Impaired Swallowing Function Research Articles

Effect of electronic moxibustion on activity of parapharyngeal wall in patients with achalasia of cricopharyngeus muscle after stroke based on musculoskeletal ultrasound

To observe the clinical effect of electronic moxibustion on dysphagia in patients with achalasia of cricopharyngeus muscle after stroke. Sixty patients with dysphagia of achalasia of cricopharyngeus muscle were randomly divided into an observation group and a control group, 30 cases in each group. One patient in the observation group and 2 cases in the control group dropped off. The patients in the control group were treated with routine medical treatment, acupuncture treatment and swallowing rehabilitation training; the patients in the observation group were additionally treated with electronic moxibustion at Lianquan (CV 23), Tiantu (CV 22), Tianding (LI 17) and Futu (LI 18), 30 min each treatment. Both groups were treated 5 times a week for 4 weeks. The musculoskeletal ultrasound (MSUS) was applied to test the activity of parapharyngeal wall and the dysphagia score of Ichiro Fujishima was compared before and after 4-week treatment. After treatment, the activity of the parapharyngeal wall and the dysphagia score of Ichiro Fujishima were increased in both groups (P<0.01, P<0.05). The changes of activity of parapharyngeal wall and dysphagia score of Ichiro Fujishima in the observation group were greater than the control group (P<0.05, P<0.01). Electronic moxibustion can improve the impaired swallowing function and reconstruct the normal swallowing process.

Association between clinical risk factors and severity of dysphagia after extubation based on a videofluoroscopic swallowing study.

Background/AimsThis study aimed to evaluate the correlation between clinical risk factors of post-extubation dysphagia (PED) and the severity of impaired pharyngeal swallowing function assessed via videofluoroscopic swallowing studies (VFSSs).MethodsThis study was a retrospective review of medical records. Of 116 patients who were admitted to the intensive care unit and underwent VFSS, 32 who had non-neurologic disorders and experienced prolonged intubation (for more than 48 hours) were diagnosed with PED. The severity of PED was evaluated by using a functional dysphagia scale (FDS) and a penetration aspiration scale (PAS), on the basis of VFSS.ResultsThe Simplified Acute Physiology Score 3 and total FDS score were positively correlated (r = 0.40, p = 0.02). Intubation duration was positively correlated with total PAS and FDS scores (r = 0.62, p < 0.001; r = 0.65, p < 0.001, respectively). The amounts of residue in the valleculae (RV) and pyriform sinuses (RP) were associated with intubation duration (r = 0.58, p < 0.001; r = 0.57, p < 0.001, respectively). Multivariate regression analysis revealed that intubation duration was significantly associated with the total FDS score, RV and RP subscales of the FDS, and total PAS score.ConclusionsThe severity of impaired swallowing function, particularly the amount of residue in the pharyngeal recesses assessed via VFSS, was strongly associated with both severity of medical illness and intubation duration. Intubation duration could be a prognostic factor for assessing impaired swallowing function on the basis of VFSS.

Are there any differences between the tongue and posterior pharyngeal wall movement patterns during normal and Masako swallow?—An ultrasound analysis

