Swallowing Disturbance Questionnaire Research Articles

The Oropharyngeal Dysphagia Screening Test for Patients and Professionals: Validation in Cognitive Impairment and in Severe Mental Illness.

Dysphagia is a symptom that appears with high prevalence in persons diagnosed with dementia, intellectual disability, or severe mental illness. Risk of aspiration pneumonia or even death is very high in these populations. However, screening for dysphagia risk in these patients is complicated by the fact that most of them suffer from cognitive impairments and behavioral manifestations that hinder the assessment process using the existing screening tests. The aim of this study was to validate the Oropharyngeal Dysphagia Screening Test for Patients and Professionals, in patients with cognitive impairment (dementia/intellectual disability) or with severe mental illness (schizophrenia and other psychotic disorders, bipolar disorder, or major depressive disorder). For this purpose, 148 institutionalized patients were evaluated by professionals responsible for their food intake. The Oropharyngeal Dysphagia Screening Test for Patients and Professionals was used to assess its validity in screening for oropharyngeal dysphagia in patients with cognitive impairments and in patients with severe mental illness. Also, the Eating Assessment Tool-10 and the Swallowing Disturbance Questionnaire were used for convergent reliability procedures. Four comparison groups were established: patients with cognitive impairment with and without oropharyngeal dysphagia, and patients with severe mental illness with and without oropharyngeal dysphagia. Results from the Oropharyngeal Dysphagia Screening Test for Patients and Professionals adequately distinguished between groups with and without dysphagia, in addition to presenting adequate levels of convergent validity and reliability. These results were obtained from other-reports (professionals responsible for patients' food intake), using a simple, quickly applied test that does not require the use of food in patients with an altered cognitive state or with severe mental illness. With this study we expand the validity of the Oropharyngeal Dysphagia Screening Test for Patients and Professionals in populations with severe cognitive deficits and mental illness in which there is a great deficiency of oropharyngeal dysphagia screening instruments.

Sensitivity and specificity of the EAT-10 and SDQ-DP in identifying the risk of dysphagia in Parkinson's disease.

The early identification of risk for dysphagia in patients with Parkinson's disease (PD) is essential for the prevention of nutritional and pulmonary complications. To analyze the sensitivity and specificity of the Swallowing Disturbance Questionnaire (SDQ-PD) and the Eating Assessment Tool (EAT-10) in identifying dysphagia risk in patients with early and intermediate stages of PD. Twenty-nine patients with PD participated in the study. EAT-10 and SDQ-PD questionnaires were applied, and a videofluoroscopic swallowing study. Dysphagia Outcome and Severity Scale (DOSS) was used to classify the presence and severity of dysphagia, and the Penetration-Aspiration Scale (PAS) was used to identify the presence of penetration/aspiration. In the statistical analysis, the sensitivity and specificity of the risk questionnaires were calculated, as well as positive predictive value, negative predictive value, and accuracy. EAT-10 to identify the risk of penetration/aspiration revealed a sensitivity of 71.42% and specificity of 45.45%; in the identification of the presence of dysphagia, the sensitivity was 47.61%, and the specificity was 12.5%. The SDQ-PD questionnaire for risk of penetration/aspiration demonstrated a sensitivity of 28.57%, and a specificity of 68.18%. In terms of identifying the presence of dysphagia, the sensitivity was 20%, while the specificity was 44.44%. The SDQ-PD revealed low sensitivity and low specificity to identify the presence of dysphagia and/or penetration/aspiration in patients with early and intermediate stages of PD in this sample. Despite its low specificity, the EAT-10 exhibited good sensitivity in indicating the risk of penetration/aspiration.

