction. Participants with swallowing dysfunction had poorer nutritional status, higher frailty levels, and worsened oral health. Frailty was the factor most strongly associated with swallowing dysfunction. Participants with swallowing dysfunction also exhibited lower tongue pressure, decreased cheek-bulging ability, fewer repetitions in the diadochokinetic task, lower scores on the RSST, lower calf circumferences, and lower grip strength. Logistic regression demonstrated that cheek bulging was most strongly associated with swallowing dysfunction. Furthermore, lower grip strength was significantly associated with swallowing dysfunction. Conclusions: Frailty was most strongly associated with swallowing dysfunction, followed by poorer nutritional status and worsened oral health. These factors should be thoroughly assessed in long-term care residents. Participants with swallowing dysfunction also experienced oral muscle weakness, particularly in cheek bulging. Grip strength, which represents frailty, was directly associated with swallowing dysfunction and could serve as a crucial indicator of swallowing dysfunction.

Time-course assessment of oral intake function and its impact on end-of-life in older individuals over 90 years with frailty.

The study investigates end-of-life trajectories, focusing on the degree of oral intake function in older individuals with frailty aged over 90 years. This retrospective observational study examined individuals aged 90 years and older who passed away at a long-term chronic care hospital and related facilities in Japan. We assessed their Clinical Frailty Scale (CFS) and Function Oral Intake Scale (FOIS), categorizing them into two groups-"preserved CFS" (CFS score ≤7) and "poor CFS" (CFS score ≥8)-considering evaluations conducted 6 months before death. We examined the transitional progression of their CFS and FOIS scores, along with a time-course assessment of low FOIS scores (≤3) in each group at various intervals. Among 66 cases, 38 were in the preserved CFS group, and 28 were in the poor CFS group. The CFS and FOIS scores of the preserved CFS group declined rapidly towards the end-of-life, with approximately half experiencing significant declines within 3 months. In contrast, both the CFS and the FOIS scores of the poor CFS group declined gradually within 6 months. The percentage of low FOIS score (≤3) was lower at 12 and 6 months than at 1 month prior to death in the preserved CFS group. The end-of-life trajectories in older individuals with frailty aged over 90 years were heterogeneous. Clinicians should carefully monitor the degree of frailty and changes in food intake as crucial indications of the end-of-life phase, providing optimal support to manage potential vicious cycles. Geriatr Gerontol Int 2024; ••: ••-••.

Personalized diet order compliance is associated with an improved functional independence measure (FIM) score in elderly patients: An eight-week follow-up study in a convalescent hospital.

It is important to establish the relationship between appropriate nutritional intake and improvements in activities of daily living (ADLs) in elderly hospitalized patients. This prospective observational study aimed to investigate diet order compliance (DOC) during 8 weeks of hospitalization and calculate the odds of improved functional independence measure (FIM) scores for high- and low-DOC groups using covariate-adjusted models in geriatric convalescent hospitals. The study subjects were elderly inpatients (>65 years old) with degenerative disease who consumed prescribed oral meals (Functional Oral Intake Scale (FOIS) = 6/7) and who did not receive physical/occupational therapy. The personalized diet order was prescript, and the DOC was calculated using dietitian-monitored daily intake data. The 73 patients were divided into a low-DOC group (< 84.0%, n = 35) and a high-DOC group (≥ 84.0%, n = 38) on the basis of the median DOC (84.0%, average for 8 weeks). Twenty (52.6%) high-DOC patients and nine (25.7%) low-DOC patients experienced motor-FIM improvements (P = 0.017). After 8 weeks, the change in motor-FIM in the high-DOC group (1.6±0.3) was greater than that in the low-DOC group (0.3±0.1; P = 0.001). According to the baseline and nutrition-intake-adjusted model of multiple logistic regression analysis, in the high-DOC group, the motor-FIM improvement OR was 5.102 (95% CI: 1.100-16.233, P = 0.036), and the total-FIM improvement OR was 5.273 (95% CI: 1.102-25.238, P = 0.037). High compliance with individualized nutritional prescriptions can increase FIM scores in clinical settings. Thus, comprehensive approaches to increase dietary compliance are needed for elderly long-term care patients.