Parkinson’s disease (PD) is a neurodegenerative movement disorder affecting volitional movement due to Dopamine-producing neuron death in the substantia nigra. Impaired swallow function is highly prevalent with nearly 100% involvement in PD during the disease course and involves all three phases of swallowing. The oral stage of swallowing is impaired first. Reduced bolus control and reduced interior-to-posterior movement of the bolus transfer lead to delayed swallowing response, premature spillage, decreased base of tongue (BOT) retraction and strength, decreased hyolarygneal elevation and excursion, and reduced action of pharyngeal constrictors. Together, these result in bolus retention, residue throughout the pharynx, and reduced airway protection leading to significant aspiration. To target these deficits we have designed an exercise regime to teach early to mid-stage PD patients to do the Masako swallow maneuver of saliva (swallow with tongue-tip held between teeth), with high intensity and frequency (i.e., 120 repetitions per day) in one month. The preliminary results are very promising. All participant demonstrated positive changes. To understand the underlying mechanism, we used Ultrasound and recorded 20 normal subjects while they did three normal swallows and 3 Masako swallow maneuver. The initial observations indicated the tongue and pharyngeal movement patterns differ between the two maneuvers.Parkinson’s disease (PD) is a neurodegenerative movement disorder affecting volitional movement due to Dopamine-producing neuron death in the substantia nigra. Impaired swallow function is highly prevalent with nearly 100% involvement in PD during the disease course and involves all three phases of swallowing. The oral stage of swallowing is impaired first. Reduced bolus control and reduced interior-to-posterior movement of the bolus transfer lead to delayed swallowing response, premature spillage, decreased base of tongue (BOT) retraction and strength, decreased hyolarygneal elevation and excursion, and reduced action of pharyngeal constrictors. Together, these result in bolus retention, residue throughout the pharynx, and reduced airway protection leading to significant aspiration. To target these deficits we have designed an exercise regime to teach early to mid-stage PD patients to do the Masako swallow maneuver of saliva (swallow with tongue-tip held between teeth), with high intensity and frequency ...

Dysphagia in Patients with Neck Dissections

A common complication in patients with malignancies in the maxillofacial and cervical area is the impaired swallowing, due to the progress of the neoplasm or as a result of the treatment applied. Operative methods for the management of malignancies in the maxillofacial and cervical areas may damage anatomical structures, therefore causing swallowing disorders.&#x0D; The purpose of the present study is to determine the degree of involvement of the swallow function depending on the volume of surgery - neck dissection.&#x0D; Methods: SSQ (Sydney Swallowing Questionnaire) tool was used to assess the presence of dysphagia in operated patients, as well as an impaired swallowing function. The results obtained were analyzed by SPSS Vers23.0. &#x0D; Results. Prospectively longitudinal study included 68 patients (25 women and 43 men) at mean age of 61.18 years (SD - 13.66). The reliability of the SSQ tool is assessed via Cronbach's coefficient alpha α = 0.871, and the validity of the sample is calculated using the Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO coefficient) - 0.857. In the postoperative period, no significant difference in dysphagia was found in terms of the volume of surgery - neck dissection.&#x0D; Conclusion. The type and the volume of neck dissection has no effect on the postoperative speech disorders and swallowing.

Dentistry considerations for the dysphagic patient: Recognition of condition and management

Dysphagia is a symptom of various underlying medical conditions. It can be attributed to age related changes, neurological, cognitive, respiratory and gastrointestinal diseases. These conditions may cause functional and anatomical changes along the swallowing tract. Impaired swallowing function and oromotor insufficiencies may result in inadvertent aspiration of fluids and/or particles during dental procedures. This article attempts to highlight the importance of identifying patients with dysphagia and discusses ways to reduce life threatening conditions that may arise during dental procedures.

Dysphagia in Patients after Total Laryngectomy

Theoretical basis: Total laryngectomy is the surgical procedure in which the larynx is totally removed and the airway is interrupted, respiration being performed through a tracheal stoma resulting from bringing the trachea to the skin in the lower, anterior, cervical area. This provides a complete and permanent separation of the superior part of the airway from the inferior one, resulting in voice and smell loss. The Aim of the study is to determine the importance of dysphagia as eating disorder in patients after total laryngectomy. Results: Swallowing may seem to be a simple process, yet it involves complex stages. Difficulty in swallowing is called dysphagia, and it involves an inability to manage the entire process of eating food of normal consistency. Dysphagia, or impaired swallowing function, has been established as a predominant negative sequel following laryngectomy. The psychosocial aspects of dysphagia, which arise as a consequence of long-term swallowing dysfunction and their ultimate impact on a patient’s quality of life have received minimal attention in the literature. Laryngectomy patients who presented with persistent dysphagia reported significantly higher levels of disability than those patients who could tolerate a normal diet. Laryngectomy patients with dysphagia reported that the prolongation of swallowing impairments following the postoperative phase had affected their ability to fulfill certain social, educational, and/or family roles; decreased their self-confidence and self-esteem; and resulted in poor ability to achieve their potential in certain situations. Conclusion: Dysphagia is very important complication in patients after total laryngectomy which can affect physical and mental recovery.

