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Taniguchi H, Hirumuta M, Nakazawa Y, Ohashi M, Aoyagi Y. Effects of Capsaicin on Masticatory and Swallowing Function. J Oral Rehabil 2025; 52:825-832. [PMID: 39861968 DOI: 10.1111/joor.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 12/15/2024] [Accepted: 01/07/2025] [Indexed: 01/27/2025]
Abstract
INTRODUCTION Recent studies have shown that capsaicin improves the pharyngeal swallowing reflex. However, the mechanism by which capsaicin alters mastication and oesophageal function remains unclear. This study aimed to investigate the effects of capsaicin on masticatory and oesophageal function. MATERIALS AND METHODS Participants were 12 healthy individuals (7 men, 5 women: aged 31.5 ± 3.0 years). The participants ingested five rice cakes without capsaicin and then five rice cakes containing capsaicin. Total mastication frequency, total mastication time, and mastication rate were measured. Pharyngeal and upper oesophageal sphincter (UES) parameters were evaluated using high-resolution manometry (HRM). The masticatory and HRM parameters were compared between the ingestion of capsaicin-containing and non-capsaicin containing rice cakes. RESULTS The total mastication frequency and total mastication time(s) for capsaicin ingestion were significantly smaller (20.3 ± 9.4 vs. 22.4 ± 7.4; p = 0.011) and shorter (14.2 ± 7.0 vs. 15.4 ± 5.6; p = 0.038), respectively, than those for non-capsaicin ingestion. Comparison of the HRM parameters revealed significantly higher hypopharyngeal contractile integral (mmHg-s-cm) (56.6 ± 40.7 vs. 49.7 ± 43.6; p = 0.016) and proximal oesophageal contractile integral (mmHg-s-cm) (492.3 ± 292.64 vs. 381.2 ± 266; p < 0.001), significantly shorter UES basal pressure (mmHg) (93.6 ± 37.8 vs. 114.5 ± 43.4; p < 0.001), and significantly longer UES relaxation time (ms) (486.7 ± 90.7 vs. 431.2 ± 82.3; p < 0.001) for capsaicin ingestion than for non-capsaicin ingestion. CONCLUSIONS Decreased mastication frequency and time, increased hypopharyngeal and proximal oesophageal contractile integral, and prolonged UES opening time with capsaicin ingestion suggests that capsaicin improves oral, pharyngeal and oesophageal phases of swallowing.
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Affiliation(s)
- Hiroshige Taniguchi
- Division of Oral Pathogenesis and Disease Control, Department of Dysphagia Rehabilitation, Asahi University School of Dentistry, Gifu, Japan
| | - Makoto Hirumuta
- Division of Oral Pathogenesis and Disease Control, Department of Dysphagia Rehabilitation, Asahi University School of Dentistry, Gifu, Japan
| | - Yuri Nakazawa
- Division of Oral Pathogenesis and Disease Control, Department of Dysphagia Rehabilitation, Asahi University School of Dentistry, Gifu, Japan
| | - Miho Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoichiro Aoyagi
- Department of Rehabilitation Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Qiu Y, Xue W, Chen Y, He X, Zhao L, Tang M, Zhang H. Development and Validation of a Prediction Model for Dysphagia in Community-Dwelling Older Adults. Biol Res Nurs 2025; 27:300-315. [PMID: 39397401 DOI: 10.1177/10998004241290727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
Objectives. Dysphagia is a geriatric syndrome, which may lead to complications such as dehydration, malnutrition, aspiration, pneumonia, and a significant reduction in quality of life. The purpose of this study was to construct and validate a prediction model for dysphagia in community-dwelling older adults and provide an assessment tool for the prevention and control of dysphagia. Design. Cross-sectional study. Setting. The community-dwelling Chinese older adults. Participants. 3655 participants aged 65 years and older were involved, who were randomly divided into the training set and the validation set. Methods. Data were collected and analyzed from June 2022 to September 2022. Univariate and multivariate logistic regression analysis were used to identify independent risk factors for dysphagia. We applied R software to develop a nomogram model to predict dysphagia in community-dwelling older adults. The predictive value of the model was assessed by the area under the ROC curve (AUC), the calibration curve was used to evaluate the reliability of the nomogram model for predicting dysphagia in community-dwelling older adults. The model's clinical utility was further evaluated using a Decision Curve Analysis (DCA). Results. The incidence of dysphagia was 11.8% (320/3655). Maximum tongue pressure, number of molars, pneumonia, ADL, sarcopenia, age, neurological diseases, and rheumatic immune diseases were selected as risk predictors for dysphagia. The prediction model demonstrated fair discriminative ability with the AUC was 0.709 (95%CI: 0.679-0.739) in the training set and 0.693 (95%Cl: 0.640-0.747) in the validation set, the calibration is adequate, and the Hosmer and Lemeshow test showed p values of 0.163 and 0.415, respectively. The DCA curve of our model shows a positive clinical net benefit. Conclusions. The prediction model established in this study was of a certain predictive value for the risk of dysphagia in community-dwelling older adults. By estimating the likelihood of future outcomes or the onset of certain diseases, it can assist medical personnel in formulating preventive strategies, lessening the workload of nurses, and also diminishing the financial burden on patients, thereby enhancing their overall quality of life.