Impact of inspiratory muscle training on aspiration symptoms in patients with dysphagia following ischemic stroke.

To investigate the impact of inspiratory muscle training on lung function and swallowing function in patients with dysphagia-induced aspiration following ischemic stroke and to evaluate the effectiveness of inspiratory muscle training on aspiration symptoms. Fifty-eight inpatients with dysphagia-induced aspiration following ischemic stroke were selected and randomly divided into a control group (n=29, conventional swallowing therapy) and a treatment group (n=29, conventional swallowing therapy plus inspiratory muscle training). Both groups received conventional swallowing function training, including oral sensory training, oral motor training, airway safety protection training, and neuromuscular electrical stimulation therapy for 10-20min per session, twice daily for 2weeks. The treatment group additionally received inspiratory muscle resistance training using the POWERbreathe device for 20min per session, twice daily for 2weeks. Swallowing function was assessed using the Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), and Functional Oral Intake Scale (FOIS) based on the videofluoroscopic swallowing study (VFSS) before and after treatment. Lung function, including maximal peak expiratory flow rate (PEF) and forced vital capacity (FVC), was evaluated using the Miraclink X-SCRIBE cardiac stress testing system. Before treatment, there were no significant differences in FOIS, FDS, and PAS scores between the two groups (P>0.05), while post-treatment, both groups showed significant improvements in these indicators (P<0.05), with the treatment group showing more significant improvements than the control group (P<0.05). Further, before treatment, there were no significant differences in FVC and PEF scores between the two groups (P>0.05), whereas post-treatment, the treatment group showed significant improvements in these indicators (P<0.05) and the control group showed no significant changes (P>0.05). The treatment group also showed more significant improvements than the control group (P<0.05). Finally, a correlation analysis revealed a significant linear relationship between FVC and PEF in the post-treatment PAS in the treatment group (P<0.05). Inspiratory muscle training can improve lung function in patients with dysphagia following ischemic stroke, as it develops swallowing function more effectively than conventional swallowing function training alone. Moreover, inspiratory muscle training is effective in treating aspiration caused by dysphagia, with enhancements in aspiration related to improved lung function.

ETWST: An Extension to the Timed Water Swallow Test for Increased Dysphagia Screening Accuracy.

We aimed to fine-tuning the Timed Water Swallow Test (TWST) screening procedure to provide the most reliable prediction of the Flexible Endoscopic Evaluation of Swallowing (FEES) assessment outcomes, with age, sex, and the presence of clinical signs of dysphagia being considered in the assessment. Participants were healthy people and patients with suspected dysphagia. TWST performance and participants' reported dysphagia symptoms were assessed in terms of their utility in predicting the outcome of a FEES assessment the same day. The FEES assessors were blinded to the nature of the TWST performance. The water swallowing capacity levels and clinical observations during a screening performance that were indicative of dysphagia/no symptoms in FEES were determined. Convergent validity was assessed as the agreement with the Functional Oral Intake Scale (FOIS) in the FEES assessment. TWST predicted FEES findings (aspiration and dysphagia) with a sensitivity of 72 and 45% and a specificity of 75% and 80%, respectively. Extended analysis of the TWST procedure (eTWST) identified aspiration (sensitivity = 92%, specificity = 62%) and dysphagia (sensitivity = 70%, and specificity = 72%) more accurately and showed a high correlation with FOIS (ɸ = 0.37). Excellent inter-rater reliability was further observed (Kw = 0.83). The extended evaluation of TWST performance has superior criterion validity to that of TWST. eTWST displayed high convergent validity and excellent interrater reliability. We therefore believe that eTWST can be highly relevant for clinical dysphagia screening.

Reliability and Validity of the Turkish Version of the Deglutition Handicap Index.