Five-parameter evaluation of dysphagia: A novel prognostic scale for assessing neurological decline in Gaucher disease type 2

BackgroundGaucher disease type 2 (GD2) is defined by acute neurological decline, failure to thrive, and early demise. Currently, there is no clear standard for evaluating, staging, and counseling regarding neurological decline in GD2. Due to the high prevalence of progressive dysphagia secondary to acute neurological involvement, we aimed to identify key components of swallow function which could serve as markers of disease progression in GD2. MethodsA post-hoc analysis of modified barium swallow studies was performed. Six parameters of swallowing were scored in a retrospective chart review of eleven infants with GD2. Mixed effects regression, principal component analysis (PCA), and a transition analysis were used to evaluate swallow function and model disease progression. ResultsAll patients exhibited impaired swallow function. There was no association between any of the swallow parameters and age, indicating non-linear disease progression. PCA and transition analysis identified five parameters capturing multiple dimensions of swallowing which defined two distinct disease states. ConclusionA five-parameter swallow evaluation was sufficient to identify distinct states of GD2 and model prospective outcomes. This multi-dimensional evaluation could be a useful efficacy parameter for future therapeutic trials in GD2 and other neurodegenerative disorders of infancy.

Pengaruh Latihan Vokal terhadap Perubahan Kemampuan Menelan pada Pasien Stroke Infark di Ruang Cempaka Rumah Sakit Umum Daerah Dr. Slamet Garut Tahun 2015

Abstract. Stroke infarction occurs due to disturbances in neurological system such as loss of motor function, sensibility and loss of consciousness due to tissue death due to oxygen supply to the brain is disrupted. Manifestations are impaired ability to swallow. One of the interventions to address the impaired ability to swallow, namely vokal exercises. This study aimed to influence vokal exercises to changes in swallow ability stroke infarction in room Cempaka dr. Slamet Garut Hospital. This study was conducted in May - June 2015 in room Cempak dr. Slamet Garut Hospital using a quasi experimental design. The sampling technique used purposive sample of 10 respondent. Date collection used observation checklist sheet and direct observations of researchers. The hypothesis test usedis Mann-Whitney. Hypothesis test results showed there are significant (p 0.004) vokal exercises to changes in the patient's ability to swallow infarction stroke at Cempaka Room dr. Slamet Garut Hospital with a meanof the ability to swallow priorto the vokal exercises of 3.00 and after the vokal exercises of 5.50.The results could be used as reference material and consideration for physicians and nurses in dealing with stroke patients with impaired myocardial swallow function by doing vokal exercises.&#x0D; Keywords : Stroke Infarction, Vokal Exercise, Ability Swallow&#x0D; Abstrak. Stroke infak terjadi karena gangguan pada sistem neurologi berupa kehilangan fungsi motorik, sensibilitas dan kehilangan kesadaran karena kematian jaringan akibat suplai oksigen ke otak terganggu. Berdasarkan data dari rekam medik RSUD dr.Slamet Garut tahun 2014, jumlah penderita stroke infark sebanyak 1.254 orang. Manifestasi yang sering terjadi adalah gangguan kemampuan menelan. Salah satu intervensi untuk mengatasi gangguan kemampuan menelan yaitu latihan vokal. Tujuan penelitian mengetahui pengaruh latihan vokal terhadap perubahan kemampuan menelan stroke infark di ruang Cempaka RSUD dr. Slamet Garut. Penelitian ini dilakukan pada bulan Mei-Juni 2015 di ruang Cempaka RSUD dr. Slamet Garut dengan menggunakan desain kuasi eksperimen. Teknik pengambilan sampel menggunakan purposive samplingsebanyak 10 responden.Pengumpulan data menggunakan lembar ceklis observasi dan pengamatan langsung peneliti. Uji hipotesis dengan menggunakan Wilcoxon. Hasil uji hipotesis terdapat pengaruh (p0,004) latihan vokal terhadap perubahan kemampuan menelan pada pasien stroke infark di Ruang Cempaka RSUD dr. Slamet Garut dengan nilai rerata kemampuan menelansebelum dilakukan latihan vokal sebesar 3,00 dan setelah dilakukan latihan vokal sebesar 5,50. Hasil penelitian ini dapat dijadikan sebagai bahan referensi dan pertimbangan bagi dokter dan perawat dalam menangani pasien stroke infark yang mengalami gangguan fungsi menelan dengan cara melakukan latihan vokal.&#x0D; Kata Kunci : Stroke Infark, Latihan Vokal, Kemampuan Menelan&#x0D;