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Affiliation(s)
- Yufeng Qiu
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Wenfeng Xue
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Yanxin Chen
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Xiaona He
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Lancai Zhao
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
| | - Mengling Tang
- Department of Epidemiology and Biostatistics, Zhejiang University School of Medicine, Hangzhou, China
| | - Huafang Zhang
- Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, China
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Kunieda K, Hayashi Y, Fujishima I, Shimohata T. Weight and Muscle Mass Loss Associated with Acute Disease Can Be Reversed with Appropriate Nutrition Therapy and Exercise in a Patient with Amyotrophic Lateral Sclerosis. Intern Med 2025; 64:133-136. [PMID: 38749729 PMCID: PMC11781936 DOI: 10.2169/internalmedicine.3622-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/26/2024] [Indexed: 01/07/2025] Open
Abstract
Nutritional interventions targeting weight loss are useful for the treatment of amyotrophic lateral sclerosis (ALS). However, the changes in body composition after nutritional intervention remain unclear. We herein present a patient with ALS who experienced an increased weight and muscle mass owing to nutritional therapy and physical exercise. An 86-year-old man presented with dysphagia and dysarthria. The patient was diagnosed with bulbar-type ALS. As weight loss progressed, a gastrostomy was performed. After 21 months of disease onset, gastrointestinal bleeding due to a bumper ulcer led to further weight loss (from 40.2 kg to 36.8 kg). The patient experienced difficulty walking and ingesting food orally. Although the total daily energy expenditure (TDEE) was estimated to be 1,122 kcal/day, an intake of 1,500 kcal/day beyond the calculated TDEE was administered. The patient continued to perform daily voluntary exercises in addition to his usual rehabilitation. After 5 months, his weight increased from 36.8 kg to 40.4 kg. Muscle mass increased from 25.1 kg to 30.1 kg, as measured using a multifrequency bioelectrical impedance device. Muscle strength improved from 8.5/10.0 kg to 15.0/18.0 kg in grip strength and from 15.2 kPa to 20.4 kPa in tongue pressure. The patient's physical and swallowing functions also improved. In patients with ALS, a decreased body weight and muscle mass due to acute disease may be improved by appropriate nutritional therapy and physical exercise.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Faculty of Nursing Science, Tsuruga Nursing University, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
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Ogawa N, Ohno T, Kunieda K, Watanabe M, Fujishima I. A Novel Exercise to Improve Suprahyoid Muscle Area and Intensity as Evaluated by Ultrasonography. Dysphagia 2024; 39:855-863. [PMID: 38324169 DOI: 10.1007/s00455-024-10667-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
Insufficient suprahyoid muscle strength with poor opening of the upper esophageal sphincter can cause dysphagia. This study investigated whether an exercise of the suprahyoid muscle, named forehead exercise for suprahyoid muscles (FESM, "Enge-Odeko-Taiso" in Japanese), improves the geniohyoid muscle area and intensity using ultrasonography. Sixty-four participants (15 men and 49 women, 82.8 ± 6.0 years) living independently with no symptoms of swallowing difficulties were enrolled. The participants were divided into the FESM and the control group. The FESM is an isometric exercise involving repetitions of looking into the navel as if the chin is pulled back with little neck motion using a hand pushed against the forehead for resistance. This exercise is performed five times in 10 courses a day (total 50 times) for 8 weeks. Participants in the control group did not conduct any exercises. Body mass index, hand grip strength, gait speed, calf circumference, Mini Nutritional Assessment short-form, eating assessment tool, repetitive saliva swallowing test (RSST), and Food Intake LEVEL Scale scores were examined. The ultrasonographic geniohyoid muscle area, intensity, and RSST were investigated before and after the program. In the FESM group, the geniohyoid muscle area increased from 2.24 to 2.52 cm2 (P < 0.05), intensity decreased from 34.6 to 32.0 (P < 0.05), and the median RSST increased from 5 to 6 (P < 0.05) significantly. Conversely, no significant differences were observed in the control group. The FESM was effective to increase the area and decrease the intensity of the geniohyoid muscle and may improve swallowing function.
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Affiliation(s)
- Nami Ogawa
- Department of Dentistry, Sakaue Dental Office, 3F-3-14-8, Tamagawa, Setagaya-Ku, Tokyo, 158-0094, Japan.
| | - Tomohisa Ohno
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu-City, Gifu, 501-1194, Japan
| | - Masato Watanabe
- Department of Internal Medicine and Respiratory Medicine, Ohisamagenki Clinic, 2F-5-2-5, Futako, Takatsu-Ku, Kawasaki-Shi, Kanagawa, 213-0002, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1, Wagou, Hamamatsu City, Shizuoka, 433-8511, Japan
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Aii S, Fujishima I, Shigematsu T, Ohno T, Kunieda K, Yamawaki M. Sliced Jelly Whole Swallowing Reduces Deglutition Risk: A Novel Feeding Method for Patients with Dysphagia. Dysphagia 2024; 39:940-947. [PMID: 38568345 DOI: 10.1007/s00455-024-10674-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/18/2024] [Indexed: 04/24/2024]
Abstract
Texture modification in the form of gels or jellies is used for patients with dysphagia. For over 20 years, our group has been using gelatin jellies, a type of gel, as a starting diet for patients with dysphagia. Gelatin jellies are served in a small-sliced form and swallowed whole. In sliced jelly whole swallowing (SJWS), sliced gelatin jelly (SGJ) passes through the pharynx in one lump without collapsing. This study aimed to examine the usefulness of SJWS. We analyzed the images of videofluoroscopic swallowing studies performed using the normalized residue ratio scale (NRRSv: vallecula, NRRSp: pyriform sinus), the penetration-aspiration scale (PAS), and pharyngeal transit time (PTT) in 50 patients with dysphagia and compared the results in a prospective study. SJWS had significantly less residue in both NRRSv and NRRSp than in moderately thickened liquid swallowing. No significant differences in PAS scores were found between SGJ and moderately thickened liquid. Additionally, no significant differences in PTT scores were noted between the two. This study demonstrated the usefulness of SJWS in improving swallowing safety in patients with dysphagia. Further studies are needed to evaluate the reproducibility of the test, the comparison of SGJ with other thickened liquids, and the safety of SJWS for different diseases.
