Oral Phase Dysphagia Research Articles

Oral Motor Exercise in Improving the Movements Of The Jaw, Lip, Tongue in Case of Oral Phase Dysphagia on a Cerebral Palsy Patient

The dysphagia case in children with cerebral palsy is a disorder that must be treated immediately because it will have a serious impact on the child's health and speech fluency. The Oral motor exercise method is one of the therapies to improve jaw, neck, and tongue movements in patients with cerebral palsy. The purpose of this study was to investigate the oral motor exercise on a dysphagia patient of 3-years old with cerebral palsy disorder at Syamsudin SH Hospital, Sukabumi, from January to March 2019. This type of research is a descriptive quantitative method with single subject experiment. A research subject was a patient with cerebral palsy, a 3- years old – boy who has dysphagia. The patient cannot speak and only cries and says 'AAAA' if he wanted something and the patient was choking and coughing when eating or drinking. To deal with this problem, 20 sessions of therapy and 1 evaluation were carried out. The results showed that by comparing the results of the initial test and the final test, there was an increase in the ability to move the organs of the lips, tongue, jaw, and chewing movements of the patient. In the initial test, the patient got 2 points and the final test result. the patient got 4 points which indicated 50% success scale. From the therapeutic success scale obtained, it was concluded that the therapy was quite successful.

P437 Bright tongue sign is prior to the oral phase dysphagia of ALS patients

P437 Bright tongue sign is prior to the oral phase dysphagia of ALS patients

Association of dysphagia with altered brain glucose metabolism in Parkinson's disease.

Dysphagia is a major clinical concern in Parkinson's disease (PD). However, the relationship between the development of phase-specific dysphagia and the regional brain glucose metabolism remains unclear. Our objective was to investigate the distributions of brain glucose metabolism specific to oral and pharyngeal phases of dysphagia in PD. In this retrospective cross-sectional study, patients with PD who underwent videofluoroscopic swallowing study (VFSS) and 18 F-fluorodeoxy-glucose positron emission tomography at intervals of <1 month were included. Each swallow was assessed by the binarized Videofluoroscopic Dysphagia Scale with 14 subitems, seven each for the oral and pharyngeal phases. Metabolism mapping was performed by superimposing significant clusters of subitems belonging to each of the two phases using voxel-wise Firth's penalized binary logistic regression model, adjusting for age and PD duration at VFSS. Eighty-two patients with PD who met the inclusion criteria were included in the analysis. The oral phase dysphagia-specific overlap map showed hypermetabolism in the right inferior temporal gyrus, bilateral cerebellum, superior frontal gyrus, and anterior cingulate cortices. Hypometabolism in the bilateral orbital and triangular parts of the inferior to middle frontal gyrus was also correlated with the occurrence of oral phase dysphagia. The development of pharyngeal phase dysphagia was related to hypermetabolism of posterior aspects of the bilateral parietal lobes, cerebellum, and hypometabolism of the mediodorsal aspects of anterior cingulate and middle to superior frontal gyri. These findings suggest that phase-specific distribution of brain glucose metabolism may explain the dysphagia of PD.

Development of the Sakiika transport test: A practical screening method for patients with oral-phase dysphagia.

This study aimed to develop a simple screening test for mastication, "the Sakiika (squid jerky) transport test (STT), which evaluates the vertical jaw movement coordinated with the lateral tongue movement during stage I transport, and investigate the possibility of its clinical application. The study included 73 people with dysphagia (mean age, 78.5 ± 7.8 years; median age, 79.0 years; interquartile range, 75.0-84.0). The STT evaluated the ability of a participant to transport a piece of squid jerky placed on the midline of the tongue to the molar region. The STT score was defined as the number of vertical jaw movements occurring as the tongue transported food to the molars. A cutoff value was set by comparing the STT scores with masticatory function evaluated via a videofluoroscopic swallowing study and with food texture evaluated using the Food Intake LEVEL Scale (FILS). The STT scores counted by the two examiners had a κ coefficient of 0.79, indicating good reliability. The STT score was significantly associated with both the presence of masticatory movement ( p = 0.019) and food texture classified by FILS ( p = 0.032) at cutoff value of "3" (3 vertical movements). The STT showed 62% sensitivity and 75% specificity for masticatory movements. The STT could be a useful screening test to assess the presence or absence of food transportation to the molars for mastication in older patients with dysphagia. In addition, the STT could be useful in identifying the need to modify food texture to meet functions.

