Swallowing Function In Patients Research Articles

The timed 100 mL water swallow test for patients with head and neck cancer: What constitutes a clinically significant difference?

Swallowing function in patients with head and neck cancer (HNC) is often assessed pre-treatment, during and at intervals post-treatment to identify those with dysphagia as early as possible. This study aims to investigate the minimal clinical important difference (MCID) for the 100 mL water swallow test (100 mL WST) to increase its utility in clinical practice and in clinical trials. Data from 211 HNC patients, treated byeither single or combined modality were included. Patients completed both the 100 mL WST and M.D. Anderson Dysphagia Inventory (MDADI) at baseline (i.e., prior to treatment) and 12 months post-treatment. The MCID for the 100 mL WST was calculated using two approaches of the anchor-based method (using the MDADI), including mean change, and ROC curve. Additionally, the distribution-based method was used utilizing the half standard deviation approach. In the anchor-based method, a 4 mL/s in the 100 mL WST was defined as an MCID for deterioration, with a sensitivity of 75% and a 1-specificity of 46%. In contrast, a change of 5 mL/s was deemed as an MCID for improvement, based on the distribution-based method. The findings showed that deterioration of 4 mL, or an increase of 5 mL from baseline to 12 months post-HNC treatment equates to an MCID from the patients' perspective. Based on these findings, it may be beneficial to increase the utilization of the 100 mL WST in clinical practice to observe the changes, and in clinical trials to interpret and compare different study arms.

Diet Outcomes in Patients With COVID-19 Who Were Intubated and Proned

Objective: During the first wave of the COVID-19 (SARS CoV-2) pandemic, patients being treated for acute respiratory distress syndrome were proned while intubated with mechanical ventilation. In this study, we aimed to compare the diet outcomes at the time of acute hospital discharge of patients with COVID-19 who were proned while endotracheally intubated (ETT-proned) with those who were intubated with but not proned (ETT-supine). Design: The design used is a single-center, retrospective, descriptive study. Results: Between March 1, 2020, and August 2020, 193 critically ill adult patients with severe COVID-19 requiring endotracheal intubation with mechanical ventilation were referred for a swallowing evaluation at our acute care tertiary hospital; 114 of these patients were ETT-proned. At the time of discharge from the hospital, there was no significant difference in diet level between ETT-proned and ETT-supine patients. Significant factors associated with restricted diet at discharge included older age ( p < .001) and non–English-speaking status ( p = .05). Conclusions: In this study, diet levels at the time of discharge did not differ significantly between the patient groups by time of discharge. These results should be interpreted with caution in relation to the clinical swallow evaluation, which was curtailed by practice restrictions imposed by pandemic protocols. Future research should objectively assess swallow function in patients who were proned during intubation with mechanical ventilation, utilizing evidence-based swallow screening protocols, standardized assessment of physiology via imaging (videofluoroscopic swallow studies or flexible endoscopic evaluation of swallowing), and long-term follow-up to directly and objectively determine the impact proning has on swallow physiology.

Efficacy of High-Intensity Training in Patients with Moderate to Severe Dysphagia after Glossectomy.

Dysphagia is the main impairment arising from glossectomy for tongue cancer treatment. The study aimed to determine if an eight-week training protocol paired with accuracy tasks and swallowing exercises is effective and can improve tongue strength and swallowing in patients after tongue resection. Maximum isometric pressures, tongue endurance, swallowing pressures, mealtime duration, and oropharyngeal swallow function were studied in patients with moderate to severe dysphagia after glossectomy. Twenty-five (25) patients and thirty-one (31) healthy participants were enrolled in the study. The therapy group (TG) consisted of seventeen (17) patients who followed an 8-week treatment protocol and had multiple measurements. The follow-up control group (FUG) consisted of eight non-treated patients who had a baseline and an 8-week follow-up examination. Healthy participants served as the reference group (RF). Maximum isometric pressures, endurance, and swallowing pressures increased significantly in the TG versus the FUG. Significant improvement was documented in the TG regarding the EAT-10 questionnaire, the Penetration-Aspiration Scale scores at thickened and solid boluses, and post-swallow residues at thickened and solid boluses. The treatment protocol with tongue strength exercises combined with accuracy tasks and swallowing exercises improves the post-operative swallowing function in patients after glossectomy. Patients in the TG had more significant and quicker improvement in pressures and endurance compared to FUG.