Neural Mechanisms of Swallowing Dysfunction and Apraxia of Speech in Acute Stroke

Speech and swallowing utilize overlapping anatomy and are thus inherently related processes. We sought to identify common neural mechanisms between risk of swallowing dysfunction and apraxia of speech (AOS). This was a retrospective analysis using data from a prospectively collected cohort. Left hemisphere stroke patients (68 subjects) tested with the Apraxia Battery for Adults II, a swallow screen, and MRI were included in the study. Main outcome measure was the presence of AOS or aspiration risk after stroke. We identified a significant association between AOS measures and increased aspiration risk (defined by failed swallow screen; p=0.04; OR 5.2). Lesions in pars opercularis of Broca's area (BA 44) were associated with both AOS (p=0.044; OR 9.7) and increased aspiration risk (p=0.04; OR 5) but deficits rarely co-occurred in the same cases. Lesions in left premotor cortex (BA 6) were not significantly associated with increased aspiration risk (p=0.06; OR 3.3) but were significantly associated with AOS (p=0.008; OR 7). Impaired swallowing function was also associated with lesions in Wernicke's area (BA 22; p=0.05; OR 3.5) and pars triangularis (BA 45; p=0.02; OR 6.8). AOS and risk of aspiration are associated in patients with acute left hemisphere stroke. Acute infarct in the pars opercularis of Broca's area is associated with both deficits, though they rarely co-occur in the same individual. The co-occurrence of AOS and risk of aspiration likely reflects dependence on closely related neural structures.

Correlations Between Patient-Reported Dysphagia Screening and Penetration\u2013Aspiration Scores in Head and Neck Cancer Patients Post-oncological Treatment

Dysphagia is a common and severe toxicity after oncological treatment of head and neck cancer (HNC). The study aim was to investigate relationships between patient-reported dysphagia and clinically measured swallowing function in HNC after modern curative radiotherapy with or without chemotherapy to identify possible alarm symptoms for clinically manifest dysphagia. Patients with tumors of the tonsil, base of tongue, hypopharynx, and larynx treated in 2007–2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific categorized symptom score was used to determine patient-reported dysphagia (DESdC = presence of Drinking, Eating, Swallowing difficulties, and Coughing when eating/drinking (any combination); scores between 0 and 4 with 0 = no symptom); the penetration–aspiration scale (PAS) to determine swallowing function by VFS. Swallowing difficulties were defined as DESdC ≥ 1 and PAS ≥ 2. Relationships between clinically relevant cut-offs for DESdC and PAS were determined by Pearson’s correlation coefficient (Pr). Swallowing difficulties according to DESdC were reported by 89% of the patients and according to PAS by 60% at a median of 7 months post-treatment. Averaged correlations between DESdC score 1/2/3/4 and PAS were 0.16/0.10/0.27/0.18. Almost one in two patients with DESdC score ≥3 had severe swallowing difficulties according to PAS. Correlations between individual DESdC:s were highest for swallowing and eating (Pr = 0.53) and lowest for swallowing and coughing (Pr = 0.11). Our data suggest that if a patient reports having swallowing difficulties, it is likely that he or she also has eating difficulties but not necessarily coughing problems when eating/drinking. However, if all these three symptoms are reported, it is likely that the patient will present with moderate or severe impaired swallowing function according to PAS and thus should be referred for further evaluation and treatment.