A Literature Review: Evidence Base in Speech-Language Pathology for the Management of Pediatric Oral Phase Dysphagia

Purpose A review was conducted of published literature regarding management of feeding difficulties at the oral phase of feeding in children with autism spectrum disorder and/or developmental disability. The articles selected were open access or free for speech-language pathologist (SLP) members of their professional bodies. The specific research question was: What research and evidence-based practice articles have been published in the SLP literature to assist SLPs in the implementation of evidence-based practice for children with challenges during the oral phase dysphagia? Method Initial inclusion criteria were articles published in English, published in SLP journals, discussed management of behavioral feeding difficulties and oral phase dysphagia, and were published between 2008 and 2018. Exclusion criteria for this review included articles that addressed dysphagia for participants who were medically fragile, used pharmacological intervention, or studies that included adults. A comprehensive search was conducted of ASHAWire, the Speech-Language and Audiology Canada website, the Royal College of Speech and Language Therapy of the United Kingdom and the website Speech Pathology Australia. Articles were analyzed using Preferred Reporting Items for Systematic Review and using a modified feasibility, appropriateness, meaningfulness, effectiveness framework for qualitative case studies. Interrater reliability was calculated using intraclass correlation coefficient across four raters. Results All but one of the articles included for this review were qualitative articles containing descriptions of strategies or case studies (e.g., food chaining), were not peer reviewed, but did constitute evidence-based practice as outlined by American Speech-Language-Hearing Association (i.e., were either Level III or Level IV evidence-based strategies or intervention models). Conclusion The review highlighted the need for additional research in SLP designed to answer questions about the management of functional skills in feeding and eating for the population of children with autism spectrum disorder and developmental disability, patients who are increasingly on caseloads of SLPs.

Oral Phase Dysphagia, the First Manifestation of Systemic Amyloidosis Associated with Multiple Myeloma

Amyloidosis is a disease in which abnormal proteins called amyloid accumulates in various tissues. In the head and neck area, the larynx is the most common site with the rare involvement of the tongue, causing symptoms of macroglossia. Most of amyloid light-chain (AL) amyloidosis are systemic amyloidosis accompanied with multiple myeloma (MM), where the involvement of tongue can be often observed. We report a case of AL amyloidosis with MM, initially with symptoms of dysarthria and dysphagia without macroglossia, but gradually over the years, macroglossia and high tongue stiffness were observed.

Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals

Oral phase dysphagia is dependent on ability to chew. As people age, general muscle atrophy contributes to decreased masseter strength. The main objective of this study was to assess the relationship between the thickness of the masseter muscle measured by ultrasonography and the presence of dysphagia in a group of institutionalized elderly people. As a secondary objective, we aimed to establish cutoff points of masseters muscle thickness (MMT) to identify elderly individuals at risk of oral dysphagia. Cross-sectional study of all residents from 3 nursing homes. All individuals underwent ultrasonographic measurements of left and right MMT and were classified according to the presence of dysphagia assessed by both the EAT-10 screening questionnaire and the volume-viscosity swallow test (V-VST). 469 patients (69% women, mean age 84.7yrs) were recruited. Dysphagia was present in 41.6% and 26% of individuals according the EAT-10 and V-VST, respectively. Multivariate logistic regression showed that 1mm increase in MMT reduced the risk of dysphagia by 21% according to the EAT-10 tool and by 30% using the V-VST after adjusting for age, sex, mini-nutritional assessment score, and body mass index. We used receiver operative characteristic (ROC) curves to identify cutoff points of MMT to detect dysphagic individuals according to either EAT-10 or V-VST. The MMT measured by ultrasonography is reduced in elderly individuals with dysphagia. Based on MMT, clinicians may be better informed about the patients'´ ability to masticate solid foods and identify potential nutrient deficiencies in geriatric settings.

Patterns of Dysphagia and Airway Protection in Infants with 22q11.2-Deletion Syndrome.

