Laryngeal Vibration Increases Spontaneous Swallowing Rates in Chronic Oropharyngeal Dysphagia: A Proof-of-Principle Pilot Study

Evaluation of the Efficacy of Focal Vibration Therapy-Novafon as an Assistive Therapeutic Tool for Children With Feeding and Swallowing Disorders

BACKGROUND

Paediatric dysphagia refers to any feeding and/or swallowing problem that affects nutritional or liquid intake safety or adequacy. There is a prominent lack of available evidence-based effective therapeutic tools to facilitate the rehabilitation of feeding and/or swallowing disorders in children.

OBJECTIVE

The purpose of this study was to assess the effectiveness of focal vibration therapy-Novafon as an assistive therapeutic intervention for children with feeding and swallowing difficulties.

METHODS

The study involved 122 children with dysphagia who were divided into two groups: (1) 61 children who received conventional dysphagia therapy (cCDTh) and (2) 61 children who received conventional dysphagia therapy in combination with Novafon therapy (cCDTh+NTh). All children were evaluated for pre-, mid- and post-dysphagia therapy with the Gugging Swallowing Screen (GUSS) and Pediatric Eating Assessment Tool-10 (PEDI-EAT-10) in different Cypriot school and health settings.

RESULTS

PEDI-EAT-10 total scores for both groups observed that the cCDTh+NTh group had a significant decrease in the overall median between pre- and post-dysphagia therapy total score (Median = 3.00) compared to the cTDTh score (Median = 7.00). GUSS total scores between the two groups showed an increase in overall medians but the cCDTh+NTh group (Median of pre-therapy = 16.50, mid-therapy = 19.00 and post-therapy = 20.00) noted a higher increase in medians compared to the cCDTh group (Median of pre-therapy = 15.00, mid-therapy = 16.00 and post-therapy = 17.00).

CONCLUSION

The present study highlights that focal vibration therapy using Novafon may serve as an effective and supportive approach within conventional dysphagia therapy for children. Further research is necessary to enhance the evidence-based literature on the use of Novafon in paediatric dysphagia.

Impact of Transcutaneous Electrical Stimulation on Oral Moisture in Older Adults with and without Xerostomia: A Pilot Study

INTRODUCTION

Xerostomia, or dry mouth, is a prevalent and distressing oral health condition in older adults that is associated with reduced swallow frequency, thereby increasing the risk of dysphagia and aspiration pneumonia in this cohort. This pseudo-experimental study investigated the association between transcutaneous electrical stimulation (TES) and changes in perceived oral moisture, as well as the function of major and minor salivary glands in two groups of older adults, including those with and without xerostomia.

METHODS

Ten older adults with self-reported xerostomia and 7 control participants were exposed to two conditions: no TES and motor TES. TES electrodes were placed on cheeks and submental areas, targeting the parotid, submandibular, and sublingual salivary glands. Participants watched a silent nature movie while receiving continuous TES (only for active TES condition) for 15 min while swallowing sounds were recorded using a microphone attached under the cricoid cartilage. Changes in key outcome measures, including perceived oral moisture (measured by a visual analog scale) along with major and minor salivary glands function (measured by stimulated swallow frequency rate and Periotron) were assessed in response to TES.

RESULTS

The findings indicated that TES increased stimulated swallow frequency rate in both groups (F(1,13) = 9.813, p < 0.008, ηp2 = 0.430). Additionally, the perceived oral moisture measures were only improved for patients with xerostomia (F(1,13) = 5.155, p < 0.041, ηp2 = 0.284). However, no significant changes were noted in minor salivary gland flow rate measures.

CONCLUSION

These preliminary findings suggest an association between TES and increased objective major salivary gland function in both groups and perceived oral moisture in patients with xerostomia. However, due to the cross-sectional nature of this study, further research involving larger cohorts and controlled designs, and follow up is necessary to understand the mechanisms and potential therapeutic effects of TES on xerostomia.

Focal muscle vibrations improve swallowing in persistent dysphagia after traumatic brain injury: A case report

Dysphagia is a common complication following traumatic brain injury (TBI), and it is related to an increased risk of malnutrition, pneumonia, and poor prognosis. In this article, we present a case of TBI with persistent dysphagia treated with focal muscle vibration. A 100 Hz and 50 Hz vibratory stimuli were applied over the suprahyoid muscles and tongue (30 min twice a day; five days a week; for a total of four weeks) in addition to the conventional therapy to quickly recover swallowing and avoid the possibility of permanent deficits. In conclusion, this case highlights a novel therapeutic approach for persistent dysphagia in TBI, which should be considered in the management of dysphagia.

Swallowing dysfunctions in patients with disorders of consciousness: Evidence from neuroimaging data, assessment, and management

Following severe brain injuries, a subset of patients may remain in an altered state of consciousness; most of these patients require artificial feeding. Currently, a functional oral phase and the presence of exclusive oral feeding may constitute signs of consciousness. Additionally, the presence of pharyngo-laryngeal secretions, saliva aspiration, cough reflex and tracheostomy are related to the level of consciousness. However, the link between swallowing and consciousness is yet to be fully understood. The primary aim of this review is to establish a comprehensive overview of the relationship between an individual's conscious behaviour and swallowing (reflexive and voluntary). Previous studies of brain activation during volitional and non-volitional swallowing tasks in healthy subjects are also reviewed. We demonstrate that the areas activated by voluntary swallowing tasks (primary sensorimotor, cingulate, insula, premotor, supplementary motor, cerebellum, and operculum) are not specific to deglutitive function but are shared with other motor tasks and brain networks involved in consciousness. This review also outlines suitable assessment and treatment methods for dysphagic patients with disorders of consciousness. Finally, we propose that markers of swallowing could contribute to the development of novel diagnostic guidelines for patients with disorders of consciousness.

