Management Of Dysphagia In Patients Research Articles

Assessment and management of dysphagia in patients with head and neck cancer who receive radiotherapy in the United Kingdom – A web-based survey

We undertook a service evaluation to establish how oropharyngeal dysphagia is managed in head and neck cancer patients receiving radiotherapy in the United Kingdom. A web-based survey including 23 open and closed questions was distributed to Speech and Language Therapy (SLT) teams via a national network of Royal College of Speech and Language Therapists (RCSLT) special interest groups with members involved in head and neck cancer care. Forty-six teams responded to the survey and 89% completed the questionnaire fully. Fifty percent (n=21/42) of the SLT teams reported routinely seeing patients prior to commencing radiotherapy. Baseline oromotor assessment (85.7% (n=36/42)), clinical dysphagia assessment (90.5% (n=38/42)) and information provision on the potential treatment effects on swallowing (97.6% (n=41/42)) and communication ability (85.7% (n=36/42)) were the most common components of initial evaluation. In keeping with expert opinion and emerging evidence, prophylactic swallowing exercises were administered by 71.4% (n=30/42) of teams targeting specific aspects of swallowing, although the nature, intensity and duration of programmes varied. A range of measures are used to monitor progress during treatment. Our survey highlighted that resource limitations affect service provision with some teams managing the consequences of treatment rather than proactive multidisciplinary intervention prior to and during treatment. Cancer- and treatment-related dysphagia can impact significantly on a broad range of outcomes following radiotherapy. There is variability in dysphagia service provision to patients before, during and following treatment. Comprehensive evaluation of swallowing function prior to treatment and proactive management can yield benefits for patients, inform multidisciplinary case management and support those involved in clinical trials to accurately determine treatment effects.

Dysphagia in Parkinson’s disease: a therapeutic challenge?

This article focuses on the current status and research directions on swallowing disorders (dysphagia) in patients with Parkinson’s disease (PD). Although epidemiological data are scarce, increased incidence of dysphagia in patients with PD leads to increased risk of mortality, secondary to aspiration pneumonia. Although studies show that aspiration pneumonia is a common cause of death in this group of patients, clinical practice lacks an evidence base and there is an increased need for randomized clinical trials. Importantly, the underlying mechanisms accounting for the progression of dysphagia in PD are still unclear. Furthermore, evidence shows that dopaminergic medication does not affect swallowing performance. Future research in the field is urgently needed and may result in improved management of dysphagia in patients with PD.

Management of dysphagia in patients affected by multiple sclerosis: state of the art

Dysphagia in multiple sclerosis (MS) has been found to be far more frequent than expected, and should be considered a dangerous condition from its onset because of its potentially serious complications. Among the several classification scales, we use the "O'Neil severity graduation scale" for its correlation between investigation imaging and patients' symptoms. In this paper we describe our treatment plans of mild, moderate and severe dysphagia following a preliminary assessment of symptoms carried out according to the O'Neil dysphagia graduation scale.

Current State of Management of Dysphagia in Patients with Neurological Disorders in the Department of Neurology in National Hospital Organization

Current State of Management of Dysphagia in Patients with Neurological Disorders in the Department of Neurology in National Hospital Organization

Cost-effectiveness of Two Types of Dysphagia Care in Head and Neck Cancer: A Preliminary Report

We conducted a prospective, preliminary study to compare the cost-effectiveness of two different instrument-based techniques for diagnosing and managing dysphagia in 30 consecutive hospitalized patients with head and neck cancer. The two techniques are videofluoroscopy via modified barium swallow (MBS) and videoendoscopy via flexible endoscopic evaluation of swallowing with sensory testing (FEESST). Medicare was the primary insurer of all patients. Fifteen of these patients had their dysphagia diagnosed and managed by MBS and the other 15 by FEESST. Cost-effectiveness was assessed by determining the average Medicare reimbursement for each procedure. We found that the mean reimbursements were $451.01 (+/- $50.55) for MBS and $321.23 (+/- $3.01) for FEESST. The mean reimbursement for FEESST was significantly lower than that for MBS (p < 0.0001; Mann-Whitney U test). We conclude that FEESST appears to be more cost-effective than MBS for the inpatient management of dysphagia in patients with head and neck cancer.

Detection and Management of Dysphagia in Patients with Acute Stroke

Detection and Management of Dysphagia in Patients with Acute Stroke

Management of dysphagia in a patient with closed head injury

This case report describes the evaluation and treatment of a closed head injured (CHI) patient with dysphagia and cognitive and language deficits. On October 27, 1985, the patient, a 35-year-old man, sustained multiple intracranial hemorrhages in a pedestrian-motor vehicle accident. Over a 4-month hospitalization in a rehabilitation setting, he progressed from nasogastric tube feeding to complete oral feeding with an unrestricted diet. When admitted to our inpatient rehabilitation unit 2 months after injury, the patient demonstrated confused, agitated, inappropriate behaviors and had a tracheostomy. He showed minimal neurologic impairment of his lips, tongue, face, jaw, velopharynx (i.e., palatopharyngeal isthmus), larynx, and respiratory motor mechanism. Three videofluoroscopic dysphagia studies were performed. Initial findings included pharyngeal paresis and laryngeal penetration of liquids. Safe swallowing was possible only by using compensatory strategies, such as decreasing bolus size and swallowing twice after each mouthful. Persisting cognitive and language deficits complicated the dysphagia treatment program. Behavior modification techniques, a structured environment, supervision, and family education were utilized to address the cognitive and language deficits contributing to dysphagia. The interactions of cognitive, language, and swallowing impairments are discussed. General considerations in the management of dysphagia in patients with closed head injuries are also addressed.