22q11.2-deletion syndrome is a genetic condition that affects 1:3000 births. In addition to cardiac anomalies and immunosuppression, individuals with 22q11.2-deletion syndrome can have feeding difficulties from birth resulting in failure to thrive and infections. This study aims to characterize the dysphagia seen in infants with 22q11.2-deletion syndrome. This is a retrospective chart review of infants with 22q11.2-deletion syndrome who underwent videofluoroscopic swallow studies (VFSS) from June 1, 2008 to January 1, 2018 at a tertiary children's hospital. Demographic data and VFSS findings were collected. Forty-four patients were identified, 52% were females, and mean age at VFSS was 71 days. In their lifetime, 30% of the patients had at least 1 episode of pneumonia, 66% had NG-tube placement and 41% required G-tube placement. 93% had oral-phase dysphagia, and 89% had pharyngeal-phase dysphagia. Twenty-two patients (50%) demonstrated evidence of penetration. Eighteen patients (41%) showed tracheal aspiration. Of the patients that showed tracheal aspiration, 83% of them aspirated "silently." Three patients (7%) had upper esophageal sphincter (UES) opening dysfunction. Vast majority of the infants with 22q11.2-deletion syndrome referred for swallow studies demonstrated evidence of dysphagia in both oral and pharyngeal phases with deficits in swallow physiology not yet documented in other studies. Importantly, more than 80% of these infants showed evidence of "silent" tracheal aspiration, which can lead to recurrent pneumonia and significant morbidity if overlooked. Prompt recognition is paramount in these infants to intervene early and reduce long-term complications and also develop targeted interventions. 4 Laryngoscope, 130:2532-2536, 2020.

Oral phase dysphagia in facial onset sensory and motor neuronopathy.

IntroductionFacial onset motor and sensory neuronopathy (FOSMN) is a rare disease whose cardinal features are initial asymmetrical facial sensory deficits followed by bulbar symptoms and spreading of sensory and motor deficits from face to scalp, neck, upper trunk, and upper extremities in a rostral–caudal direction. Although bulbar involvement is frequently observed in FOSMN, dysphagia in these patients has not been fully described. In this study, we aimed to characterize dysphagia as a prognostic factor in FOSMN by investigating our institutional case series.MethodsWe retrospectively reviewed the medical records, including swallowing function tests, of six patients with FOSMN (three men and three women) who were thoroughly examined at Kyushu University Hospital between 1 January 2005 and 30 November 2017.ResultsAverage age at onset was 58.5 years; average disease duration was 5.7 years. All patients developed bulbar dysfunction and dysphagia (at an average of 1.8 and 2.6 years from onset, respectively), resulting in choking episodes in three patients, percutaneous endoscopic gastrostomy placement in three, and recurrent aspiration pneumonia in one. Four of five patients evaluated with videofluoroscopic swallowing studies had poor oral retention, leading to bolus flowing into the pharynx before swallowing; the fifth patient showed poor lingual transfer. Fiberoptic endoscopic evaluation of swallowing revealed leakage of blue‐dyed water from the mouth to the pharynx in three patients because of poor oral retention, but only mild pharyngeal phase dysphagia in all four cases evaluated.ConclusionsOral phase dysphagia predominates in the early stage of FOSMN.

Impact of formal training on agreement of videofluoroscopic swallowing study interpretation across and within disciplines.