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Affiliation(s)
- Seijiro Aii
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan.
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu City, Shizuoka, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masanaga Yamawaki
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Chuo-Ku, Hamamatsu City, Shizuoka, 433-8511, Japan
- Department of Medical Education Research and Development, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, Tokyo, Japan
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Mori T, Wakabayashi H, Fujishima I, Narabu R, Shimizu A, Oshima F, Itoda M, Ogawa S, Ohno T, Yamada M, Kunieda K, Shigematsu T, Ogawa N, Nishioka S, Fukuma K, Ishikawa Y, Saito Y. Cutoff value of the geniohyoid muscle mass to identify sarcopenic dysphagia by ultrasonography. Eur Geriatr Med 2024; 15:1031-1037. [PMID: 38587613 DOI: 10.1007/s41999-024-00971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Determining the strength and area of the swallowing muscles is important in patients with sarcopenic dysphagia. Although the normative data on the strength of the swallowing muscles have been reported, those of the area of the geniohyoid muscle are poorly investigated. We investigated the cross-sectional area of the geniohyoid muscle in Japanese subjects without dysphagia using ultrasonography to determine the normative and cut-off values. METHODS 142 subjects without dysphagia were included. The older group (age ≥ 65 years) included 36 (women 27/men 9) subjects, and the younger group (age ≤ 39 years) included 106 (women 54/men 52) subjects. The cross-sectional area of the geniohyoid muscle was measured by ultrasound. The mean of the younger group-2 standard deviation (SD) was calculated and used as a cut-off value for low swallowing muscle mass. RESULTS The mean (SD) of the area of the geniohyoid muscle of each group was as follows: older women group 167.2 (32.6) mm2, older men group 193.2 (49.5) mm2, younger women group 247.3 (37.4) mm2, younger men group 313.1 (59.2) mm2. The mean 2SD of the geniohyoid muscle area in the younger women group was 172.5 mm2 and in the younger men group 194.7 mm2. CONCLUSION We found that the cut-off value of the ultrasonographic cross-sectional area of the geniohyoid muscle was 172.5 mm2 for women and 194.7 mm2 for men. These values could be used as cut-off values for the mass of the geniohyoid muscle to identify patients with sarcopenic dysphagia.
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Affiliation(s)
- Takashi Mori
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Yatsuyamada 7-115, Koriyama, Fukushima, Japan.
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Risa Narabu
- Fukushima Medical Device Development Support Centre, Fukushima, Japan
| | - Akio Shimizu
- Department of Food and Health Science, Faculty of Health and Human Development, The University of Nagano, Nagano, Japan
| | - Fumiko Oshima
- Department of Rehabilitation, Japanese Red Cross Society Suwa Hospital, Nagano, Japan
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | | | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Kazuki Fukuma
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yukari Ishikawa
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Yatsuyamada 7-115, Koriyama, Fukushima, Japan
| | - Yuto Saito
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Yatsuyamada 7-115, Koriyama, Fukushima, Japan
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Okamoto K, Kunieda K, Ohno T, Nomoto A, Fujishima I. A Case of Impaired Upper Esophageal Sphincter Opening Due to Sarcopenic Dysphagia Successfully Treated With Balloon Dilatation. Cureus 2024; 16:e65595. [PMID: 39211685 PMCID: PMC11357837 DOI: 10.7759/cureus.65595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
A case of an 84-year-old man diagnosed with "probable sarcopenic dysphagia" using the sarcopenic dysphagia diagnostic algorithm is presented. The patient demonstrated improved upper esophageal sphincter (UES) passage by the immediate effect of balloon dilatation. He had suffered a myocardial infarction and was unable to eat orally for approximately a month, presenting with sarcopenia and severe dysphagia, as indicated by the Food Intake LEVEL Scale (FILS) score of 1. Videofluoroscopic examination of swallowing study at 67 hospital days revealed impaired UES opening, with food bolus unable to pass through the UES. After confirming the loss of the gag reflex, we performed balloon dilatation, resulting in improved UES passage. With swallowing rehabilitation using balloon dilatation and appropriate nutritional therapy, the patient progressed to full oral intake and achieved FILS score of 8. This case suggests the effectiveness of combined nutritional therapy and swallowing rehabilitation with balloon dilatation in managing sarcopenic dysphagia. In addition, balloon dilatation could be applied for patients with sarcopenic dysphagia presenting impaired UES opening.