Accumulated Secretions and Associated Aerodigestive Function in Patients With Dysphagia

PURPOSE

Accumulated pharyngo-laryngeal secretions are associated with dysphagia, aspiration, and poor health outcomes. Despite ongoing developments in the evaluation of pharyngo-laryngeal secretions, understanding of the underlying mechanisms is limited. Pathophysiology associated with accumulated secretions is needed to guide tailored, targeted treatment pathways. This study reports the prevalence of accumulated pharyngo-laryngeal secretions in a large acute care caseload and explores the relationship between secretions and aerodigestive function.

METHOD

Consecutive inpatients (N = 222) referred for flexible endoscopic evaluation of swallow (FEES) with suspected dysphagia following assessment by a speech-language pathologist were recruited (43% neurological, 22% neurosurgical, 20% critical care, 15% other), and 250 standardized FEES were completed (222 first FEES, 28 repeat FEES). The assessment protocol included secretion assessment using the New Zealand Secretion Scale (NZSS), pharyngeal squeeze maneuver, laryngeal motor and sensory assessment, Penetration-Aspiration Scale, and Yale Pharyngeal Residue Severity Rating Scale. Urge-to-clear ratings were collected during endoscopy. Cough peak expiratory flow and swallow frequency measures were also collected, as well as clinical outcomes at time of discharge.

RESULTS

There was a high incidence of accumulated secretions, with 77% of inpatients having elevated NZSS (Mdn = 3, range: 0-7) and 37% with pooled laryngeal secretions. Accumulated secretions were associated with reduced swallow frequency, reduced laryngeal adductor reflex, impaired pharyngeal squeeze maneuver, and peak expiratory flow. NZSS scores also correlated with swallow measures (Penetration-Aspiration Scale and Yale Pharyngeal Residue Severity Rating Scale) and patient outcomes including diet recommendations at discharge and pneumonia during admission.

CONCLUSIONS

This large study contributes to evidence associating both sensory and motor impairments with secretion accumulation and aspiration risk. Further exploration of the key physiological mechanisms contributing to accumulated secretions will serve as markers to provide proof of principle for targets for secretion management protocols.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24101667.

The Feasibility of Home-Based Treatment Using Vibratory Stimulation in Chronic Severe Dysphagia

PURPOSE

Previously, externally placed vibratory laryngeal stimulation increased rates of swallowing in persons with and without dysphagia. This study examined the feasibility of using a vibratory device on the skin over the thyroid cartilage for home-based swallowing rehabilitation in long-standing dysphagia.

METHOD

Only participants with long-standing dysphagia (> 6 months) following cerebrovascular accident or head/neck cancer who had not previously benefited from dysphagia therapy participated. The device had two modes used daily for 90 days. In automatic mode, participants wore the device when awake, which vibrated for 4-8 s every 5 min to trigger a volitional swallow. In manual mode, participants practiced by activating vibration while swallowing rapidly. Study-related adverse events, such as pneumonia, and device-recorded adherence were tracked. Swallowing function on a modified barium swallow study was assessed at baseline and after 3 months of device use. Outcome measures included the Dysphagia Outcome and Severity Scale (DOSS), Penetration-Aspiration Scale (PAS), and swallowing timing measures. Participants' perceptions of the vibratory device and training were obtained.

RESULTS

The intent to treat analysis showed seven of 11 participants completed the study, all with severe chronic dysphagia. Of those seven participants completing the study, two developed respiratory complications (possibly due to pneumonia) that cleared after antibiotic intervention. For prescribed practice trials, adherence was 80% or greater in four of seven participants (57%) whereas prescribed automatic stimulations were met in only two of seven participants (29%). Three participants (43%) had a modest benefit on DOSS. The time to vestibule closure after the bolus passed the ramus was reduced in five participants (71%) on the modified barium swallow study.

CONCLUSION

Overall, the results have indicated that intensive home-based practice with stimulation may provide limited functional benefits in severe chronic dysphagia.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21498591.

Evaluation of Spontaneous Swallow Frequency in Healthy People and Those With, or at Risk of Developing, Dysphagia: A Review

Dysphagia is a common and frequently undetected complication of many neurological disorders and of sarcopoenia in ageing persons. Spontaneous swallowing frequency (SSF) has been mooted as a possible tool to classify dysphagia risk. We conducted a review of the literature to describe SSF in both the healthy population and in disease-specific populations, in order to consider its utility as a screening tool to identify dysphagia. We searched Medline, Embase, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials databases. Metadata were extracted, collated and analysed to give quantitative insight. Three hundred and twelve articles were retrieved, with 19 meeting inclusion and quality criteria. Heterogeneity between studies was high (I² = 99%). Mean SSF in healthy younger sub-groups was 0.98/min [CI: 0.67; 1.42]. In the Parkinson's sub-group, mean SSF was 0.59/min [0.40; 0.87]. Mean SSF in healthy older, higher risk and dysphagic populations were similar (0.21/min [0.09; 0.52], 0.26/min [0.10; 0.72] and 0.30/min [0.16; 0.54], respectively). SSF is a novel, non-invasive clinical variable which warrants further exploration as to its potential to identify persons at risk of dysphagia. Larger, well-conducted studies are needed to develop objective, standardised methods for detecting SSF, and develop normative values in healthy populations.