Videofluoroscopic Measures of Swallowing After Partial Epiglottidectomy for Dysphagia.

Partial epiglottidectomy has a role in improving dysphagia due to epiglottic obstruction. This study evaluates objective parameters of swallow function in patients who underwent partial epiglottidectomy. Retrospective study design. Tertiary Care University Academic Medical Center. A review was performed of patients who underwent CO2 laser partial epiglottidectomy for the treatment of dysphagia at a single tertiary care academic center over a 4-year period. Objective swallowing parameters were evaluated from pre- and postoperative modified barium swallow studies using SwallowTail Advanced Measurement software using blinded reviewers. The postswallow pharyngeal residue (bolus clearance ratio or BCR), spatiotemporal swallowing variables (oropharyngeal [OPT], hypopharyngeal [HPT], and total pharyngeal transit times [TPT]), and airway protection (Penetration-Aspiration Scale [PAS]) were analyzed. Student paired ttest was used to determine significant changes in outcome parameters pre- and postsurgery. Forty-three patients (age range 45-92 years, median 70) met the inclusion criteria. A majority (69.8%) had a history of external beam radiation therapy for head and neck cancer. BCR decreased significantly from a mean of 31.7% presurgery to 24.2% (p = .01) postsurgery. OPT, HPT, and TPT did not differ significantly postsurgery. The mean Eating Assessment Tool-10 score improved from 25.1 to 20.2 after treatment (p = .03). PAS score improved by 15.4% and remained stable at 66.2% after surgery. Partial epiglottidectomy improves pharyngeal bolus clearance in properly selected patients with dysphagia due to epiglottic obstruction. Patients demonstrated stable swallow function with the benefit of reduced postswallow residue following surgical intervention.

Nursing adherence, barriers and facilitators to conduct post-stroke dysphagia screening and assessment: A study based on theoretical domain framework.

There are an increasing number of evidence-based recommendations for managing dysphagia in post-stroke patients. However, it is unclear whether nurses adopt these recommendations in their daily nursing practices. This study aimed to explore nurses' adherence, barriers, facilitators and views on dysphagia screening and assessment of post-stroke dysphagia. In this study, multiple methods were adopted. In Phase 1, a general information questionnaire and a knowledge-attitude-practice and barriers/facilitators questionnaire for dysphagia screening and assessment were distributed in 55 hospitals online. In Phase 2, semi-structured interviews were conducted to explore nurses' views on barriers. Descriptive and one-way variance analyses were used to analyse the quantitative data, while content analysis was used to analyse the qualitative data. This study adheres to STROBE and COREQ guidelines. Nine hundred and forty-two completed questionnaires were collected. Only 36.52% of the nurses screened for swallow function in patients as a guideline. The biggest barrier was 'memory, attention and decision process', with an average score of 3.22 (.74). The different stages of implementation had various types and degrees of barriers (p< .001). Five themes were extracted after interviews, namely 'Inadequate environment and resource support', 'Increased workload', 'Professional value perception', 'Organisational culture', and 'Poor knowledge and skill'. Nurses' practice of dysphagia screening and assessment of patients with dysphagia after stroke were inadequate, and the barriers originated from patients, leadership and the nurses themselves. This research extracted five barriers of guidance adherence for post-stroke dysphagia screening and assessment and identified the different kinds and degrees of barriers in five implementation stages, providing a basis for nursing managers to break through the bottleneck of guideline implementation. The nurses recruited in this study completed validated questionnaires in the survey and suggestive answers in interviews.

Dosimetric Predictors of Acute and 1-Year Functional Oral Intake for Head and Neck Cancer Patients Treated with Radiotherapy