Swallowing impairment is a significant factor for predicting life prognosis of elderly at the end of life.

In end-of-life care of elderly, the decision of care plan including gastrostomy is difficult frequently because of insufficient knowledge relating the life prognosis of elderly. It is important the families to decide correctly the life prognosis of elderly with geriatric diseases. Our purpose is to examine the significant factors for predicting life prognosis of elderly in end-of-life care. A total of 320 elderly patients was enrolled (male/female 151/169; averaged age: male 84.7 ± 5.9year, female 86.8 ± 6.3year) and retrospective analyses were performed. The elderly patients were classified as either: (1) with or without past illness of aspiration pneumonia; (2) with or without incidence of cerebrovascular disorder; (3) impaired or normal cognitive function; (4) impaired or normal swallowing function, and performed Kaplan-Meier survival analysis. Swallowing function was examined using video endoscopic (VE) evaluation method. The Kaplan-Meier analysis of the number of days from implementation of VE test (day 0) to death was evaluated with the log-rank Mantel-Cox test. The maximum follow-up time recorded was 180 days. There were no significant differences in number of days when divided with or without past illness of aspiration pneumonia, cerebrovascular disorder and impaired cognitive function. The survival probabilities of elderly with impaired swallowing function were significant lower than in elderly with the normal function. For judgement of life prognosis, the condition of being frail such as impaired swallowing function might be a useful factor, and the viewpoint would contribute to decide the treatment plan for the good end-of-life care of elderly.

Effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia.

[Purpose] This study was conducted to identify the effects of expiratory muscle strength training on swallowing function in acute stroke patients with dysphagia. [Subjects and Methods] A total of 18 stroke patients with dysphagia were enrolled in the study. All participants were randomly assigned to either an experimental group (n=9) or a control group (n=9). All participants performed traditional-swallowing rehabilitation therapy in 30-minute sessions five times a week for four weeks; however, only the experimental group received expiratory muscle strength training. [Results] Both groups showed significant improvements after mediation. When compared with the control group, the functional dysphagia scale, vallecular residue, and penetration-aspiration scale were significantly improved in the experimental group. [Conclusion] Expiratory muscle strength training is an effective intervention for impaired swallowing function in acute strike patients with dysphagia.

Swallow Function and Airway Protection During Thin Liquid Swallows in Patients With Nontuberculous Mycobacteria