Formal agreement studies on interpretation of the videofluoroscopic swallowing study (VFSS) procedure among speech-language pathologists, radiology house officers, and staff radiologists have not been pursued. Each of these professions participates in the procedure, interprets the examination, and writes separate reports on the findings. The aim of this study was to determine reliability of interpretation between and within the disciplines and to determine if structured training improved reliability. Thirteen speech-language pathologists (SLPs), ten diagnostic radiologists (RADs) and twenty-one diagnostic radiology house officers (HOs) participated in this study. Each group viewed 24 VFSS samples and rated the presence or absence of seven aberrant swallowing features as well as the presence of dysphagia and identification of oral dysphagia, pharyngeal dysphagia, or both. During part two, the groups were provided with a training session on normal and abnormal swallowing, using different VFSS samples from those in part one, followed by re-rating of the original 24 VFSS samples. A generalized estimating equations (GEE) approach with a binomial link function was used to examine each question separately. For each cluster of tests, as example, all pairwise comparisons between the three groups in the pretraining period, a Hochberg's correction for multiple testing was used to determine significance. A GEE approach with a binomial link function was used to compare the premeasure to postmeasure for each of the three groups of raters stratified by experience. The primary result revealed that the HO group scored significantly lower than the SLP and RAD group on identification of the presence of dysphagia (p = 0.008; p = 0.001, respectively), identification of oral phase dysphagia (p = 0.003; p = 0.001, respectively), and identification of both oral and pharyngeal phase dysphagia, (p = 0.014, p = 0.001, respectively) pretraining. Post training there was no statistically significant difference between the three groups on identification of dysphagia and identification of combined oral and pharyngeal dysphagia. Formal training to identify oropharyngeal dysphagia characteristics appears to improve accuracy of interpretation of the VFSS procedure for radiology house officers. Consideration to include formal training in this area for radiology residency training programs is recommended.

Lesions Responsible for Delayed Oral Transit Time in Post-stroke Dysphagia.

Some stroke patients show oral phase dysphagia, characterized by a markedly prolonged oral transit time that hinders oral feeding. The aim of this study was to clarify the clinical characteristics and lesions responsible for delayed swallowing. We reviewed 90 patients with stroke. The oral processing time plus the postfaucial aggregation time required to swallow semisolid food was assessed. The patients were divided into two groups according to oral transit time, and we analyzed the differences in characteristics such as demographic factors, lesion factors, and cognitive function. Logistic regression analyses were performed to examine the predictors of delayed oral transit time. Lesion location and volume were measured on brain magnetic resonance images. We generated statistic maps of lesions related to delayed oral phase in swallowing using voxel-based lesion symptom mapping (VLSM). The group of patients who showed delayed oral transit time had significantly low cognitive function. Also, in a regression model, delayed oral phase was predicted with low K-MMSE (Korean version of the Mini Mental Status Exam). Using VLSM, we found the lesion location to be associated with delayed oral phase after adjusting for K-MMSE score. Although these results did not reach statistical significance, they showed the lesion pattern with predominant distribution in the left frontal lobe. Delayed oral phase in post-stroke patients was not negligible clinically. Patients' cognitive impairments affect the oral transit time. When adjusting it, we found a trend that the lesion responsible for delayed oral phase was located in the left frontal lobe, though the association did not reach significance. The delay might be related to praxis function.

Validity of maximum isometric tongue pressure as a screening test for physical frailty: Cross-sectional study of Japanese community-dwelling older adults.

Maximum isometric tongue pressure (MIP) seems to have a diagnostic value for oral phase dysphagia. The present study aimed to examine the association between MIP and frailty, and to assess the screening validity of MIP for physical frailty. We carried out a cross-sectional study, and enrolled participants aged ≥60 years from Japanese national medical check-ups in 2015 and 2016. The Fried frailty phenotype model was used. We analyzed odds ratios (OR) and 95% confidence intervals (CI) of physical frailty using one standard deviation increments of tongue pressure. Receiver operating characteristic curves were obtained to predict physical frailty using MIP values. Out of 1603 participants, 968 were categorized as non-frail, 605 as pre-frail and 30 as frail. In logistic regression analysis, one standard deviation increment of MIP significantly differentiated frail and pre-frail: the OR for frail with one standard deviation increment in MIP was 0.37 (95% CI 0.26-0.54, P < 0.001), and the OR for pre-frail was 0.63 (95% CI 0.57-0.70, P < 0.001). The area under the receiver operating characteristic curve for predicting frailty with MIP score was as high as 0.776 (95% CI 0.689-0.862). A point of MIP 35 kPa had a sensitivity of 90.0%, specificity of 40.4%, a positive likelihood ratio of 1.5 and a negative likelihood ratio of 0.2 for predicting frailty. MIP performance is independently associated with frailty. MIP also can be used as a simple screening tool for frailty. Geriatr Gerontol Int 2018; 18: 240-249.

Oral tactile sensitivity and masticatory performance are impaired in stroke patients.