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Affiliation(s)
- Keishi Okamoto
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
| | - Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, JPN
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, JPN
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Ogawa M, Kenjiro K, Ohno T, Okamoto K, Fujishima I. Mechanism of the Immediate Effect of Balloon Dilation Therapy in Spinal Muscular Atrophy With Dysphagia: A High-Resolution Manometric Study. Cureus 2024; 16:e62191. [PMID: 39006706 PMCID: PMC11239239 DOI: 10.7759/cureus.62191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 07/16/2024] Open
Abstract
Balloon dilation therapy (BDT) is used to treat pharyngeal dysphagia in patients with impaired upper esophageal sphincter (UES) relaxation due to cricopharyngeal dysfunction. However, the mechanism underlying this immediate effect remains unclear. Here, we present a case in which we investigated the immediate effects of BDT on UES dysfunction using high-resolution manometry (HRM). A 67-year-old man was diagnosed with spinal muscular atrophy (SMA). He gradually developed dysphagia, and a gastrostomy was performed. Despite continuing oral intake of supplemental nutrition, the patient developed dysphagia. Videofluoroscopic (VF) examination of swallowing revealed pharyngeal residue, while HRM showed weak pharyngeal contractility and impaired UES opening. BDT was performed to address the UES dysfunction. Immediately following BDT, VF demonstrated improved pharyngeal bolus passage. As for the UES function during swallowing, HRM revealed that the UES relaxation duration was significantly longer and the UES nadir pressure was significantly decreased. The patient continued the BDT before oral intake. HRM revealed immediate and prolonged UES opening with decreased UES pressure during swallowing as an immediate effect of BDT. This suggests that these findings represent the mechanisms underlying dysphagia in this patient with SMA. BDT resulted in an immediate improvement in UES function, potentially leading to dysphagia improvement. BDT should be combined with conventional rehabilitation for impaired UES opening. However, further studies are needed to confirm the long-term effectiveness of BDT for dysphagia due to SMA.
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Affiliation(s)
- Mika Ogawa
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Kunieda Kenjiro
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, JPN
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Keishi Okamoto
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, JPN
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Vishak MS, Ramasamy K. Swallowing Rehabilitation: Tracing the Evolution of Assessment and Intervention Approaches for Dysphagia over 30 Years. Indian J Otolaryngol Head Neck Surg 2024; 76:2171-2175. [PMID: 38566735 PMCID: PMC10982211 DOI: 10.1007/s12070-023-04325-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/26/2023] [Indexed: 04/04/2024] Open
Abstract
Dysphagia or difficulty in swallowing is a common condition affecting millions worldwide. It can occur due to structural problems, neurological disorders, cancer treatment, aging, etc. Swallowing rehabilitation aims to help patients regain safe and efficient swallowing function through compensatory strategies and exercises. This literature review examines the recent advancements in swallowing rehabilitation techniques over the past three decades, with a focus on innovations in diagnostics, personalized medicine, and patient care.
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Affiliation(s)
- M. S. Vishak
- Department of Otorhinolaryngology, JIPMER, Puducherry, Karaikal India
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Kim JM, Kim MS, Choi SY, Ryu JS. Prediction of dysphagia aspiration through machine learning-based analysis of patients' postprandial voices. J Neuroeng Rehabil 2024; 21:43. [PMID: 38555417 PMCID: PMC10981344 DOI: 10.1186/s12984-024-01329-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Conventional diagnostic methods for dysphagia have limitations such as long wait times, radiation risks, and restricted evaluation. Therefore, voice-based diagnostic and monitoring technologies are required to overcome these limitations. Based on our hypothesis regarding the impact of weakened muscle strength and the presence of aspiration on vocal characteristics, this single-center, prospective study aimed to develop a machine-learning algorithm for predicting dysphagia status (normal, and aspiration) by analyzing postprandial voice limiting intake to 3 cc. METHODS Conducted from September 2021 to February 2023 at Seoul National University Bundang Hospital, this single center, prospective cohort study included 198 participants aged 40 or older, with 128 without suspected dysphagia and 70 with dysphagia-aspiration. Voice data from participants were collected and used to develop dysphagia prediction models using the Multi-Layer Perceptron (MLP) with MobileNet V3. Male-only, female-only, and combined models were constructed using 10-fold cross-validation. Through the inference process, we established a model capable of probabilistically categorizing a new patient's voice as either normal or indicating the possibility of aspiration. RESULTS The pre-trained models (mn40_as and mn30_as) exhibited superior performance compared to the non-pre-trained models (mn4.0 and mn3.0). Overall, the best-performing model, mn30_as, which is a pre-trained model, demonstrated an average AUC across 10 folds as follows: combined model 0.8361 (95% CI 0.7667-0.9056; max 0.9541), male model 0.8010 (95% CI 0.6589-0.9432; max 1.000), and female model 0.7572 (95% CI 0.6578-0.8567; max 0.9779). However, for the female model, a slightly higher result was observed with the mn4.0, which scored 0.7679 (95% CI 0.6426-0.8931; max 0.9722). Additionally, the other models (pre-trained; mn40_as, non-pre-trained; mn4.0 and mn3.0) also achieved performance above 0.7 in most cases, and the highest fold-level performance for most models was approximately around 0.9. The 'mn' in model names refers to MobileNet and the following number indicates the 'width_mult' parameter. CONCLUSIONS In this study, we used mel-spectrogram analysis and a MobileNetV3 model for predicting dysphagia aspiration. Our research highlights voice analysis potential in dysphagia screening, diagnosis, and monitoring, aiming for non-invasive safer, and more effective interventions. TRIAL REGISTRATION This study was approved by the IRB (No. B-2109-707-303) and registered on clinicaltrials.gov (ID: NCT05149976).