SESSION TITLE: Chest Infections SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Non-tuberculous mycobacteria (NTM) can cause asymptomatic infection of the lungs as well as clinically significant lung disease. NTM is often associated with destructive changes of the airways that can lead to impairment of quality of life. It is unknown whether impaired swallowing contributes to the pathophysiology of NTM. Micro-aspiration occurs in normal individuals and its prevalence is higher in lung diseases such as COPD, asthma, obstructive sleep apnea, and lung infections due to typical and atypical microorganisms (such as non-tuberculous mycobacteria). It is possible that patients with NTM may exhibit decreased airway protection causing risk for micro-aspiration during thin liquid swallows. The objective of this study was to determine airway protection in 3 and 5ml thin liquid swallows in patients with newly diagnosed NTM METHODS: Videofluoroscopy (VF) was collected from 41 newly diagnosed patients with NTM (11 male) aged 55-87. Two boluses of 3 and 5ml thin liquid Varibar were analyzed per subject (N=164 swallows). The primary interest was airway protection as measured by the Penetration Aspiration Scale (PAS). The PAS is an eight-point validated scale that captures the depth of airway invasion. Scores of 1 are considered normal while scores of 2- 8 represent increasing level of impairment. RESULTS: Inter- and intra-rater reliability of PAS ratings were assessed using two-way mixed intraclass correlation coefficients (ICC) on 20% of the data with excellent results (intra-rater: ICC = 0.98, 95%CI = 0.95-0.98 and inter-rater: ICC = 0.85, 95%CI = 0.69-0.92).The grand mean for PAS was 1.38 (SD = 0.99). The proportion of impaired swallows in the whole dataset was 19.5 % (32/164 swallows with PAS scores ≥2). Similar pattern regardless of bolus volume was noted (3ml versus 5 ml). It was apparent that the proportion of subjects with at least one unsafe swallow PAS (≥2 ) was 41.5%. CONCLUSIONS: Patients with NTM appear to have impaired swallow function as represented by impaired airway protection. Future work should explore swallowing physiology in this population. CLINICAL IMPLICATIONS: Swallowing function and airway protection may be compromized on patient s with NTM DISCLOSURE: The following authors have nothing to disclose: Matina Balou, Sonja Molfenter, Joanna Smith, Melissa Lumish, Danielle Brates, Jeremy Feintuch, Joshua Feintuch, David Kamelhar No Product/Research Disclosure Information

Predictable swallowing function after open horizontal supraglottic partial laryngectomy.

After horizontal supraglottic partial laryngectomy, patients have an increased risk of dysphagia as they are not able to close the laryngeal entrance during swallowing, especially if the surgical defect of the tongue base has increased. There is no investigation that studies risk factors for impaired swallow function, or that predicts postoperative swallow outcomes based on radiologically determined tumor dimensions. The present study investigated the impact of the tongue base tumor extension (determined by CT scan in patients undergoing partial laryngectomy) on the recovery rate of swallow function. The retrospective study in a tertiary hospital between 2000 and 2015 included all patients who underwent open horizontal supraglottic partial laryngectomy due to oropharyngeal cancer of the tongue base, or supraglottic laryngeal cancer with tongue base infiltration. All clinicopathological data were collected. The dimension of tongue base infiltration was measured using CT scan. Swallow function was recorded by Fiberoptic Endoscopic Evaluation of Swallowing and determined by evaluating both the duration until nasogastric tube removal and changing of the cuffed tracheostomy tube for an uncuffed speech cannula. The study included 26 patients (44-76 years, median 59 years). The clinical tumor (cT) classification included cT2 and cT3, while the pathologic tumor (pT) classification included pT2 and pT3 in 90% and pT1 and pT4 in 10% respectively. The duration until using the speech cannula was not associated with clinicopathological data, including the investigated radiologic tumor dimensions (biggest tumor diameter, tongue base infiltration depth, width, height, area and volume). The duration until nasogastric tube removal was significantly associated with the tongue base infiltration width (p=0.012), height (p=0.026) and area (p<0.0001). The patients were divided into two groups according to the median tongue base infiltration area estimated as 6.20cm(2). In patients <6.20cm(2), 50% of the nasogastric tubes were removed after 4 days (95% CI 0-8.6 days) and in patients ≥6.20cm(2), 50% were removed after 22 days (95% CI 6.8-37.2 days; p<0.0001). The postoperative swallow function after open horizontal supraglottic partial laryngectomy depends on the tumor extension of the tongue base. The tongue base infiltration area is a useful tool for surgical planning as it can be used to predict postoperative swallow function. In foreseeably permanent dysphagia, as well as permanent and necessary tracheotomy tube cuffs after organ-preserving surgery, alternative therapy methods should be particularly preferred as the primary chemoradiation.

