Impaired Swallowing Function Research Articles

Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application

Doeltgen SH, Huckabee M-L. Swallowing neurorehabilitation: from the research laboratory to routine clinical application.The recent application of neurostimulation techniques to enhance the understanding of swallowing neural plasticity has expanded the focus of rehabilitation research from manipulation of swallowing biomechanics to manipulation of underlying neural systems. Neuromodulatory strategies that promote the brain's ability to reorganize its neural connections have been shown to hold promising potential to aid the recovery of impaired swallowing function. These techniques include those applied to the brain through the intact skull, such as transcranial magnetic stimulation or transcranial direct current stimulation, or those applied to the sensorimotor system in the periphery, such as neuromuscular electrical stimulation. Recent research has demonstrated that each of these techniques, either by themselves or in combination with these and other treatments, can, under certain circumstances, modify the excitability of motor representations of muscles involved in swallowing. In some studies, experimentally induced plastic changes have been shown to have functional relevance for swallowing biomechanics. However, the transition of novel, neuromodulatory brain stimulation techniques from the research laboratory to routine clinical practice is accompanied by a number of ethical, organizational, and clinical implications that impact professions concerned with the treatment of swallowing rehabilitation. In this article, we provide a brief overview of the neuromodulatory strategies that may hold potential to aid the recovery of swallowing function, and raise a number of issues that we believe the clinical professions involved in the rehabilitation of swallowing disorders must confront as these novel brain stimulation techniques emerge into clinical practice.

Clinical experience in the placement of a novel motility capsule by using a capsule delivery device in critical care patients

ered to patients with impaired swallowing function or abnormal upper gastrointestinal anatomy with a net, snare, or capsule delivery device. However, few published studies report clinical application of capsule technology in critically ill patients [1]. We report the placement of a novel motility capsule (SmartPill, SmartPill Corp., Buffalo, New York, USA) in eight critically ill patients who were sedated, intubated, and mechanically ventilated. The motility capsule we evaluated measures pH, pressure, and temperature; it is also used for assessing gastric emptying in patients with suspected gastroparesis. This motility capsule has been available in the United States since 2006 [2,3]. The motility capsule (● Fig. 1) has a relatively soft polyurethane body; consequently, a snare insertion system could damage the sensors. We used a delivery device (AdvanCE, US Endoscopy, Mentor, Ohio, USA) designed for insertion of fragile video capsules. The application device was stabilized by loading it into a regular gastric feeding tube (● Fig. 2). The capsule was placed into the cup of the device (● Fig. 3). In order to compensate for the narrowing of the hypopharynx caused by the endotracheal tube, we inserted the device into the esophagus under direct laryngoscopy and then advanced it blindly into the stomach. Once a pH change was indicated in real-time by the data recorder, the capsule was released. Its position was confirmed by abdominal radiography. All capsules were safely deployed into the patients’ stomachs. All patients underwent capsule placement without complication. There was no premature release or dislodgement from the device. There were no iatrogenic injuries or capsule retention. Preliminary experience suggests that the AdvanCE delivery device facilitates insertion of wireless motility capsules in sedated and mechanically ventilated, critical care patients.

The effect of early rehabilitation nursing on swallowing function of supranuclear paralysis patients

0bjective To study the effect of early rehabilitation nursing on swallowing function of patients with supranuclear paralysis.Methods 100 patients with supranuclear paralysis were randomly divided into rehabilitation group and routine treating group(control group).Swallowing function testing was done on the admission dav and four weeks later after rehabilitation training.and the results were analyzed statistically. Results The swallowing function of rehabilitation group wag significantly improved compared with control group (P<0.05).Conclusions Rehabilitation training should be done fits early as possible to the acuteroke patients with impaired swallowing function,which can recover the swallowing function,reduce the complications and improve the nutrition state. Key words: Supranuclear paralysis; Swallowing function; Rehabilitation nursing

Identification of Swallowing Events from sEMG Signals Obtained from Healthy Adults