Validation of the Arabic Version of the Swallowing Disturbance Questionnaire in Dysphagic Patients

Validation of the Arabic Version of the Swallowing Disturbance Questionnaire in Dysphagic Patients

Effectiveness of Expiratory Muscle Strength Training on Dysphagia Risk in Pre-Frail Elderly

Pre-frail dan frail elderly are susceptible to dysphagia. Dysphagia leads to vulnerability to aspiration pneumonia, undernutrition, and dehydration, which negatively affect physical condition and quality of life. Expiratory muscle strength training (EMST) is an intervention for dysphagia. However, the effects of EMST on pre-frail elderly are still unclear. This study aimed to investigate effectiveness of expiratory muscle training on dysphagia risk of pre-frail elderly. The study design was a randomized clinical trial. Twenty-four pre-frail elderly at Rindang Asih I and II Elderly Social Service Institution randomly assigned into experimental group (n=12) or control group (n=12). The experimental group received expiratory muscle training using PEP Threshold® device 5 times per week for 6 weeks. Both of group also received typical multicomponent exercise for elderly 3 times per week for 6 weeks. Outcome measure was risk of dysphagia assessed using Swallowing Disturbance Questionnaire (SDQ). The intra-group analysis showed significant differences pre- and post-intervention in experimental group but not in control group (p<0,001 and p=0,107, respectively). Inter-group analysis showed significant differences between experimental and control group post-intervention (p<0,001). This finding indicate that expiratory muscle training effective on reducing dysphagia risk in pre-frail elderly.

Validation of the swallowing disturbance questionnaire in people with multiple sclerosis

BackgroundThe DYSPHAGIA IN MULTIPLE SCLEROSIS (DYMUS) questionnaire is the only specific tool developed to screen for dysphagia in people with Multiple Sclerosis (pwMS). However, some limitations of DYMUS could potentially be addressed by the SWALLOWING DISTURBANCE QUESTIONNAIRE (SDQ), which has not yet been validated in pwMS. The objective of this study was to translate and validate the SDQ into the Italian language for use in pwMS to detect swallowing disturbances. MethodsWe translated the SDQ into Italian and adapted it for use in Italian pwMS. PwMS aged > 18 years, assessed for disability using the Expanded Disability Status Scale (EDSS), completed the SDQ and DYMUS questionnaires and performed the 3-OUNCE WATER SWALLOW TEST (WST). Clinical and demographic data were collected for each patient. The Italian version of the SDQ was retested after 30 days. ResultsA total of 84 pwMS were recruited for the study, consisting of 73.8 % women and 48.8 % with a relapsing-remitting form of MS. The mean age of participants was 44.5 years (SD: ±12.46), with a mean disease duration of 17 years (SD: ±10.27), and a median EDSS of 4 (range 1.5–7.5). The Cronbach's alpha for SDQ (to assess internal consistency) was 0.902, which increased to 0.908 after the elimination of item 15, resulting in the SDQ composed of 14 items. ROC analysis demonstrated good accuracy of the 14-item SDQ in pwMS (AUC: 0.811). By dividing the 14-item SDQ score into quartiles, three risk levels for dysphagia were identified: low (score 1–3), intermediate (score 4–8), and high (score ≥9). 14-item SDQ scores significantly correlated with DYMUS (r = 0.820; p<0.0001) and with EDSS (r = 0.541; p<0.0001). PwMS who reported dysphagia had a significantly higher mean 14-item SDQ score (8.27 ± SD 8.15) compared to those without swallowing problems (2.77 ± SD 4.25; p = 0.003). Additionally, pwMS with a positive WST had a significantly higher mean 14-item SDQ score (10.17 ± SD 8.96) than those with a negative WST (2.96 ± SD 3.93; p = 0.02). The Intraclass Correlation Coefficient for the retest, calculated on 48 pwMS in a stable phase of the disease, was 0.91 (95 % CI 0.84–0.95). ConclusionThe 14-item SDQ has demonstrated high internal consistency, good accuracy, and reliability in pwMS, making it a readily applicable tool for investigating dysphagia in MS.