<h3>Purpose/Objective(s)</h3> In order to reduce risks of radiation-induced dysphagia after head and neck radiotherapy, a better understanding of the relationship between dose to various swallowing-related organs at risk (SOARs) is necessary. There is limited data regarding the association of 6–12-month functional swallowing outcomes and the dose to SOARs including the pharyngeal constrictor muscle (PC), cricopharyngeus (C), glottic (GL) supraglottic larynx (SGL), and the RTOG-defined Pharynx OAR (POAR). We assessed dosimetric predictors of change in swallowing function from up to 1-year post-RT. <h3>Materials/Methods</h3> We retrospectively reviewed our institutional database of patients treated with head and neck cancer from 2017-2020. Swallowing function was assessed at 1-, 3-, 6-, and 12-months post-treatment using the Functional Oral Intake Scale (FIOS, 1=no oral intake, 7=total oral intake without restrictions). Mean dose, V50, and V60 were abstracted from the treatment planning software for each SOAR. Patients were categorized by whether clinically relevant constraint parameters were met for each SOAR, which were then evaluated for association with FOIS using the Wilcoxon test. <h3>Results</h3> In total, 141 patients with evaluable treatment plans and swallowing outcomes were analyzed. Of the patients included for analysis, 51% had oropharyngeal cancer, 100% received concurrent chemotherapy, and 31% were treated post-operatively. Across all included treatment plans, the median prescribed dose to PTV was 70 Gy (38-70 Gy). Swallowing outcomes at 1-, 3-, 6-, and 12-months post-treatment were available for 132 (94%), 129 (91%), 121 (86%), and 111 (79%) patients, respectively. The median (range) FOIS scores at baseline, 1-, 3, 6-, and 12-months were 7 (5-7), 4 (2-7), 6 (3-7), and 7 (6-7). For each swallowing structure the mean (Gy) doses (listed as median (IQR)) were: 57.7 (49.0-64.3) for PC, 47.3 (38.7-51.4) for C, 38.9 (33.6-43.4) for GL, 47.4 (38.8-52.2) for SGL, and 53.2 (45.4-59.5) for POAR. The V50 (%) for each SOAR was: 77.5% (52.6-93.5) for PC, 23.3% (5.1-59.8) for C, 0.2% (0-5.1) for GL, 36.4% (19.5-48.5) for SGL, and 67.3% (42.8-86.6) for POAR. The V60 (%) for each SOAR was: 47.5% (23.0-75.5) for PC, 0.5% (0-8.6) for C, 0% (0-0) for GL, 21.4% (4.2-34.5) for SGL, and 32.2% (8.3-55.7) for POAR. On dosimetric analysis, PC mean≤50Gy, POAR mean≤45Gy, and POAR V50<33% were associated with increased FOIS at 1- and 3-months (p<0.05). POAR V60<15% and SGL mean<=40Gy was associated with FOIS at 1-mo (p<0.05). No evaluated factors were associated with 6- or 12-month FOIS. <h3>Conclusion</h3> Lower doses of radiation to pharyngeal constrictor, RTOG-defined pharynx, and supraglottic larynx are associated with improved swallowing function in patients with head and neck cancer. Radiation treatment plans should be optimized to reduce dose to these structures in order to improve acute swallowing outcomes. A larger sample size is needed to better evaluate the impact of radiation dose to these structures on long term swallowing outcomes.

A Comparative Study on the Effect of Acute Pharyngeal Stimulation with TRP Agonists on the Biomechanics and Neurophysiology of Swallow Response in Patients with Oropharyngeal Dysphagia.

Fluid thickening is the main compensatory strategy for patients with oropharyngeal dysphagia (OD) associated with aging or neurological diseases, and there is still no pharmacological treatment. We aimed to compare the effects of increasing bolus viscosity with that of acute stimulation with TRPV1, TRPA1 or TRPM8 agonists on the biomechanics and neurophysiology of swallow response in patients with OD. We retrospectively analyzed seven studies from our laboratory on 329 patients with OD. The effect of increasing shear viscosity up to 3682 mPa·s was compared by videofluoroscopy and pharyngeal sensory evoked potentials (pSEP) with that of adding to the bolus: capsaicin (TRPV1, 150 μM/10 μM), piperine (TRPA1/V1, 1 mM/150 μM), menthol (TRPM8, 1 mM/10 mM), cinnamaldehyde-zinc (TRPA1, 100 ppm–70 mM), citral (TRPA1, 250 ppm) or citral-isopulegol (TRPA1-TRPM8, 250 ppm–200 ppm). Fluid thickening improved the safety of swallow by 80% (p < 0.0001) by delaying bolus velocity by 20.7 ± 7.0% and time to laryngeal vestibule closure (LVC) by 23.1 ± 3.7%. Capsaicin 150μM or piperine 1 mM significantly improved safety of swallow by 50% (p < 0.01) and 57.1% (p < 0.01) by speeding time to LVC by 27.6% (p < 0.001) and 19.5% (p < 0.01) and bolus velocity by 24.8% (p < 0.01) and 16.9% (p < 0.05), respectively. Cinnamaldehyde-zinc shortened the P2 latency of pSEPs by 11.0% (p < 0.01) and reduced N2-P2 amplitude by 35% (p < 0.01). In conclusion, TRPV1 and TRPV1/A1 agonists are optimal candidates to develop new pharmacological strategies to promote the recovery of brain and swallow function in patients with chronic OD.