Surface electromyography (sEMG) is being used with increasing frequency to identify the occurrence of swallowing, to describe swallow physiology, and to treat impaired swallowing function in dysphagic patients. Despite this increased utilization, limited information is available regarding the validity and reliability of investigators and clinicians to interpret sEMG data in reference to swallowing. This study examines the validity and interjudge reliability of swallow identification using sEMG records obtained from healthy adults. Validity and reliability estimates were compared between experienced and naïve judges in the identification of swallows from graphic sEMG records. Multiple validity estimates were high, indicating a strong degree of accuracy in identification of swallows versus nonswallow movements from sEMG traces. Experienced judges were more accurate than naïve judges (classification accuracy: experienced = 90% vs. naïve = 81%; p = 0.006, kappa: experienced = 0.89 vs. naïve 0.62; p = 0.008). Judges in both groups were more likely to classify swallows as nonswallow movements (false negatives) than to classify nonswallow movements as swallows (false positives). Interjudge reliability estimates indicated a high degree of agreement among judges in the identification of swallows versus nonswallow movements from the sEMG signal, with higher agreement among experienced judges (average kappa coefficient: experienced = 0.75 vs. naïve = 0.51). These results suggest that the sEMG graphic record is a valid and reliable tool for identifying normal swallows and that experience with this technique results in better identification and interjudge agreement.

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

アルツハイマー病は血管病としての治療すべきである（Ｐｒｏ）

Elevated plasma homocysteine levels are associated with an increased risk of developing atherosclerotic vascular disorders such as stroke, but have also been implicated for neurodegenerative diseases including Alzheimer's disease (AD). Other studies have reported that hyperhomocysteinemia is associated with developing silent brain infarctions and white matter lesions in community-dwelling elderly people. It is not uncommon for such ischemic cerebrovascular lesions to be found in otherwise typical AD patients on magnetic resonance imaging. Such co-existing cerebrovascular diseases in AD must be important in developing aspiration pneumonia and falls. Previous studies demonstrated that basal ganglia infarcts, either silent or symptomatic, impaired swallowing function and these lesions were associated with an increased risk of developing aspiration pneumonia in AD patients, particularly in later stages. Further, periventricular white matter lesions are associated with an increased risk of falls irrespective of clinical stages of AD.

Clinical progression and outcome of dysphagia following paediatric traumatic brain injury: a prospective study

Objectives: To provide a preliminary clinical profile of the resolution and outcomes of oral-motor impairment and swallowing function in a group of paediatric dysphagia patients post-traumatic brain injury (TBI). To document the level of cognitive impairment parallel to the return to oral intake, and to investigate the correlation between the resolution of impaired swallow function versus the resolution of oral-motor impairment and cognitive impairment.Participants: Thirteen children admitted to an acute care setting for TBI.Main outcome measures: A series of oral-motor (Verbal Motor Production Assessment for Children, Frenchay Dysarthria Assessment, Schedule for Oral Motor Assessment) and swallowing (Paramatta Hospital’s Assessment for Dysphagia) assessments, an outcome measure for swallowing (Royal Brisbane Hospital’s Outcome Measure for Swallowing), and a cognitive rating scale (Rancho Level of Cognitive Functioning Scale).Results: Across the patient group, oral-motor deficits resolved to normal status between 3 and 11 weeks post-referral (and at an average of 12 weeks post-injury) and swallowing function and resolution to normal diet status were achieved by 3–11 weeks post-referral (and at an average of 12 weeks post-injury). The resolution of dysphagia and the resolution of oral-motor impairment and cognitive impairment were all highly correlated.Conclusion: The provision of a preliminary profile of oral-motor functioning and dysphagia resolution, and data on the linear relationship between swallowing impairment and cognition, will provide baseline information on the course of rehabilitation of dysphagia in the paediatric population post-TBI. Such data will contribute to more informed service provision and rehabilitation planning for paediatric patients post-TBI.

Eating difficulties, complications and nursing interventions during a period of three months after a stroke.

The aim of this study was to describe eating difficulties and especially swallowing in patients with dysphagia, types of nursing intervention, and the development of complications over 3 months. The aim was also to explore common characteristics of eating difficulties that influenced the ability to finish meals. Twenty-four consecutive patients admitted because of stroke and dysphagia were included. Nursing interventions, based on assessments, were individually designed. Three subgroups could be identified: those (n=9) who were unable to complete a meal, despite assisted feeding, because of reduced alertness/energy and impaired swallowing function; those (n=5) who could complete a meal, despite suffering from reduced alertness/energy; and those (n=10) who could complete meals with minor difficulties. Patients in the first two groups developed complications such as respiratory infections and/or malnutrition. There was a tendency towards that complications in the third group were less frequent and the hospital stay was significantly shorter than in the other groups. The level of alertness/energy in patients with dysphagia after stroke was important for the ability to eat and swallow and the development of complications over time, and thus of great importance for the interventions applied.