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Affiliation(s)
- Jung-Min Kim
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, South Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min-Seop Kim
- Department of Multimedia Engineering, Dongguk University, Seoul, South Korea
| | - Sun-Young Choi
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
- Seoul National University College of Medicine, 82 Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Seoul, Gyeonggi-Do, 13620, South Korea.
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11
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Walters RK, Gudipudi R, Gordis T, Davidson K, Nguyen SA, O'Rourke AK. A Systematic Review of Pharyngeal High-Resolution Manometry Normative Data. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:1059-1068. [PMID: 38127890 DOI: 10.1044/2023_ajslp-23-00221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE The utilization of high-resolution pharyngeal manometry (HRPM) in the evaluation of pharyngeal dysphagia has been increasing; however, standardization of its use has lagged behind. Without standardization using normative values, it is difficult for clinicians to adopt this emerging technology into meaningful use. Our goal is to map and compare the published normative values for common HRPM metrics in order to help establish consensus reference values. METHOD A systematic review was conducted on prospective and retrospective studies that included HRPM metrics, defined by an international working group consensus, in healthy adult populations. Data on the following variables were extracted when available: contractile integrals of the pharynx (PhCI), velopharynx, mesopharynx, and hypopharynx, as well as the upper esophageal sphincter (UES) integrated relaxation pressure (IRP), relaxation time (RT), maximum admittance, and hypopharyngeal intrabolus pressure. RESULTS Thirty studies were included. Significant variation existed in the technique and equipment used to perform procedures between the different studies. Lower PhCIs and UES IRPs were seen in younger compared to older individuals. Higher UES RTs were found in individuals in the upright position compared to the supine position and in those using larger boluses sizes or smaller catheters. CONCLUSIONS Due to the wide variety of protocols, catheter configurations, manufacturers, and software used in the existing literature, it is difficult to formulate consensus on HPRM normative values using pooled data. Prospective studies adhering to standardized HRPM protocols for specific catheter configurations and manufacturers with larger cohorts of normal individuals are necessary to establish proper reference values for HRPM metrics. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24843753.
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Affiliation(s)
- Rameen K Walters
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Rachana Gudipudi
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Tamar Gordis
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Kate Davidson
- Department of Speech-Language Pathology, Medical University of South Carolina, Charleston
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
| | - Ashli K O'Rourke
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston
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12
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Kunieda K, Hayashi Y, Yamada M, Nishida S, Moribayashi R, Ohno T, Fujishima I, Kimura A, Shimohata T. The Evaluation of Benzodiazepine-induced Dysphagia Using High-resolution Manometry. Intern Med 2023; 62:3537-3540. [PMID: 37062746 PMCID: PMC10749804 DOI: 10.2169/internalmedicine.1539-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 04/18/2023] Open
Abstract
We evaluated the pathophysiology of dysphagia considered to be induced by benzodiazepine using high-resolution manometry (HRM). A 53-year-old man with Parkinson disease had had dysphagia for over 3 months. He had been taking several benzodiazepines for more than four years. Two weeks after discontinuation of the benzodiazepines, HRM revealed increased pharyngeal contractility and residual pressure at the upper esophageal sphincter. A video-fluoroscopic swallowing study showed improved pharyngeal bolus passage. Benzodiazepine-induced dysphagia may be due to the muscle relaxant effects on the swallowing muscles and attenuation of the barrier function which prevents reflux from the esophagus into the pharynx.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
| | - Yuichi Hayashi
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
- Department of Nursing, Tsuruga City Nursing University, Japan
| | - Megumi Yamada
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
| | | | | | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
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13
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Kakehi S, Isono E, Wakabayashi H, Shioya M, Ninomiya J, Aoyama Y, Murai R, Sato Y, Takemura R, Mori A, Masumura K, Suzuki B. Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update. Ann Rehabil Med 2023; 47:337-347. [PMID: 37907225 PMCID: PMC10620494 DOI: 10.5535/arm.23101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient's pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.
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Affiliation(s)
- Shingo Kakehi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Eri Isono
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Moeka Shioya
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Junki Ninomiya
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Yohei Aoyama
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Ryoko Murai
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Yuka Sato
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Ryohei Takemura
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Amami Mori
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Kei Masumura
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
| | - Bunta Suzuki
- Department of Rehabilitation Medicine, Tokyo Women’s Medical University Hospital, Tokyo, Japan
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14
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Cheriyan SS, Schar MS, Woods CM, Bihari S, Cock C, Athanasiadis T, Omari TI, Ooi EH. Swallowing biomechanics in tracheostomised critically ill patients compared to age- and gender-matched healthy controls. CRIT CARE RESUSC 2023; 25:97-105. [PMID: 37876599 PMCID: PMC10581277 DOI: 10.1016/j.ccrj.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objective The mechanistic effects of a tracheostomy on swallowing are unclear. Pharyngeal high-resolution manometry with impedance (P-HRM-I) is a novel swallow assessment tool providing quantifiable metrics. This study aimed to characterise swallowing biomechanics in tracheostomised critically ill (non-neurological) patients. Design Cohort study. Setting Australian tertiary hospital intensive care unit. Participants Tracheostomised adults, planned for decannulation. Main outcome measures Swallowing assessment using P-HRM-I, compared to healthy age- and gender-matched controls. Results In this tracheostomised cohort (n = 10), the Swallow Risk Index, a global measure of swallow function, was significantly elevated (p < 0.001). At the upper oesophageal sphincter (UOS), hypopharyngeal intrabolus pressure and UOS integrated relaxation pressure were significantly elevated (control 0.65 mmHg [-1.02, 2.33] v tracheostomy 13.7 mmHg [10.4, 16.9], P < 0.001; control -4.28 mmHg [-5.87, 2.69] v tracheostomy 12.2 mmHg [8.83, 15.6], P < 0.001, respectively). Furthermore, UOS opening extent and relaxation time were reduced (control 4.83 mS [4.60, 5.07] v tracheostomy 4.33 mS [3.97, 4.69], P = 0.002; control 0.52 s [0.49, 0.55] v tracheostomy 0.41 s [0.37, 0.45], P < 0.001, respectively). Total pharyngeal contractility (PhCI) measuring pharyngeal pressure generation was significantly elevated (control 199.5 mmHg cm.s [177.4, 221.6] v tracheostomy 326.5 mmHg cm.s [253.3, 399.7]; P = 0.001). Conclusion In a critically ill tracheostomised cohort, UOS dysfunction was the prevalent biomechanical feature, with elevated pharyngeal pressures. Pharyngeal weakness is not contributing to dysphagia in this cohort. Instead, elevated pharyngeal pressures may represent a compensatory mechanism to overcome the UOS dysfunction. Further studies to extend these findings may inform the development of timely and targeted rehabilitation.