Examination of Suprahyoid Muscle Resection and Other Factors Affecting Swallowing Function in Patients With Advanced Oral Cancer After Surgical Resection and Reconstruction.

Dysphagia is one of the most common adverse effects associated with oral cancer therapy and could greatly impair postoperative quality of life. The objective of this study was to analyze postoperative swallowing outcomes and factors influencing postoperative swallowing function in patients with advanced oral cancer who underwent primary reconstruction after surgical resection to identify patients at risk of experiencing severe dysphagia after immediate reconstruction of surgical defects, and to determine an ideal approach to provide appropriate perioperative interventions. The swallowing status was evaluated at 4 week postoperatively using the Functional Oral Intake Scale. We also analyzed the effects of patient, tumor, surgical, and other factors on postoperative swallowing function. The study included 67 patients. At 4 weeks postoperatively, 11 patients showed reduced swallowing function, whereas 56 patients showed good swallowing function. The number of resected suprahyoid muscles (odds ratio, 1.55; 95% confidence interval, 1.03-2.32; P=0.035) was an independent factor influencing postoperative swallowing function. Thus, among patients who underwent radical resection of oral cancer with primary reconstruction, those with extensive resection of the suprahyoid muscles were at higher risk of developing postoperative dysphagia. These findings are expected to facilitate increased vigilance for dysphagia, better counseling, and appropriate rehabilitation interventions.

Characterizing Swallows From People With Neurodegenerative Diseases Using High-Resolution Cervical Auscultation Signals and Temporal and Spatial Swallow Kinematic Measurements.

Purpose The prevalence of dysphagia in patients with neurodegenerative diseases (ND) is alarmingly high and frequently results in morbidity and accelerated mortality due to subsequent adverse events (e.g., aspiration pneumonia). Swallowing in patients with ND should be continuously monitored due to the progressive disease nature. Access to instrumental swallow evaluations can be challenging, and limited studies have quantified changes in temporal/spatial swallow kinematic measures in patients with ND. High-resolution cervical auscultation (HRCA), a dysphagia screening method, has accurately differentiated between safe and unsafe swallows, identified swallow kinematic events (e.g., laryngeal vestibule closure [LVC]), and classified swallows between healthy adults and patients with ND. This study aimed to (a) compare temporal/spatial swallow kinematic measures between patients with ND and healthy adults and (b) investigate HRCA's ability to annotate swallow kinematic events in patients with ND. We hypothesized there would be significant differences in temporal/spatial swallow measurements between groups and that HRCA would accurately annotate swallow kinematic events in patients with ND. Method Participants underwent videofluoroscopic swallowing studies with concurrent HRCA. We used linear mixed models to compare temporal/spatial swallow measurements (n = 170 ND patient swallows, n = 171 healthy adult swallows) and deep learning machine-learning algorithms to annotate specific temporal and spatial kinematic events in swallows from patients with ND. Results Differences (p < .05) were found between groups for several temporal and spatial swallow kinematic measures. HRCA signal features were used as input to machine-learning algorithms and annotated upper esophageal sphincter (UES) opening, UES closure, LVC, laryngeal vestibule reopening, and hyoid bone displacement with 66.25%, 85%, 68.18%, 70.45%, and 44.6% accuracy, respectively, compared to human judges' measurements. Conclusion This study demonstrates HRCA's potential in characterizing swallow function in patients with ND and other patient populations.

Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients

IntroductionThe best strategy to manage an interarytenoid defect [Type 1 laryngeal cleft (LC-1) or deep interarytenoid groove (DIG)] in pediatric aerodigestive patients with dysphagia remains uncertain. This study compared benefit of interarytenoid augmentation (IAA) to suture repair or clinical observation alone in pediatric patients. MethodsA 3-year retrospective, single-center analysis of children with dysphagia undergoing endoscopic airway evaluation was performed. Physician preference guided treatment plan: suture repair with CO2 laser, IAA (carboxy methylcellulose or calcium hydroxyapatite), or observation. Primary outcome was improved post-operative diet. Significance was assumed at p < 0.05. Results449 patients underwent diagnostic endoscopy. Mean age (±SD) at procedure was 21 ± 13 months, with nearly one fourth (28 %) of children ≤ 12 months. Eighty (18 %) had either an LC-1 (n = 55) or DIG (n = 25). Of these, 35 (42 %) underwent suture repair, 22 (28 %) IAA, and 23 (30 %) observation only. Aspiration improved overall in the interventional groups compared to observational controls (58 % vs. 9 %, p < 0.05), with no change in benefit observed by age of intervention. IAA was as effective as suture repair (59 % vs 55 %, p = 0.46). In patients with only a DIG, IAA intervention alone significantly improved swallow function (66.6 % vs. 0 %, p < 0.05). ConclusionIn pediatric aerodigestive patients with dysphagia, 18 % of children have an addressable lesion. IAA or suture repair similarly improves dietary advancement. IAA improves swallow function in patients with DIG. These findings support a novel protocol to intervene in dysphagia patients with LC-1 or DIG via IAA at the initial operative evaluation.

Effect of dentures on pharyngeal swallowing function in patients with dysphagia.

Dentures play an important role in improving masticatory and oropharyngeal swallowing functions in some edentulous patients without dysphagia. However, few studies have been conducted on patients with dysphagia. This study investigated the effect of dentures on pharyngeal swallowing function in patients with dysphagia. Older inpatients with dysphagia who used well-fitting dentures were included in the study. Videofluoroscopic swallowing study findings with and without dentures were compared. Pharyngeal residue and area as spatial, the distance between the maxilla and mandible, hyoid bone/laryngeal displacement, and upper esophageal sphincter opening as kinematics, oral/pharyngeal transit time as temporal measurements, and patient-reported symptoms were evaluated. The primary outcome was the pharyngeal residue measured using the normalized residue ratio scale. Comparisons were made using the paired t-test, Wilcoxon signed-rank test and Fisher's exact test. The mean age of the 27 participants was 86.1 ± 6.8 years. The vallecular residue was more in those without dentures (with dentures: 0.01 [0-0.02], without dentures: 0.03 [0-0.08]; P= 0.003). The pyriform sinus residue showed no significant difference. Denture removal significantly increased the pharyngeal area. The distance between the maxilla and mandible decreased in the absence of dentures, and other kinematic measurements showed no significant differences. Oral/pharyngeal transit time was prolonged without dentures. Morphological changes caused by the removal of dentures led to pharyngeal expansion, which may result in increased vallecular residue. A treatment plan that considers the effect of dentures on pharyngeal swallowing function may provide rehabilitation that is more effective. Geriatr Gerontol Int 2021; 21: 907-912.

The treatment effi cacy of disturbed swallowing function in patients with ischemic stroke and neurogenic dysphagia

The aim. To evaluate the effi cacy of swallowing recovery of patients with ischemic stroke carried out with the use of training rehabilitation method using special nutrient mixtures as part of combination therapy. Material and methods. The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients (control group) were treated with special binding compounds as part of a combination therapy. Thirty fi ve patients (comparison group) did not use the mixture. The dynamics of the recovery function of swallowing using the Penetration–Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from tube to independent feeding were studied. Results. The training method of rehabilitation using special nutritional mixtures is eff ective assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia (p &lt; 0.05). The most pronounced eff ect was achieved in the group of patients with pseudobulbar syndrome. In patients with bulbar syndrome no statistically signifi cant diff erences were observed in the dynamic assessment of the severity of dysphagia on the PAS and FEDSS scales. The application of the training method leads to a signifi cantly better transition from tube to independent feeding. Conclusion. The training method of rehabilitation using special nutritional mixtures is eff ective in patients with ischemic stroke and neurogenic dysphagia and leads to a signifi cantly better transition from tube to independent feeding.

Effectiveness of fibreoptic endoscopic evaluation of swallowing and dietary intervention during home-visit dental care in older individuals.