Signs for identifying risk factors for aspiration pneumonia in elderly people needing nursing care

Signs for identifying risk factors for aspiration pneumonia in elderly people needing nursing careAbstractAim: To identify signs predictive of pneumonia development that can be recognized at nursing homes where limited medical staff and equipment are available.Methods: Subjects were 761 elderly individuals needing nursing care (172 men 594 women; mean age, 86.8±7.2 years), from 42 nursing homes across Japan who could eat orally and had not received antibiotic treatment during the previous three months. Dental hygienists examined each subject for wet hoarseness during and after eating a meal as a sign of impaired swallowing function, prolongation of mealtime length, refusal of oral care, dry mouth and halitosis. Data on the subjects’ activities of daily living, body mass index (BMI) calculated from body height and weight as a measure of nutritional status, and underlying diseases were transcribed from the medical records kept at each nursing home.Results: During the study period, pneumonia occurred in 116 subjects (44 men, 72 women). Significant associations with pneumonia development were identified for nutritional status (P = 0.007) and swallowing function (P = 0.002). Analysis including comorbid conditions further identified heart disease (P = 0.03).Conclusion: In this study, decreased BMI and wet hoarseness during and after eating a meal were identified as signs of pneumonia risk at nursing homes.

Effects on caregiver burden of a donepezil hydrochloride dosage increase to 10 mg/day in patients with Alzheimer's disease.

BackgroundIn this study, we evaluated changes in functioning and caregiver burden in Alzheimer’s disease (AD) patients after a dosage increase that was made based on pharmacists’ evaluation of AD patients’ behavior in daily life.MethodsPharmacists used a checklist, a questionnaire, and the Repetitive Saliva Swallowing Test (RSST) to gather data on the daily life of AD patients taking donepezil 5 mg/day and their caregivers. In 27 cases, pharmacists suggested a dosage change to 10 mg/day to AD patients’ physicians. Pharmacists then evaluated these patients for 16 weeks after the increase to determine changes in functional assessment staging, caregiver burden, and swallowing function.ResultsDuring the 16-week study, 20 of the 27 patients showed at least one-stage improvement in relation to the five assessed aspects of daily life (time/place, speech, bathing, dressing, and toileting). The mean score for caregiver burden due to personal strain was significantly lower after the dosage increase than before (5.15±3.76 at baseline; from 3.89±3.42 at week 4 to 3.59±3.90 at week 16; P<0.05), as was the mean score due to role strain (2.19±2.80 at baseline; 1.56±2.64 at week 8; P<0.05). After the dosage increase, the impaired swallowing function that accompanies AD was improved in the patients with swallowing problems, as indicated by a higher mean RSST score (1.22±0.67 at baseline; from 2.78±1.72 at week 4 to 2.78±1.79 at week 16; P<0.05).ConclusionThe dosage increase not only decreased caregiver burden, but also appeared to improve impaired swallowing function. Medication therapy management by pharmacists of AD patients, including the use of a checklist, contributed to the correct use of donepezil and improved quality of life for caregivers.

Impaired laryngopharyngeal sensitivity in patients with COPD: The association with swallow function

Research indicates that patients with Chronic Obstructive Pulmonary Disease (COPD) have increased aspiration risk. Several factors may pre-dispose a patient to aspiration including a reduction in laryngopharyngeal sensitivity (LPS). Reduced LPS has been associated with increased aspiration risk in pathologies including stroke; however, this has not been examined in COPD. This study aims to explore possible associations between LPS and swallowing function in COPD patients, and determine whether a LPS predictive value may be used as a method of evaluating dysphagia risk in this patient population. Twenty participants with COPD underwent LPS discrimination testing, respiratory function testing, self-reporting swallowing questionnaire, clinical swallowing examination, and fibre-optic endoscopic evaluation of swallowing (FEES). Participants with COPD demonstrated impaired LPS defined by elevated laryngeal adductor reflex thresholds and high incidence of pharyngeal residue on FEES. Positive correlations were identified between their clinical swallowing examination and FEES results for the presence of laryngeal penetration/aspiration (p < 0.04), vallecular residue (p < 0.01), and piriform residue (p < 0.01). In conclusion, COPD patients have reduced laryngopharyngeal mechanosensitivity and impaired swallowing function characterized primarily by pharyngeal stasis. The combination of these deficits may place patients with COPD at increased aspiration risk due to lack of detection of pharyngeal residue and subsequent inhalation of pharyngeal contents.