The Deglutition Handicap Index (DHI) is a self-reported questionnaire focus on dysphagia related quality of life of patients. The present study was aimed to translate the DHI into Turkish, and investigate the reliability and validity of the Turkish version of the DHI (T-DHI). A total of 100 patients with different diagnoses participated. The study was carried out in 3 phases including translation, reliability and validation phases. The translation phase was performed by the forward-backward-forward translation methodology. The internal consistency and test-retest reliability were used for reliability phase. The criterion validity of the T-DHI was investigated for validation phase. The Cronbach's alpha value of the T-DHI was 0.93 of which indicates excellent internal consistency. The Intraclass Correlation Coefficient ranged from 0.96 to 0.99 for test-retest reliability. There was negative and weak correlation between functional subscale score from the T-DHI and the Functional Oral Intake Scale (r=-0.29, p = 0.004), and positive and moderate to strong correlations between total and subscale scores from the T-DHI and the Turkish version of the Eating Assessment Tool (r = 0.67-0.78, p < 0.001) indicating sufficient criterion validity. The T-DHI is a reliable and valid questionnaire to define dysphagia related quality of life of patients. Clinicians could be used the T-DHI during swallowing evaluation part during the management process of deglutition disorders to plan patient centered rehabilitation, improve care and follow up.

Prophylactic Swallowing Exercises in Patients with Laryngeal Cancer Who Underwent Total Laryngectomy-A Randomized Trial.

This study aims to determine the efficacy of prophylactic swallowing exercises on swallowing function in patients undergoing total laryngectomy for laryngeal cancer. The design was a randomized controlled trial set in one tertiary care academic medical center. A total of 92 patients undergoing total laryngectomy for stages III and IV laryngeal cancer performed five targeted swallowing exercises for a period of three months after their surgery, starting two weeks after the surgery. Weekly swallowing therapy sessions were held with the patients in order to encourage adherence and proper technique. The controls received no preventive exercise and were referred for swallowing treatment following the surgery, as well as radiation therapy if necessary. The Functional Oral Intake Scale (FOIS) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-H&N) were used to measure swallowing function at the baseline, one week following the surgery, and three, six, nine, and twelve months following the surgery. Right after the surgery, there were no statistically significant variations between the intervention and control groups in the FOIS scores (p value = 0.64), the Eating in Public subscale scores (p value = 1) and Normalcy of Diet subscale scores (p = 0.33) of the PSS-H&N. The scores were significantly better among the intervention patients at months 3, 6, 9, and 12 for all the scores, with p values smaller than 0.000. Although not immediately following the surgery, the patients who engaged in prophylactic swallowing exercises showed improvements in their ability to swallow at 3, 6, 9, and 12 months following their procedure.

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 (ie, lip exercise, tongue exercise, and lower jaw exercise). The training was conducted 5 days a week over 4 weeks. Outcome measuresThe swallowing function and swallowing-related quality of life between the 2 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 2 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<.05). Patients in the intervention group demonstrated better swallowing function than the control group on the Gugging Swallowing Screen (P=.015) and Functional Oral Intake Scale (P=.004). The intervention group had a high acceptance of the FR-VG training and had significantly better adherence compared to the control group (P=.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.

Interventions and evaluation to improve oral health in patients with stroke: a scoping review

Objectives: This scoping review aimed to identify and analyze intervention strategies and assessment methods for oral hygiene management (OHM) and oral function management (OFM) in patients with stroke admitted to general wards, with the goal of providing directions for future research. Methods: We conducted a comprehensive literature search on studies published over the past 10 years across databases, including Cochrane, Embase, Medline, PubMed, and ProQuest. A total of 18 studies met the inclusion and exclusion criteria. Results: In the OHM studies (N=7), oral hygiene care was primarily provided by nurses, dental assistants, and nursing care aides. Oral hygiene was assessed using plaque and gingival bleeding indices with products such as electronic toothbrushes and mouth rinses. In the OFM studies (N=11), care was provided by speech-language pathologists, occupational therapists, and dental hygienists. Assessment tools included the Functional Oral Intake Scale, the PenetrationAspiration Scale, and Video Fluoroscopic Swallowing Studies. Conclusions: Improving the oral health of patients with stroke requires both hygiene and functional management. Therefore, it is necessary to develop a method that provides specialized oral care tailored to the hospitalization environment and the specific conditions of patients with stroke.