Currently, patients with dysphagia are receiving dietary management that deviates from their original swallowing function. To evaluate the clinical significance of fibreoptic endoscopic evaluation of swallowing (FEES) and dietary intervention (DI) by multi-professional collaboration during visit care for determining the actual oral intake status in patients with dysphagia. Five hundred and eighteen patients with dysphagia underwent FEES, focusing on the penetration-aspiration scale, and DI. Oral intake status was categorised using the functional oral intake scale (FOIS). FOIS scores at the first visit, after FEES, and at the reassessment were compared. At the first visit, 34.7% of the patients had an FOIS score of level 1 (no oral intake) and 65.3% had a score of level 2 or higher (capable of oral intake). Following FEES, 7.1% of patients had an FOIS score of level 1, and 44.4% had a score of level 2 with resumption of oral intake. At the reassessment, 489 patients (94.4%) were capable of oral ingestion (FOIS level 2 or higher). There were significant differences between the distributions of FOIS scores at the first visit and following FEES (P<.01) and between those at the first visit and at the reassessment (P<.01). Regarding tube feeding, 17 (5.9%) of 289 patients, who had received tube feeding at the first visit, were completely capable of oral intake following FEES and at the reassessment. Appropriate evaluation of swallowing function using FEES and DI helps to understand the definite swallowing function in patients with dysphagia.

Impact of Transoral Radiofrequency Microsurgery and Radiotherapy on Long-term Swallowing Function in Patients with T1 Glottic Carcinoma.

To compare the impact of transoral radiofrequency microsurgery (TRM) and radiotherapy (RT) on long-term swallowing function in patients with T1 glottic carcinoma. A total of 41 cases of T1 glottic carcinoma treated with TRM or RT alone more than 5years ago were collected, including 17 cases treated with TRM (TRM group) and 24 cases treated with RT (RT group). The Chinese version of the Swallowing Quality-of-Life Questionnaire (CSWAL-QOL) and videofluoroscopic swallowing study results at the last follow-up (more than 5years after TRM or RT) were assessed. The TRM group scored significantly better than the RT group on overall CSWAL-QOL, the Frequency score, and 6 out of 10 CSWAL-QOL dimensions. The RT group scored significantly better than the TRM group only on the Communication dimension. The dysphagia score (DS) and penetration-aspiration scale (PAS) score of the TRM group were better than those of the RT group. The overall CSWAL-QOL score, the Frequency score, DS, and PAS scores were not significantly different between patients who received conventional radiotherapy and patients who received intensity-modulated radiation therapy. The RT dose was correlated with the DS. TRM provides better swallowing outcomes as compared to RT in management of early glottic cancer. In addition, there is a correlation between RT dose and dysphagia. Prospective studies should be conducted to further evaluate the impact of TRM and RT on swallowing function.

The addition of respiratory muscle strength training to facilitate swallow and pulmonary rehabilitation following massive tissue loss and severe deconditioning: A case series

IntroductionImpaired respiratory and swallow function in patients with intensive care unit–acquired deconditioning, such as associated with massive tissue loss, is not uncommon and can require prolonged rehabilitation. AimThe aim of the study was to examine the effect of combined inspiratory and expiratory respiratory muscle strength training (RMST) on respiratory and swallow function in two critical care patients with marked deconditioning after massive tissue loss. MethodsCase 1 was a 19-year-old male patient with 80% body surface area burns; case 2 was a 45-year-old man with group A streptococcus myositis necessitating quadruple amputation. Both required prolonged intensive care and mechanical ventilation. Both received routine intensive pulmonary and swallow rehabilitation before the trial; however, chronic aspiration and poor secretion clearance remained. At 25 and 26 weeks after initial injury, RMST was performed using EMST150 (expiratory) and Threshold IMT (inspiratory) devices, respectively. At baseline and throughout treatment, data collected included peak expiratory flow (PEF), anthropometry measures, aspiration risk (Penetration-Aspiration Scale [PAS]), pharyngeal clearance (Yale Pharyngeal Residue Scale), secretions (New Zealand Secretion Scale [NZSS]), and functional diet (Functional Oral Intake Scale [FOIS]) via endoscopy. Results/discussionAt baseline, the PEF score of case 1 was 41% (predicted age–height norm) and the PEF score of case 2 was 14%, indicating severe expiratory compromise. Both had extreme energy requirements (3300 kcal/day; 3500 kcal/day). The baseline swallowing scores of case 1 and 2 were as follows: PAS, 8 and 8; Yale, 9 and 10; NZSS, 4 and 7; and FOIS, 1 and 1, respectively, indicating profound dysphagia. At week 3 of 7 of RMST, swallow function improved to allow both to commence oral intake, followed by tracheostomy decannulation. At weeks 10 and 11, full dysphagia resolution was achieved (FOIS = 7; PAS = 1, Yale = 2, NZSS = 0), with PEF at 70% and 48% predicted respectively. Both patients continued RMST, and at discharge from the acute facility, PEF was 84% and 80% predicted respectively. ConclusionThe addition of RMST assisted swallow and pulmonary rehabilitation in both cases and was clinically viable to deliver. Controlled validation trials are now required.