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Affiliation(s)
- Sanith S. Cheriyan
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Mistyka S. Schar
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Speech Pathology and Audiology, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Charmaine M. Woods
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Shailesh Bihari
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
- Department of Intensive & Critical Care, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Charles Cock
- Department of Gastroenterology & Hepatology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Theodore Athanasiadis
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Taher I. Omari
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Eng H. Ooi
- Department of Otolaryngology, Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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15
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Arakawa‐Kaneko I, Watarai Y, Schimmel M, Abou‐Ayash S. Relationship between tongue pressure and handgrip strength: A systematic review and meta-analysis. J Oral Rehabil 2022; 49:1087-1105. [PMID: 35972300 PMCID: PMC9804501 DOI: 10.1111/joor.13362] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Muscle strength decreases with age, causing a decline in physical and oro-facial function. However, the impact of physiological and pathophysiological factors on tongue pressure (TP) has not been clarified. The purpose of this systematic review and meta-analysis was to compare and analyse TP and handgrip strength (HGS) between individuals aged <60 and ≥60 years, gender and need for care (independent older adults (IC) and older adults receiving nursing care (NC)). Furthermore, the effect of HGS in physical function on TP was examined. METHODS Human clinical studies reporting HGS and TP were searched systematically using PubMed and Ichushi-Web published from 1969 to Nov 2021. Random-effects meta-regressions were performed to compare between subgroups and to examine the association between HGS and TP (α < .05). RESULTS Forty-four studies with a total of 10 343 subjects were included. TP and HGS values were significantly higher in people aged <60 years relative to ≥60 years and in IC relative to NC (all p < .001). Regarding gender, there was no significant difference in TP (p = .370). However, a significant gender-dependent difference in TP was observed in people aged <60 years (p < .001), but not in aged ≥60 years in IC group (p = .118) and aged ≥60 years in NC group (p = .895). There was a significant positive correlation of HGS and TP (p < .001). CONCLUSIONS Similar to decrease in HGS, age-related sarcopaenia seems to have an effect on oro-facial muscles like the tongue. Research on rehabilitation measures for oro-facial muscle strength, similar to HGS might be beneficial to improve the personally acquired oro-facial potential.
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Affiliation(s)
- Itsuka Arakawa‐Kaneko
- Department of Reconstructive Dentistry and Gerodontology, School of Dental MedicineUniversity of BernBernSwitzerland,Comprehensive Dental Care UnitThe Nippon Dental University Niigata HospitalNiigataJapan
| | - Yuko Watarai
- Department of Removable ProsthodonticsThe Nippon Dental University School of Life Dentistry at NiigataNiigataJapan
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental MedicineUniversity of BernBernSwitzerland,Division of Gerodontology and Removable ProsthodonticsUniversity Clinics of Dental Medicine, University of GenevaGenevaSwitzerland
| | - Samir Abou‐Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental MedicineUniversity of BernBernSwitzerland
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16
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Sensitivity and Specificity of Body Mass Index for Sarcopenic Dysphagia Diagnosis among Patients with Dysphagia: A Multi-Center Cross-Sectional Study. Nutrients 2022; 14:nu14214494. [PMID: 36364757 PMCID: PMC9655070 DOI: 10.3390/nu14214494] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
The accuracy of body mass index (BMI) for sarcopenic dysphagia diagnosis, which remains unknown, was evaluated in this study among patients with dysphagia. We conducted a 19-site cross-sectional study. We registered 467 dysphagic patients aged ≥ 20 years. Sarcopenic dysphagia was assessed using a reliable and validated diagnostic algorithm. BMI was assessed using the area under the curve (AUC) in the receiver operating characteristic analysis to determine diagnostic accuracy for sarcopenic dysphagia. The study included 460 patients (median age, 83.0 years (76.0−88.0); men, 49.8%). The median BMI was 19.9 (17.3−22.6) kg/m2. Two hundred eighty-four (61.7%) patients had sarcopenic dysphagia. The AUC for sarcopenic dysphagia was 0.60−0.62 in the overall patients, male, female, and patients aged ≥ 65 years The BMI cut-off value for sarcopenic dysphagia diagnosis was 20.1 kg/m2 in the overall patients (sensitivity, 58.1%; specificity, 60.2%) and patients aged ≥ 65 years (sensitivity, 59.8%; specificity, 61.8%). Conclusion: Although the AUC, sensitivity and specificity of BMI for sarcopenic dysphagia diagnosis was approximately 0.6, BMI < 20.0 kg/m2 might be a predictor for sarcopenic dysphagia. In clinical settings, if patients with dysphagia have a BMI < 20.0 kg/m2, then sarcopenic dysphagia should be suspected as early as possible after admission.
