Neurogenic Population Research Articles

Oral Sensory Influences on Eating and Swallowing in the Neurogenic Population

Oral Sensory Influences on Eating and Swallowing in the Neurogenic Population

The challenges of managing dysphagia in brain-injured patients.

Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury. Assessment of dysphagia is normally undertaken by speech and language therapists in conjunction with the multidisciplinary team. A bedside screening assessment may be augmented by instrumental assessment, such as videofluoroscopy, in cases where silent aspiration of food or liquid into the lungs is suspected. Dysphagia is treated using a variety of strategies, depending on the presenting symptoms. Individuals with dysphagia following traumatic brain injury present with particular difficulties, relating to impairments of cognition, communication and behavioural control. A description of the normal swallow is presented below with a review of dysphagic disorders, assessment methods and management. This is followed by a case account of a young man with dysphagia subsequent to traumatic brain injury to highlight some of the difficulties which can be encountered in the management of dysphagia.

Clinicians’ Preferences and Practices in Conducting Clinical/Bedside and Videofluoroscopic Swallowing Examinations in an Adult, Neurogenic Population

The purposes of this investigation were: (a) to determine which clinical/bedside and videofluoroscopic (VFS) examination methods and measures clinicians believe should be employed to assess swallowing in adults with neurogenic etiologies, (b) to determine which clinical/bedside and VFS examination methods and measures clinicians actually use, and (c) to compare clinicians’ preferences and practices with examination methods and measures that have research support. A survey was sent to 300 speech-language pathologists, selected randomly, from the American Speech-Language-Hearing Association’s Dysphagia Special Interest Division. Sixty-one surveys (20%) provided the data for analysis. Results indicate clinicians vary regarding which clinical/bedside and videofluoroscopic methods and measures should be employed to assess swallowing function in an adult, neurogenic population. Nevertheless, clinicians, for the most part, use the methods they believe should be employed. There appears to be a need to validate, through research, a number of methods and measures clinicians employ in clinical/bedside evaluations. In addition, there appears to be a need to reduce and define clearly the number of duration measures, as well as other VFS measures, that are being proposed. Results also indicate a need to determine the sensitivity, specificity, and reliability of the variety of methods employed in both clinical/bedside and VFS examinations.

A comparison of assessment findings using videofluoroscopy and fibreoptic endoscopic evaluation of swallowing safety

ABSTRACT Videofluoroscopic assessment (VF) is the most widely used objective assessment technique for the assessment of dysphagia, but many will acknowledge that the procedure has some limitations. Fibreoptic endoscopic evaluation of swallowing safety (FEESS) was developed in an attempt to provide an adjunct to VF and to meet some of its limitations. It is essentially an extension of the routine fibreoptic examination of the larynx and pharynx used by ENT consultants, in which the patient is given various textures to swallow and observations about swallow events and overall swallowing efficiency can be made. The literature includes several studies comparing results of these two procedures and outlining their relative advantages and disadvantages, but no one has looked at a wide range of swallow events and directly compared results obtained. Before introducing the procedure it was felt that it would be useful to evaluate it with our specific neurogenic population. The questions to be asked in our study were: (1) Do patients tolerate the procedure comfortably enough to make it a valid tool for the assessment of swallowing? Specifically, how many patients tolerate the fibreoptic endoscope in position for the average of 10 minutes which is required? (2) Does the procedure allow us to identify significant swallow events identified with VF?(3) What information, if any, is provided by FEESS that VF does not provide? The study involved 20 neurogenic patients with dysphagia, who were routinely referred to Neuro‐otology for assessment of laryngeal function and who reported swallowing difficulties. All the patients were known to the speech and language therapy department. An extended fibreoptic assessment of palatal, pharyngeal and laryngeal function, and trial swallows of various textures, was carried out within one week of FEESS and involved trial swallows of similar textures to those used in FEESS in lateral and AP views. Facilitators were trialled. Results were collected and recorded in relation to individual swallow events, for example, amount of tongue base retraction, triggering of swallow reflex, and evaluation of facilitators. Analysis of results is incomplete at this stage. Eighteen of the 20 patients tolerated FEESS assessment tasks. However, only eight of the 18 patients tolerated Mailing of facilitators, in particular those involving head positioning. Preliminary results revealed that oral stage events are better evaluated with VF. Nasal regurgitation is identified equally on VF and DEESS. Delay in triggering of the swallow reflex is identified equally with both procedures, but it is possible to obtain objective times with VF. Pharyngeal swallow events are not visualised with FEESS, but residual pharyngeal pooling was clearly visualised and amounts of residue more easily estimated. Aspiration was identified reliably with both procedures. Full results will be presented. Conclusions at this point support those suggested in the literature that FEESS is a useful adjunct to VF and may, in fact, be the assessment technique of choice for some patients, depending on the specific goals of assessment. The procedure was tolerated by most patients but may be limited in allowing evaluation of positioning facilitators.