THE NEW STIMULATING METHOD IN THE SPEECH THERAPY WORKOUT SYSTEM FOR THE RESTORATION OF THE SWALLOWING FUNCTION IN SEVERE BRAIN INJURIES

Background. The significance of this study becomes more relevant due to the higher incidence and complication of dysphagia in patients with severe brain damage as a result of stroke, traumatic brain injury, and other diseases and injuries. Purpose The study aimed to assess the effectiveness of the new stimulating method - "passive-active logopedic cryomassage" for restoring impaired swallowing function (dysphagia) in patients with severe brain injury, used in the system of speech therapy measures at the early stage of rehabilitation in the neurointensive care unit. Methods. The study involved 96 patients with dysphagia caused by severe brain damage, who received speech therapy assistance aimed at restoring the impaired swallowing function in a system of early rehabilitation measures carried out in a neurorehabilitation department. The severity of dysphagia was evaluated using an integrative assessment of swallowing function scale. Results. The practice of using the new method developed in combination with thermal and tactile stimulation: "passive-active logopedic cryomassage" indicated its higher efficiency in comparison with the traditionally used methods of speech therapy stimulation. In the course of this study, there were three categories of patients: patients with a rapid positive effect, patients with a delayed effect, and patients with no apparent positive effects. There was an analysis of all possible causes of different therapeutic effects. Conclusion. This new method of combined thermal and tactile stimulation - "passive-active logopedic cryomassage" can be recommended with all its indications and contraindications for widespread use in the clinical practice assisting speech therapists in the restoration of impaired swallowing function in patients with severe brain injury

Real-time evaluation of swallowing in patients with oral cancers by using cine-magnetic resonance imaging based on T2-weighted sequences

The aim of this study was to evaluate whether a new cine-magnetic resonance imaging (CMRI) technique might be useful for evaluating swallowing function in patients with different types of oral cancers by assessing 12 CMRI-related parameters. In total, 111 patients with oral cancers were evaluated. We examined whether visualization of fluid flow and determination of flow direction to the trachea or the esophagus were possible with CMRI. We evaluated the correlations between CMRI-related parameters and self-reported dysphagia scores as the status of dysphagia, T classification groups as tumor staging for preoperative patients, alterations in CMRI-related parameters between pre- and postoperative patients, and the degree of invasiveness of oral cancer surgery. We could judge the flow direction to the esophagus on CMRI in all 111 patients. Six CMRI-related parameters showed significant correlations with dysphagia status. Increases in CMRI-related parameters were significantly related to deterioration of swallowing status, as shown by a decrease in self-reported dysphagia scores, advances in the T classification, and degree of invasiveness of oral cancer surgery. The results of the present study suggest that CMRI can be used to directly visualize swallowing dynamics and objectively evaluate the swallowing complaints of patients with oral cancer.

Effect of chin-down-plus-larynx-tightening maneuver on improving choking cough and swallowing function in patients after esophageal cancer surgery

Objective To explore the effect of Chin-down-plus-larynx-tightening maneuver on improving choking cough and swallowing function in patients after esophageal cancer surgery. Methods A total of 121 patients with esophageal cancer surgery had been randomly divided into control group and observation group from November 2018 to September 2019. Starting from feeding after surgery, the head and neck were in normal habits when swallowing in the control group, and the observation group used Chin-down-plus-larynx-tightening maneuver to perform swallowing training. The feeding process of two groups was observed and recorded for one week. One week after eating, the water swallowing test and M. D. Anderson Symptom Inventory for Gastrointestinal cancer (MDASI-GI) were used to evaluate the difference of swallowing function and gastrointestinal symptoms between the two groups. Results During one week period of feeding, the incidence of choking cough in observation group was 3.39%, (2/59), which was significantly lower than that in the control group (14.52%, 9/62)(χ2 value was 4.53, P=0.033). After one week of feeding, the swallowing function showed significant difference (Z value was 6.07, P=0.014), the gastrointestinal symptoms and the degree of life interference caused by gastrointestinal symptoms of observation group scored 2.57 ± 0.81, 1.76 ± 0.84, lower than those of the control group (4.25 ± 1.54, 2.18 ± 1.24), and the difference was statistically significant(t values were -7.56, -2.17, P<0.05). Conclusions The Chin-down-plus-larynx-tightening maneuver can promote recovery of postoperative swallowing function in patients with esophageal cancer, reduce the incidence of choking cough, and help reduce the symptoms of digestive tract, and then raise the level of patient′s clinical prognosis. Key words: Chin-down-plus-larynx-tightening maneuver; Esophageal cancer; Choking cough; Swallowing function