Airway Somatosensory Deficits and Dysphagia in Parkinson's Disease

Individuals with Parkinson's disease (PD) often experience substantial impairment of swallow control, and are typically unaware of the presence or severity of their impairments suggesting that these individuals may also experience airway sensory deficits. However, the degree to which impaired swallow function in PD may relate to airway sensory deficits has yet to be formally tested. The purpose of this study was to examine whether airway sensory function is associated with swallow impairment in PD. Eighteen PD participants and 18 healthy controls participated in this study and underwent endoscopic assessment of airway somatosensory function, endoscopic assessment of swallow function, and clinical ratings of swallow and disease severity. PD participants exhibited abnormal airway somatosensory function and greater swallow impairment compared with healthy controls. Swallow and sensory deficits in PD were correlated with disease severity. Moreover, PD participants reported similar self-rated swallow function as healthy controls, and swallow deficits were correlated with sensory function suggesting an association between impaired sensory function and poor self-awareness of swallow deficits in PD. These results suggest that control of swallow is influenced by airway somatosensory function, that swallow-related deficits in PD are related to abnormal somatosensation, and that swallow and airway sensory function may degrade as a function of disease severity. Therefore, the basal ganglia and related neural networks may play an important role to integrate airway sensory input for swallow-related motor control. Furthermore, the airway deficits observed in PD suggest a disintegration of swallow-related sensory and motor control.

The Effect of Chronic Obstructive Pulmonary Disease on Laryngopharyngeal Sensitivity

Patients with chronic obstructive pulmonary disease (COPD) may be at increased risk of aspiration secondary to impaired swallow function. One possible cause of this impairment is a reduction in laryngopharyngeal sensitivity. The relationship between COPD and laryngopharyngeal sensitivity has not been previously determined. We conducted a study to investigate the effect of COPD on laryngopharyngeal sensitivity by using laryngopharyngeal sensory discrimination testing (LPSDT). Our study population was made up of 20 adults (mean age: 71.7 yr) with clinically proven COPD and 11 healthy, age-matched controls. All 31 subjects underwent LPSDT with the use of an air-pulse stimulator via a nasendoscope. The threshold of laryngopharyngeal sensation was evaluated by measuring the amount of air pressure required to elicit the laryngeal adductor reflex (LAR). We found that the patients with COPD had a significantly higher LAR threshold than did the controls (p< 0.001). We conclude that patients with COPD have significantly less mechanosensitivity in the laryngopharynx. This sensory change may place patients with COPD at increased risk for aspiration.

Subtotal gastrectomy for gastric tube cancer after esophagectomy: A safe procedure preserving the proximal part of gastric tube based on intraoperative ICG blood flow evaluation

Recent improvements in the survival of patients after esophagectomy have led to an increase in the occurrence of gastric tube cancer (GTC). Total resection of the gastric tube with lymphadenectomy is a standard and reliable treatment for GTC, but problems may arise during or after surgery, such as laryngeal nerve injury, reduced selection of organs for reconstruction, and impaired swallowing function. We recently performed a less invasive procedure, subtotal gastrectomy with preservation of the upper region of the gastric tube, in two patients. In these patients, blood supply to the gastric tube was evaluated by indocyanine green fluorescence imaging. Blood flow was confirmed as passing from the remnant esophagus to the upper region of the gastric tube through the esophago-gastric anastomotic site by indocyanine green fluorescence imaging. Therefore, we resected the gastric tube while preserving the upper region of the gastric tube. There was no necrosis of the remnant gastric tube or anastomotic leakage postoperatively, and postoperative swallowing and eating functions were quite good in both patients. In summary, subtotal gastrectomy as a treatment for GTC is potentially safe, curative, and beneficial for the patient's quality of life.