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17
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de Sire A, Ferrillo M, Lippi L, Agostini F, de Sire R, Ferrara PE, Raguso G, Riso S, Roccuzzo A, Ronconi G, Invernizzi M, Migliario M. Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review. Nutrients 2022; 14:nu14050982. [PMID: 35267957 PMCID: PMC8912303 DOI: 10.3390/nu14050982] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.
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Affiliation(s)
- Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Martina Ferrillo
- Department of Health Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (M.F.)
| | - Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy;
| | - Roberto de Sire
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy;
| | - Paola Emilia Ferrara
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Giuseppe Raguso
- Department of Otolaryngology-Head and Neck Surgery, University of Verona, 37129 Verona, Italy;
| | - Sergio Riso
- Dietetic and Clinical Nutrition Unit, Maggiore della Carità Hospital, 28100 Novara, Italy;
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland;
- Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), 2100 Copenhagen, Denmark
| | - Gianpaolo Ronconi
- University Polyclinic Foundation Agostino Gemelli IRCSS, Catholic University of Sacred Heart, 00168 Rome, Italy; (P.E.F.); (G.R.)
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Mario Migliario
- Dental Clinic, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy;
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18
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Kunieda K, Sugiyama J, Nomoto A, Ohno T, Shigematsu T, Fujishima I. Compensatory swallowing methods in a patient with dysphagia due to lateral medullary syndrome-vacuum and prolonged swallowing: A case report. Medicine (Baltimore) 2022; 101:e28524. [PMID: 35029918 PMCID: PMC8735762 DOI: 10.1097/md.0000000000028524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The nature of pharyngeal swallowing function during the course of recovery of dysphagia due to lateral medullary syndrome (LMS) is unclear. Vacuum swallowing is a compensatory swallowing method that improves the pharyngeal passage of a bolus by creating negative pressure during swallowing in the esophagus in patients with dysphagia due to LMS. We present a case involving a patient with dysphagia due to LMS who involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. PATIENT CONCERNS We report a unique case involving a 52-year-old patient with dysphagia due to LMS. His dysphagia was severe but improved gradually with swallowing rehabilitation. The patient involuntarily acquired a swallowing method with prolonged and increased pharyngeal contraction and vacuum swallowing. DIAGNOSIS The patient presented with dysphagia due to left LMS. A videofluoroscopic examination of swallowing revealed pharyngeal residue. INTERVENTIONS Forty-five days after the onset of the dysphagia, the swallowing pressure along the pharynx and esophagus was measured using high-resolution manometry. OUTCOMES Vacuum swallowing was observed in six out of 19 swallows (32.5%). The velopharyngeal contractile integral (CI) and mesohypopharyngeal CI values increased during swallowing, reflecting prolonged and increased pharyngeal contraction. We named this swallowing method "prolonged swallowing." CONCLUSION The findings in this case indicate that vacuum and prolonged swallowing may be compensatory swallowing methods observed in individuals recovering from dysphagia due to LMS. Further research is needed to clarify the relationship between these swallowing methods and the pathophysiology, prognosis, and treatment of dysphagia in patients with LMS.
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Affiliation(s)
- Kenjiro Kunieda
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Junya Sugiyama
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
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Mizuno S, Wakabayashi H, Wada F. Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability. Curr Opin Clin Nutr Metab Care 2022; 25:29-36. [PMID: 34456248 PMCID: PMC8694258 DOI: 10.1097/mco.0000000000000787] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW We describe the recent advances in rehabilitation nutrition, which is especially important for disabled or frail older individuals. RECENT FINDINGS Recent evidence pertaining to rehabilitation nutrition conducted in rehabilitation wards and acute care hospitals has been accumulating. The combination of rehabilitation nutrition and rehabilitation pharmacotherapy is important for eliciting higher functions. The 2020 update of the clinical practice guidelines for rehabilitation nutrition provides a weak recommendation for enhanced nutritional care for patients with cerebrovascular disease, hip fracture, cancer, or acute illness who are undergoing rehabilitation. Rehabilitation nutritional care process and the International Classification of Functioning, Disability and Health-Dietetics are used to implement high-quality rehabilitation nutrition. Aggressive nutrition therapy incorporates the daily energy expenditure plus daily energy accumulation to increase body weight and muscle mass. Preventing and treating sarcopenic dysphagia should include iatrogenic sarcopenia prevention and aggressive nutrition therapy. The diagnosis criteria for respiratory sarcopenia and sarcopenic respiratory disability have been established. SUMMARY The International Association of Rehabilitation Nutrition and Total Nutrition Therapy Rehabilitation program may contribute to international expansion of rehabilitation nutrition. Improving evidence-practice gaps in rehabilitation nutrition and increasing national health insurance coverage of aggressive nutrition therapy and rehabilitation nutrition teams are warranted.