Swallowing difficulties among traumatic brain injury patients in Bangladesh

Aim: To determine the number of people having swallowing difficulties among traumatic brain injury patient. Methods: This is a quantitative type of cross-sectional survey study where 117 samples were assigned purposively from Dhaka Medical College Hospital (DMCH). The Swallowing Disturbance Questionnaire (SDQ) was used for the study. Data were analyzed by using descriptive statistical analysis (SPSS = Statistics package for social science) method. Results: On an average, most of the participants 90.60% (106) were males and other participants 9.40% (11) were females. The maximum numbers of participants 25.6% (30) were in the age range 18–27 years. The majority numbers of participants 33.30% (39) were at secondary level education. The maximum numbers of respondents 22.20% (26) found were day laborer (driver, rickshaw puller, and masons). Most of the participants 63.20% (74) had injuries in 0–2 months earlier. Among 117 participants, 76 (64.95%) participants had no swallowing difficulties (dysphagia) and 41 (35.05%) participants had swallowing difficulties (dysphagia). Conclusions: Swallowing difficulty (dysphagia) is a common problem in patients with traumatic brain injury (TBI). Researchers explored the prevalence of swallowing difficulty among TBI patients. In this study, among 117 participants most of the participants 90.60% (106) were males and 9.40% (11) participants were females. So, swallowing difficulty is common in TBI patients who are associated with other condition of swallowing. According to SDQ score among 117 participants, (35.05%) participants had swallowing difficulties. So, TBI patients are vulnerable for presence of swallowing difficulties.

Assessment of the Sensitivity of the Vocal Tract in Parkinson Disease by Nasal Video Endoscopy.

Introduction Sensory deficits of the upper airways are common in people with Parkinson disease. Compounded by considerable deterioration of the swallowing function, these deficits may contribute to the elevated rates of morbidity and mortality among this population. Objective To examine the sensitivity of the vocal tracts of people with Parkinson disease using nasal videoendoscopy and to compare the results with paired controls. Methods The present was a prospective, observational, case-control study. Sensitivity assessments were conducted in a sample of 24 people divided into 2 groups: one group of 12 patients with Parkinson's disease, and a control group with 12 healthy subjects. The study group also underwent a fiberoptic endoscopic evaluation of swallowing and answered the Swallowing Disturbance Questionnaire (SQD) to detect dysphagia. Results There was a significant difference ( p < 0.05) in the region of the arytenoid cartilages, showing that sensitivity was better preserved among the control group, and that sensitivity deficits were present in the study group. The qualitative results showed sensorial impairment in the study group than in the control group regarding the base of the tongue, the vestibular folds, and the vocal folds. The study group showed self-awareness regarding the deficits in the swallowing function, but there was no statistically significant association between swallowing function deficits and deterioration of sensorial function among them. Conclusions Sensorial deficits were present in the study group when compared to the healthy subjects, mainly in the qualitative evaluation.

Effect of Conventional Speech Therapy Combined with Music Therapy on Swallowing in Patients with Parkinson's Disease (Telerehabilitation): A Randomized-Controlled Trial

Background: Swallowing difficulties or dysphagia is the main cause of aspiration pneumonia and death in patients with Parkinson's disease (PD). Although dysphasia occurs in 90% of patients with PD, there is insufficient evidence to support the effectiveness of behavioral speech therapy in this disease. Objectives: This study aimed to investigate the effect of a new telerehabilitation program that was a combination of speech and music therapy on dysphagia in patients with PD. Methods: This study was a 3-arm randomized controlled trial (RCT). Thirty-three subjects with PD (mean age, 58.88 years; 25 men and 8 women with complaints of swallowing problems) were randomly assigned to the combination therapy (including breathing, speech, voice, and singing exercises), conventional speech therapy, and music therapy groups. Each patient participated in 12 telerehabilitation sessions over 4 weeks. Swallowing Disturbance Questionnaire (SDQ) and dysphagia handicap index (DHI), as the outcomes of this study, were evaluated 1 week before the first intervention session, 1 week after the last intervention session, and 3 months after the last evaluation. Results: The results showed a significant improvement in SDQ and all sub-tests (functional, physical, and emotional), as well as the total score of DHI in the combination therapy and conventional speech therapy groups after treatment (P &lt; 0.05). Also, the music therapy group had a significant improvement in the SDQ score, emotional sub-test, and the total score of DHI (P &lt; 0.05). The combination therapy group demonstrated a significant outperform in the SDQ score compared to the other 2 groups, as well as in all sub-tests and the total score of DHI compared to the music therapy group (P &lt; 0.05). The combination therapy group also showed more improvement in all sub-tests, as well as the total score of DHI, compared to the music therapy group (P &lt; 0.05). The results also indicated that the speech therapy group had a more significant effect on the physical sub-test of DHI compared to the music therapy group (P &lt; 0.05). Conclusions: Although swallowing function improved in all 3 groups, this improvement was more in the combination therapy group than in the other groups. Therefore, it can be concluded that combination therapy has the potential to provide additional benefits for swallowing efficiency in this patient group. The results also suggest that the telerehabilitation method is feasible to deliver intensive therapy to individuals with PD to improve swallowing functions.