Oro-facial impairment following stroke frequently involves reduced chewing performance, that is oral phase dysphagia. The aim was to investigate the sensitivity of oral tissues following stroke and its potential impact on masticatory function. Therefore, hospitalised post-stroke patients were recruited and compared to healthy controls. Outcome measures comprised masticatory performance employing a colour-mixing ability, that is a bolus-kneading test, maximum lip- and bite force and the one-point and two-point tactile thresholds. Food hoarding and prevalence of dry mouth were evaluated with ordinal scales. Twenty-seven stroke patients (age 64·3 ± 14·1 years) and 27 healthy controls (age 60·8 ± 14·3 years, P = 0·254) participated in this study. The groups had similar numbers of occluding units. Stroke patients reported more frequently dry mouth sensations and food hoarding. The intra-oral tactile sensitivity on the contra-lesional side was significantly lower in stroke patients compared to controls (0·0001 < P < 0·0002), and significant intra-group side differences were found only in the stroke group (0·0001 < P < 0·0010). For the lip, both sides were less sensitive in the stroke group compared with controls. The experiments confirmed lower masticatory performance and lip force in the stroke group, but the bite force was similar compared to healthy controls. Oral sensitivity was correlated with masticatory performance when a global correlation model was applied. A stroke may affect the sensitivity of the intra-oral tissues contra-lesionally, thus potentially affecting chewing function. Rehabilitation should therefore not only focus on motor impairment, but equally stimulate the sensitivity of the oral tissues, employing dry ice application or similar specific treatments.

Clinical Characteristics of Dysphagia in Children with Down Syndrome

Aspiration is an often unrecognized comorbidity in children with Down syndrome with serious medical consequences. This retrospective chart review of swallow study reports characterizes oral and pharyngeal phase dysphagia and diet modifications on videofluoroscopic swallow studies (VFSS) in a large cohort of children with Down syndrome. A total of 158 pediatric patients (male=95; female=63; mean age 2.10years, SD 3.17years) received an initial VFSS at a pediatric teaching hospital as part of their medical care. A total of 56.3% (n=89) children had pharyngeal phase dysphagia with aspiration and deep laryngeal penetration occurring most frequently. Of the 61 patients who aspirated, 90.2% (n=55) did so silently with no cough or overt clinical symptoms. In 76.7% of cases of pharyngeal phase dysphagia, a functional feeding plan, with use of thickened liquids or change in feeding system to control flow rate and/or bolus size, was able to be established, which allowed children to continue eating by mouth. Thickened liquids (76.7%, n=46) were the most effective adaptation, with change in feeding system alone effective in only 8.3% (n=5) cases. Oral phase dysphagia was reported in the majority of patients (63.8%, n=88/138); however, this was not predictive of pharyngeal phase dysphagia. Age, sex, and reason for referral, including prior clinical symptoms, did not have a statistically significant impact on the presence of dysphagia. This comprehensive review has application to clinical understanding and management of dysphagia in children with Down syndrome.

Feeding Impairments Associated with Plasma Sterols in Smith-Lemli-Opitz Syndrome

To quantitatively evaluate feeding impairment in children with Smith-Lemli-Opitz syndrome (SLOS) and to correlate feeding impairment with clinical and biochemical indices of disease severity. The study subjects were 26 children with SLOS ranging in age from 0.4 to 19years. Clinical severity was measured using an existing scoring system. We created a tool to quantitatively evaluate feeding. Plasma sterol concentrations were measured, and statistical associations (correlations) with feeding scores were calculated. Oral hyposensitivity or hypersensitivity, adverse behaviors, and risk for dysphagia were seen in ∼65% of the children with SLOS. Thirteen of the 26 children experienced failure to thrive, and 10 children required gastrostomy. Plasma concentration of 7-dehydrocholesterol, as a measure of severity, was correlated with total feeding score and oral function subcategory score (P<.001) and less so with oral structure score, adverse behaviors, or dysphagia. Correlations with cholesterol concentrations were less statistically significant. A plasma 7-dehydrocholesterol concentration >0.24mmol/L or cholesterol concentration <1.95mmol/L was predictive of gastrostomy tube use. Feeding impairments may improve with age. Feeding impairment is common and complex in patients with SLOS. Our findings confirm that oral sensitivities, adverse feeding behaviors, and risk of oral phase dysphagia are amenable to quantitative evaluation and analysis. Feeding difficulties in children with SLOS are correlated with plasma sterol concentrations, suggesting a link between the biochemical severity of SLOS and feeding function. These findings expand the behavioral phenotype of SLOS and begin to provide insight into the biological causes of feeding difficulties.