Effects of different surgical treatment on swallowing function in partial laryngectomy patients

Objective To explore the effects of different surgical treatments on swallowing function in partial laryngectomy patients and to analyze the development trend of swallowing function. Methods From January 2019 to September 2019, this study selected 54 patients first diagnosed as laryngeal carcinoma with partial laryngectomy at a ClassⅢ Grade A hospital as subjects by convenience sampling. There were 25 patients with vertical partial laryngectomy (vertical group) , 12 patients with horizontal supra-glottic partial laryngectomy (horizontal group) and 17 patients with supra-cricoid partial laryngectomy (SCPL group) . This study observed the time of gastric tube extubation of patients, video-fluoroscopic swallowing study (VFSS) 15 days after surgery, score of Modified Penetration Aspiration Scale (MPAS) and scores of Gugging Swallowing Screen (GUSS) 15, 20 and 30 days after surgery, and compared the swallowing function of patients among three groups. Results There were statistical differences in the time of gastric tube extubation, scores of GUSS and VFSS+MPAS 15 days after surgery among three groups (P<0.01) . When taking time as main effect, the Roy maximum root test displayed F=460.693, P<0.001 which showed that time had influence on the score of GUSS; when taking surgery as the main effect, the Roy maximum root test displayed F=218.387, P<0.001 which showed that surgery type had influence on the score of GUSS. There were statistical differences in the development trends of swallowing at different times among three surgery types when time interacted with the surgery type (F=164.033, P<0.001) . Conclusions The vertical partial laryngectomy has the small impact on swallowing function and patients recovery quickly. However, horizontal supra-glottic partial laryngectomy and SCPL have great impact on swallowing function; swallowing function can't be well compensated by sphincter function of remnant larynx in a short time; besides, patients with horizontal supra-glottic partial laryngectomy need a long rehabilitation period. Key words: Laryngeal neoplasms; Partial laryngectomy; Deglutition disorders

Clinical observation of comprehensive rehabilitation training in the treatment of stroke dysphagia

Objective To observe the clinical effect of comprehensive rehabilitation training on stroke patients with dysphagia. Methods From August 2016 to December 2017, 90 patients with stroke dysphagia admitted to Yiwu Central Hospital were selected.The patients were divided into two groups by random number table method, with 45 cases in each group.The control group was treated with conventional treatment.The observation group was treated with comprehensive rehabilitation training, and the course of treatment in both two groups was 8 weeks.The nerve function defect, swallowing function and quality of life improvement of the two groups were observed, and the clinical efficacy of the two groups was compared. Results Before treatment, there were no statistically significant differences in the SAWL-QOL(quality of life) score, NIHSS(neurological impairment) score and Burke(swallowing function) score between the two groups(all P>0.05). After treatment, the SAWL-QOL score of the observation group was (83.35±1.62)points, which was higher than that of the control group [(74.41±2.71)points], and the difference was statistically significant(t=18.995, P<0.05). The NIHSS and Burke scores of the observation group were (2.09±0.52)points, (0.48±0.09)points, respectively, which were lower than those of the control group[(5.87±1.03)points, (3.09±0.56)points](t=21.977, 30.869, all P<0.05). The total improvement rate of the observation group was 93.33%(33/45), which was significantly higher than that of the control group[73.33%(42/45)](χ2=6.480, P<0.05). The incidence of aspiration pneumonia in the observation group was 8.89%(4/45), which was significantly lower than that in the control group[26.67%(12/45)](χ2=4.865, P<0.05). Conclusion Comprehensive rehabilitation training has significant clinical effect on stroke dysphagia, which can promote the improvement of nerve function and swallowing function of patients and improve the quality of life of patients. Key words: Stroke; Deglutition disorders; Rehabilitation; Problems and exercises; Activities of daily living; Combined modality therapy; Quality of life