Cardiac sympathetic denervation could be associated with dysphagia in Parkinson's disease.

BackgroundDysphagia is an important non-motor symptom that is closely associated with quality of living and mortality in Parkinson's disease (PD). However, the pathophysiology of dysphagia in PD remains inconclusive. We tried to confirm whether the occurrence of dysphagia could be related to sympathetic degeneration using cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy.MethodsWe prospectively recruited 27 PD patients and classified them into two groups (PD with dysphagia vs. PD without dysphagia) by Swallowing Disturbance Questionnaire (SDQ) score and compared the clinical characteristics, videofluoroscopic swallowing study (VFSS) findings and parameters from cardiac MIBG scintigraphy.ResultsThe mean early and late H/M ratios were significantly lower in the PD with dysphagia group than those in the PD without dysphagia group (1.39 ± 0.21 vs. 1.86 ± 0.21, p < 0.01; 1.26 ± 0.18 vs. 1.82 ± 0.29, p < 0.01). In the correlation analysis, both the early and late H/M ratios were negatively correlated with the SDQ score and total VDS score (r = −0.65, p < 0.01; r = −0.53, p < 0.01; r = −0.65, p < 0.01, r = −0.58, p < 0.01).ConclusionWe confirmed that cardiac sympathetic denervation might be associated with the presence and severity of dysphagia. This finding indicates that dysphagia in PD could be associated with a nondopaminergic mechanism.

Transcranial Magnetic Stimulation Versus Transcutaneous Neuromuscular Electrical Stimulation in Post Stroke Dysphagia: A Clinical Randomized Controlled Trial

ObjectivesTo evaluate the efficacy of high-frequency repeated transcranial magnetic stimulation (rTMS) applied contralesionally versus transcutaneous neuromuscular electrical stimulation (TNES) in acute post-stroke dysphagic patients. Materials and methodsA randomized, parallel, comparative, controlled trial was conducted on patients with acute ischemic stroke who were admitted to our department. Fifteen patients received rTMS, 15 patients received TNES, and 15 patients were recruited as a control group. Between the second and tenth days after a stroke, patients were enrolled. The study and follow-up periods were completed by all patients. ResultsAmong the screened patients, 45 (31.47%) right-handed patients were diagnosed with post-stroke dysphagia with a mean age of 60.53 ± 8.23 years. Immediately after intervention both rTMS and TNES groups significantly improve the swallowing disturbance questionnaire (SDQ) and penetration aspiration scale (PAS), compared to the control (p < 0.001 and p = 0.027), respectively. rTMS was more effective than TNES in reducing SDQ and PAS (p < 0.05). rTMS and TNES improved the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) significantly (p = 0.002); however, their efficacy was comparable (p > 0.05). A significant (p < 0.001) strong negative correlation was observed between the grade of weakness and all scores. ConclusionOur findings showed that high-frequency rTMS and TNES effectively improved the clinical condition of acute post-stroke dysphagic patients in terms of swallowing disturbance assessed by SDQ, pharyngeal residue assessed by YPRSRS, and the severity of penetration and aspiration events evaluated by PAS, compared to the controls. The outcomes of high-frequency rTMS were more favorable than those of TNES in terms of SDQ and PAS.

Endoscopic Characteristics of Dysphagia in Multiple System Atrophy Compared to Parkinson's Disease.