Characteristics and clinical assessment of deglutition disorders and oral movement function in children with cerebral palsy

Objective To investigate the symptom characteristis as well as the clinical assessment methods of dysphagia and oral motor function in children with cerebral palsy(CP).Methods A total of 116 children with CP,aged 18 months to 96 months(66 boys and 50 girls),treated in Qingdao Rehabilitation Center for Disabled Children from June 2009 to September 2010,were included in the study.Diagnosis and subtype of CP were determined by neuropaediatrician,the dysphagia disorders survey(DDS)as well as oral motor assessment were conducted by the speech therapists.Results Of the 116 cases,22.4％ of the cases were with mild dysphagia and 34.5％ with moderate to severe dysphagia,resulting in a prevalence of dysphagia of 56.9％.The main problems of these cases occurred during oral phase and pharyngeal phase,including inadequate feeding skills(involving sucking,biting,chewing or/and swallowing),coughing,vomiting and choking during feeding,cry/overextension of neck and head during feeding,drooling,hypertonic tongue and inadequate tongue lateralization.The severe dysphagia was encountered frequently in children with spastic quadriplegic,dyskinetic or mixed type CP children.Of the 116 cases,90 cases(77.59％)were with oral motor dysfunction(including all spastic quadriplegic,dyskinetic or mixed type children).The oral motor scores of CP children were significantly lower than those of the controls(P ＜ 0.01).Conclusions Oral phase dysphagia and oral motor disorder might be considered as the common clinical problems among the patients with CP,and could be assessed by using DDS combined with oral motor assessment,but for dysphagia during pharyngeal or esophagus phase,the videofluoroscopic modified barium swallow should be used for further evaluation. Key words: Cerebral palsy; Deglutition disorder; Oral movement disorder; Clinical assessment

Incidence and description of dysphagia in infants and toddlers with tracheostomies: A retrospective review

An increasing number of infants and toddlers with tracheostomies were identified at a large paediatric referral hospital in South Africa. They are at risk for swallowing and feeding difficulties, however, there is limited literature reporting the incidence and describing the dysphagia in this population, and no literature specific to a developing country. The purpose of this study was therefore to report the incidence and describe the dysphagia in infants and toddlers with tracheostomies at a large paediatric referral hospital in South Africa. A retrospective, descriptive review of the medical records of 80 infants and toddlers (0-3 years) with tracheostomies between 2002 and 2004 was conducted. Eighty percent (64/80) of the participants presented with dysphagic symptoms. Oral phase dysphagia was reported in 81.25% (52/64), pharyngeal phase dysphagia in 60.9% (39/64) and oesophageal phase dysphagia in 79.7% of the dysphagic participants. Infants and toddlers with tracheostomies are at increased risk for dysphagia. Multiple risk factors for dysphagia associated with tracheostomies, underlying medical conditions and the context of a developing country were identified in the study population.

Tongue Measures in Individuals With Normal and Impaired Swallowing

This investigation sought to add to the extant literature on measures of normal tongue function, to provide information on measures of tongue function in a group of individuals with oral phase dysphagia, and to provide a comparison of these 2 groups matched for age and gender. The Iowa Oral Performance Instrument was utilized to measure tongue function (strength and endurance) in a group of individuals with normal (N=200) and impaired (N=50) swallowing. The peak measure of 3 encouraged trials was recorded as participants' strength, and 50% of their peak was sustained as long as possible for endurance. Results for the control group supported previous investigations wherein greater tongue strength was found in males than in females and in the youngest versus oldest groups. The experimental group demonstrated a similar trend in strength for gender. When matched for age and gender, the experimental group demonstrated significantly lower strength. Significant differences were not revealed on measures of tongue endurance. We were able to extend the normative database on tongue function and document reduced tongue strength in a group of individuals with dysphagia. The findings provide evidence that in this group, tongue weakness coincided with signs of dysphagia, adding justification for tongue-strengthening protocols.