Tongue Pressure and Grip Strength as Indicators of Persistent Dysphagia After Acute Stroke.

This study aimed to identify the independent predictors of postacute stroke dysphagia at discharge using sarcopenia-related parameters. This single-center prospective observational study assessed consecutive inpatients diagnosed with cerebral infarction or cerebral hemorrhage upon admission to the stroke unit. Tongue pressure, grip strength, and body composition were evaluated within 48h. Dysphagia was defined by a functional oral intake scale of ≤ 5. Patient characteristics were compared between non-dysphagia and dysphagia groups using Mann-Whitney or chi-squared tests. Logistic regression analysis was performed using age, sex, tongue pressure, grip strength, skeletal muscle mass index (SMI), and National Institutes of Health Stroke Scale (NIHSS) scores as explanatory variables, with dysphagia at discharge as the objective variable. A total of 302 patients (mean age: 69.4 ± 13.8 years, 67.5% male) were analyzed, with 64 having dysphagia at discharge (21.2%). The dysphagia group was significantly older (p<0.001), had higher NIHSS scores on admission (p<0.001), lower SMI (p = 0.002), lower grip strength (p<0.001), and lower tongue pressure (p<0.001) than the non-dysphagia group. Logistic regression revealed that age (OR: 1.042, p = 0.018), tongue pressure (OR: 0.954, p = 0.010), and grip strength (OR: 0.943, p = 0.048) on admission were independent predictors of dysphagia at discharge, while NIHSS scores (OR: 1.403, p = 0.106), sex, and SMI (OR: 1.403, p = 0.150) were not. Older age, reduced tongue pressure, and reduced grip strength are strong predictors of persistent poststroke dysphagia at discharge. Thus, muscle strength is a more valuable parameter than muscle mass in predicting persistent poststroke dysphagia.

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.

Prevalence and Management of Oral Intake Restrictions in Critically Ill Patients: Insights from a Multicenter Point Prevalence Study.

Oral intake restrictions due to dysphagia in the intensive care unit (ICU) can increase morbidity, mortality, and negatively impact quality of life. The current oral intake practice and clinical management strategies for addressing dysphagia in the ICU are not well-defined. This study aimed to elucidate the clinical practices surrounding oral intake restrictions due to dysphagia and its management strategies in the ICU. A multicenter, prospective, cross-sectional, 2-day point prevalence study was conducted in Japan. Relevant data on the clinical circumstances surrounding oral intake practice and the implementation of strategies to prevent dysphagia for patients admitted to the ICU on November 1, 2023, and December 1, 2023, were collected. The primary outcome was the prevalence of oral intake restrictions in patients, defined by a Functional Oral Intake Scale score of less than 7 among eligible patients for oral intake. Out of 326 participants, 187 were eligible for the final analysis after excluding 139 patients who were not eligible for oral intake, primarily due to tracheal intubation. Among those eligible, 69.0% (129/187) encountered oral intake restrictions. About 52.4% (98/187) of patients underwent swallowing screenings; 36.7% (36/98) of these were suspected of having dysphagia. Compensatory and behavioral swallowing rehabilitation were provided to 21.9% (41/187) and 10.6% (20/187) of patients, respectively, from ICU admission to the survey date. Only 27.4% (14/51) of post-extubation and 9.3% (3/32) of post-stroke patients received swallowing rehabilitation. Notably, no ICUs had dedicated speech and language therapists, and most (85.7%, 18/21) lacked established swallowing rehabilitation protocols. This 2-point prevalence survey study revealed that oral intake restrictions due to dysphagia are common in ICUs, but few patients are screened for swallowing issues or receive rehabilitation. More clinical studies are needed to develop effective protocols for identifying and managing dysphagia, including screenings and rehabilitation in the ICU.