Dysphagia is a major clinical concern in multiple system atrophy (MSA). A detailed evaluation of its major endoscopic features compared with Parkinson's disease (PD) is lacking. This study systematically assessed dysphagia in MSA compared with PD and correlated subjective dysphagia to objective endoscopic findings. Fifty-seven patients with MSA (median, 64 [interquartile range (IQR): 59-71] years; 35 women) underwent flexible endoscopic evaluation of swallowing using a specific MSA-flexible endoscopic evaluation of swallowing task protocol. Findings were compared with an age-matched cohort of 57 patients with PD (median, 67 [interquartile range: 60-73] years; 28 women). In a subcohort, subjective dysphagia was assessed using the Swallowing Disturbance Questionnaire and correlated to endoscopy findings. Patients with MSA predominantly showed symptoms suggestive of oral-phase disturbance (premature spillage, 75.4%, piecemeal deglutition, 75.4%). Pharyngeal-phase symptoms occurred less often (pharyngeal residues, 50.9%; penetration/aspiration, 28.1%). In contrast, pharyngeal symptoms were the most common finding in PD (pharyngeal residues, 47.4%). Oral symptoms occurred less frequently in PD (premature spillage, 15.8%, P< 0.001; piecemeal deglutition, 1.8%, P< 0.01). Patients with MSA had a greater risk for oral-phase disturbances with increased disease severity (P < 0.05; odds ratio,3.15). Patients with MSA showed a significantly higher intraindividual interswallow variability compared with PD. When correlating Swallowing Disturbance Questionnaire scores with endoscopy results, its cutoff, validated for PD, was not sensitive enough to identify patients with MSA with dysphagia. We developed a subscore for identifying dysphagia in MSA and calculated a new cutoff (sensitivity 85%, specificity 100%). In contrast with patients with PD, patients with dysphagic MSA more frequently present with oral-phase symptoms and a significantly higher intraindividual interswallow variability. A novel Swallowing Disturbance Questionnaire MSA subscore may be a valuable tool to identify patients with MSA with early oropharyngeal dysphagia. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Screening of dysphagia in relapsing-remitting multiple sclerosis patients in Montenegro.

Objectives:To perform screening of dysphagia in Montenegrin multiple sclerosis (MS) patients. Dysphagia is often neglected problem in patients with MS.Methods:We included 104 patients with relapsing-remitting MS who completed 3 questionnaires: dysphagia in multiple sclerosis (DYMUS), eating assessment tool-10 (EAT-10) and swallowing disturbance questionnaire (SDQ). Our study was performed in the clinic for neurology of the Clinical Center of Montenegro (Podgorica, Montenegro) and Polyclinic Neuron (Bijelo Polje, Montenegro) between November 2020 and December 2020.Results:Self-reported prevalence of this symptom in our group was simmilar to previously reported results. We did not find correlation between DYMUS and expanded disability status scale (EDSS), as it was reported before. Time spent from disease onset to diagnosis is strongly correlated with reported SDQ results. The population of dysphagia-patients is statistically significantly older compared to the non-dysphagia patients, and statistically higher mean values in this population of our subjects were proven on all 3 questionnaires used.Conclusion:The importance of this issue is not just because it warns of potientially malnutrion in MS patients, but also important factor in therapy choosing algorithm in the era of orally used immunomodulatory drugs.

Dysphagia in non-intubated patients affected by COVID-19 infection.

PurposePatients affected by COVID-19 are assumed to be at high risk of developing swallowing disorders. However, to our best knowledge, data on the characteristics and incidence of dysphagia associated with COVID-19 are lacking, especially in non-intubated patients. Therefore, we investigated the onset of swallowing disorders in patients with laboratory-confirmed COVID-19 infection who have not been treated with invasive ventilation, in order to evaluate how the virus affected swallowing function regardless of orotracheal intubation.MethodsWe evaluated 41 patients admitted to the COVID department of our Hospital when they had already passed the acute phase of the disease and were therefore asymptomatic but still positive for SARS-CoV-2 RNA by RT-PCR. We examined patients’ clinical history and performed the Volume-Viscosity Swallow Test (VVST). Each patient also answered the Swallowing Disturbance Questionnaire (SDQ). After 6 months, we performed a follow-up in patients with swallowing disorders.ResultsEight of 41 patients (20%) presented with dysphagia symptoms during hospitalization and 2 of them (25%) still presented a SDQ high score and swallowing disorders with liquid consistency after 6 months.ConclusionNon-intubated patients can experience various grades of swallowing impairment that probably directly related to pulmonary respiratory function alterations and viral direct neuronal lesive activity. Although these symptoms show natural tendency to spontaneous resolution, their impact on a general physical impaired situation should not be underestimated, since it can adversely affect patients’ recovery from COVID-19 worsening health outcomes.

Dysphagia in Parkinson’s disease: Analysis of screening questionnaire and videofluoroscopy findings

Background: Dysphagia is a common symptom of Parkinson’s disease (PD), which is often overlooked. Reliable screening methods for definitive radiological investigation need to be developed. Objectives: To analyze the objective videofluoroscopic study of swallowing (VFSS) findings in PD patients screened using a validated 11-item swallowing disturbance questionnaire (SDQ) and to check for a correlation between the questionnaire and VFSS scale scores, as well as the sensitivity of SDQ to detect abnormal VFSS findings. Material and Methods: PD patients attending a movement disorder clinic were screened using SDQ and underwent VFSS. The findings were recorded and objectively rated by experienced speech and language pathologists using standardized scales. Statistical analysis was performed to check for correlation. Results: Twelve patients were enrolled in the study. Their SDQ scores ranged from 2 to 16. Of the 11 questions, six were checked for correlation with VFSS findings. Bolus stuck in the mouth was reported by four patients; all displayed corresponding VFSS findings. Oral residue was reported by nine, of which seven showed VFSS findings. Multiple swallows were reported by eight, and VFSS findings were observed in seven of them. Overall, even at very low scores, abnormalities were observed in corresponding VFSS parameters. However, no statistical significance (P > 0.05) was found between the SDQ scores and VFSS parameters. Conclusion: VFSS analysis revealed abnormal oropharyngeal swallowing parameters, which corresponded with the SDQ scores, but without statistical significance. Therefore, our questionnaire is a useful tool to predict VFSS findings in PD patients.

Cross-cultural adaptation and validation of the Swallowing Disturbance Questionnaire and the Sialorrhea Clinical Scale in Portuguese patients with Parkinson’s disease

Introduction To date, no valid outcome measure has been developed in European Portuguese (EP) to evaluate the Parkinsons’ Disease (PD) patients' (PwP) reports regarding their swallowing disturbances. Objectives The aim of this study was to translate and cross-culturally adapt the Swallowing Disturbance Questionnaire (SDQ) and the Sialorrhea Clinical Scale for PD (SCS-PD) into EP and to determine its clinimetric properties in PwP. Materials and Methods The original English SDQ and SCS-PD versions were cross-culturally adapted following recommendations established in international guidelines. The validation process involved 75 PwP and 65 healthy sex- and age-matched participants. Results The EP versions of the SDQ and SCS-PD are equivalent to the original versions (content, depth, and scoring). Statistical analyses for the SDQ tool revealed good feasibility (missing data <5%), acceptability (no floor or ceiling effects), excellent internal consistency (Cronbach´s α = 0.95), good construct validity (78.5% revealed large to moderate loadings), moderate convergent validity (r = 0.60), good divergent validity (r = 0.40), good known-groups validity (p-value < .05) and a fair sensitivity and specificity (AUC = 0.700). Statistical analyses for the SCS-PD tool shows good feasibility, reasonable acceptability (floor effect), good internal consistency (Cronbach´s α = 0.85), good construct validity (85.7% showed between large to moderate loadings), good convergent validity (r = 0.78), good divergent validity (r = 0.39), good known groups validity (p-value < .05) and a fair sensitivity and specificity (AUC = 0.704). Conclusions The EP versions of the SDQ and SCS-PD maintained the characteristics of the original versions and therefore consistent tools to be used in PwP.

Obstruction-related dysphagia in inclusion body myositis: Cricopharyngeal bar on videofluoroscopy indicates risk of aspiration

ObjectiveTo show the predictive risk factors for aspiration pneumonia and prognostic importance of a cricopharyngeal bar (CPB) on videofluoroscopic examination of swallowing (VFS) in inclusion body myositis (IBM). MethodsIn this retrospective study, we examined a consecutive series of 37 patients with clinico-pathologically defined IBM based on the European Neuromuscular Center diagnostic criteria for IBM from 2013. The Swallowing Disturbance Questionnaire was used for the evaluation of dysphagia. A standard VFS was performed at diagnosis. The primary outcome was aspiration pneumonia. Secondary outcomes included IBM Functional Rating Scale score, forced vital capacity (FVC), and body mass index. ResultsAspiration pneumonia occurred in 10 of 37 IBM patients (27%). Based on univariate analysis, 4 factors increased aspiration pneumonia risk: BMI < 18.5 (n = 5; hazard ratio [HR], 10.7; 95% CI, 2.50–46.0; p = .001); aspiration (n = 7; HR, 7.57; 95% CI, 1.82–31.6; p = .005); insufficient opening of the upper esophageal sphincter (n = 11; HR, 4.53; 95% CI, 1.12–18.3; p = .03); and CPB presence (n = 15; HR, 11.6; 95% CI, 1.46–91.8; p = .02). Clinical features of IBM-CPB(+) were elderly onset, obstruction-related dysphagia, and mild decreases in FVC, resulting in aspiration pneumonia in 1.3 years (interquartile range, 0.9–5.2); 67% of IBM-CPB(+) patients underwent interventional procedures for dysphagia. IBM-CPB(+) patients had a lower FVC than IBM-CPB(−). ConclusionsA CPB in IBM largely contributes to obstruction-related dysphagia and is a risk factor that predicts aspiration pneumonia and refractory dysphagia requiring aggressive therapy.

Prevalence of oropharyngeal dysphagia in hereditary spastic paraplegias.

Hereditary spastic paraplegias (HSP) are a group of genetic diseases characterized by lower limb spasticity with or without additional neurological features. Swallowing dysfunction is poorly studied in HSP and its presence can lead to significant respiratory and nutritional complications. The aim of this study was to evaluate the frequency and clinical characteristics of dysphagia in different types of HSP. A two-center cross-sectional prevalence study was performed. Genetically confirmed HSP patients were evaluated using the Northwestern Dysphagia Patient Check Sheet and the Functional Oral Intake Scale. In addition, self-perception of dysphagia was assessed by the Eat Assessment Tool-10 and the Swallowing Disturbance Questionnaire. Thirty-six patients with spastic paraplegia type 4 (SPG4), five with SPG11, four with SPG5, four with cerebrotendinous xanthomatosis (CTX), three with SPG7, and two with SPG3A were evaluated. Mild to moderate oropharyngeal dysphagia was present in 3/5 (60%) of SPG11 and 2/4 (50%) of CTX patients. A single SPG4 (2%) and a single SPG7 (33%) patient had mild oropharyngeal dysphagia. All other evaluated patients presented with normal or functional swallowing. Clinically significant oropharyngeal dysphagia was only present in complicated forms of HSP Patients with SPG11 and CTX had the highest risks for dysphagia, suggesting that surveillance of swallowing function should be part of the management of patients with these disorders.

Effect of Shaker Exercises on Swallowing Disturbance among Patients with Hyperthyroidism at a Selected University Hospital

Background: Apparently; the most common causes of hyperthyroidism represent in Graves’ disease. Shaker Exercises implementation through head lift exercise and tongue strengthening exercises aim to improve motility and strength the muscles of the neck and enhance swallowing capabilities as well. Aim of the current study was to examine the effect of shaker exercises on swallowing disturbance among patients with hyperthyroidism at a selected University Hospital, Egypt. Design: A quazi-experimental design time series Non-equivalent design was utilized, the study conducted at surgical departments at one of University Hospital; Egypt. Research hypothesis: H1: Study group who received the Shaker Exercises will have a significant lower mean swallowing disturbance score than the control group who received only routine hospital care. H2 (a,b,c & d): Study group who received the Shaker Exercises will have higher correlation between total swallowing disturbance score and selected related sub-Items than the control group who received only routine hospital care. Sample: 60 adult male and female patients divided randomly into two equal groups, control group (n=30 patients) received the routine hospital of the hyperthyroidism, and study group (n=30 patients) received routine hospital in addition to the Shaker Exercises. Tools: Tool I: Demographic and medical data sheet. Tool II: Swallowing Disturbance Questionnaire (SDQ). Results: there was a statistical significant difference among study group comparing to control group regarding the swallowing disturbance after shaker exercise interventions. Conclusion: study group patients who received the Shaker Exercise in addition to their routine hospital care which was medical treatment was improved significantly comparing to the control group who received only their medical treatment. Recommendation: Replicate the study on a larger group to add to solid evidence practice and replicate the study on other disease rather than hyperthyroidism that interfere with swallowing function.

Identification of swallowing disorders: the perception of patients with neurodegenerative diseases.

To verify the perception of patients with neurodegenerative diseases regarding swallowing changes and to know the perceptions of swallowing sensations that can promote the early identification of dysphagia. It is a cross-sectional study with 44 patients with neurodegenerative diseases. All of them answered a questionnaire to know the sensation perceived during swallowing and its intensity. The Fatigue Severity Scale was applied to measure fatigue and the Swallowing Disturbance Questionnaire was applied to detect swallowing complaints. The Functional Oral Intake Scale was used to classify the swallowing functionality. Videofluoroscopic swallowing study (VFSS) was performed to verify the correspondence between the patient's perceptions and swallowing physiopathology. A descriptive and exploratory statistical analysis was performed. There was correspondence between VFSS findings and the patient's perception in 76.5% of the cases. Sensations such as discomfort and fatigue were perceived during swallowing, especially with solids. Such feelings have predominantly been reported in the throat, from the half to the end of the meal. There was association between fatigue and odynophagia. Fatigue during swallowing was associated with worse functionality of oral intake. Most participants perceived the disorders in their swallowing. Sensations such as burning, discomfort, tiredness, pain, cramp, or irritation were perceived by participants and were associated with symptoms that may suggest risk of aspiration due to fatigue resulting from weakness, incoordination, and/or stiffness of muscles.

Evaluation of dysphagia in different phenotypes of early and idiopathic Parkinsonism

BackgroundParkinsonism (PD) is a common neurodegenerative disorders into which dysphagia occurs mainly in the late stage and to a lesser extent in an early stage. Diagnosis of dysphagia particularly in early idiopathic Parkinson’s disease (IPD) is important as dysphagia affects the quality of life of patients and most of the patients are unaware of this important symptom.MethodFifty-four patients were enrolled in this study presented with early IPD attending to the outpatient clinic of Sohag University Hospital. All PD patients were assessed by using Unified Parkinson’s Disease Rating Scale (UPDRS) and modified Hoehn and Yahr scale. IPD patients were classified into tremor dominant (TD) and postural instability/gait disorder (PIGD) phenotypes. Swallowing disturbance questionnaire (SDQ) and fiberoptic endoscopic evaluation of swallowing (FEES) were used to evaluate dysphagia.ResultsThirty-five percent of patients experienced dysphagia when the patients were questioned, and this percent rises to 40% on using FEES. The results of SDQ were significantly correlated to the results of more accurate FEES. The percentage of dysphagia was higher in patients with PIGD than TD phenotype. Dysphagia was significantly associated with the mean of the Mini-Mental State Examination (MMSE), UPDRS, and modified Hoehn and Yahr scale.ConclusionsDysphagia is a prevalent symptom in early IPD and significantly correlated with Parkinsonism phenotype, UPDRS, and modified Hoehn and Yahr scale.