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Affiliation(s)
- Satoko Mizuno
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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20
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Nakao Y, Uchiyama Y, Honda K, Yamashita T, Saito S, Domen K. Age-related composition changes in swallowing-related muscles: a Dixon MRI study. Aging Clin Exp Res 2021; 33:3205-3213. [PMID: 33904143 DOI: 10.1007/s40520-021-01859-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/07/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Dysphagia is considered a social problem in the super-aging society. However, age-related changes in swallowing-related muscles have not been fully deciphered. AIMS We aimed to identify intramuscular fatty infiltration and muscle atrophy in multiple swallowing-related muscles on magnetic resonance imaging (MRI). Moreover, an appropriate muscle strength parameter for the evaluation of swallowing-related muscle mass was examined. METHODS We analyzed the Dixon MRI results of 20 elderly and 20 young adults without head and neck cancer, stroke, neuromuscular disease, or whole-body sarcopenia to evaluate intramuscular fatty infiltration (IMF) and lean muscle mass (LMM) in the tongue, geniohyoid, and pharyngeal muscles. The pharyngeal lumen size was also assessed. Tongue pressure, jaw-opening strength, occlusal force, and head-lifting strength were evaluated within a week before and after MRI. RESULTS Aging significantly affected the IMF of the swallowing-related muscles, and the tongue muscle was most affected, followed by the pharyngeal muscle and then the geniohyoid muscle. Only the LMM of the geniohyoid muscle significantly decreased with aging. The pharyngeal lumen size did not significantly differ between the elderly and young participants, and only tongue pressure was significantly correlated with tongue, geniohyoid, and pharyngeal muscle mass. CONCLUSIONS IMF is primarily associated with age-related composition changes in swallowing-related muscles, and it is commonly observed in the tongue and pharyngeal muscles. The geniohyoid muscle is more at risk of muscle atrophy rather than fatty infiltration. In addition, tongue pressure can be a parameter for the evaluation of swallowing-related muscle mass.
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Affiliation(s)
- Yuta Nakao
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Nishinomiya, Hyogo, Japan
- Department of Rehabilitation, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kosuke Honda
- Department of Dentistry and Oral Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Taiji Yamashita
- Department of Rehabilitation Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
- Department of Rehabilitation, Matsuyama Rehabilitation Hospital, Matsuyama, Ehime, Japan
| | - Shota Saito
- Department of Rehabilitation, Hyogo College of Medicine College Hospital, Nishinomiya, Hyogo, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Chen KC, Jeng Y, Wu WT, Wang TG, Han DS, Özçakar L, Chang KV. Sarcopenic Dysphagia: A Narrative Review from Diagnosis to Intervention. Nutrients 2021; 13:nu13114043. [PMID: 34836299 PMCID: PMC8621579 DOI: 10.3390/nu13114043] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022] Open
Abstract
Sarcopenia, defined as a decline in muscle mass and function related to aging, affects both limb and swallowing-related muscles. Sarcopenic dysphagia is characterized by decreased swallowing function; therefore, early detection of subclinical dysphagia and subsequent intervention appear to be crucial in the elderly. Numerous tools have been employed to measure the function, strength, and mass of swallowing-related muscles in sarcopenic elderly. The swallowing function can be evaluated by questionnaires like Eating Assessment Tool, Functional Oral Intake Scale, and Food Intake Level Scale, and tests such as the modified water swallowing test and videofluoroscopic swallowing study. Surface electromyography and high-resolution manometry can be applied for quantifying swallowing-related muscle strength. Modalities such as ultrasonography and magnetic resonance imaging are capable of estimating the swallowing muscle mass. In patients with sarcopenic dysphagia, a thorough assessment should be given followed by an integrated intervention combining swallowing muscle strengthening, nutrition support, food texture modification, physical, and occupational therapies. This article aimed to comprehensively summarize the diagnostic criteria/tools as well as their associations/performance in sarcopenic dysphagia. The intervention strategy will also be narrated in this review.
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Affiliation(s)
- Kuan-Cheng Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, Far Eastern Memorial Hospital, New Taipei 22000, Taiwan
| | - Ying Jeng
- Department of Medical Image, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan;
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 10048, Taiwan; (K.-C.C.); (T.-G.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan;
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
- Correspondence: ; Tel.: +886-223717101 (ext. 5309)
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Diagnosis of Sarcopenic Dysphagia in the Elderly: Critical Review and Future Perspectives. Dysphagia 2021; 37:1093-1102. [PMID: 34535803 DOI: 10.1007/s00455-021-10371-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
Sarcopenic dysphagia (SD) is swallowing difficulty associated with loss of generalized skeletal muscles and swallowing-related muscles. Diagnostic criteria for SD were suggested, yet there is a variability in instruments and cut-offs used. The aim of the current review is to critically evaluate tools used in diagnosis of sarcopenic dysphagia in the elderly. Comprehensive review of the literature was performed. Studies were qualitatively evaluated for the diagnostic tools used to make a diagnosis of "sarcopenic dysphagia" and compared to the known diagnostic criteria for SD and other accepted measures. Fourteen studies (N = 10,282) were selected from a search yield of 331 de-duplicated studies. Ninety-three percent of studies (13/14) were conducted in Japan. All subjects included were over the age of 65 years old (mean, 76.5 years). Various tools were used to assess sarcopenia including handgrip strength (14/14 of studies), followed by skeletal muscle mass/index (7/14), tongue pressure, gait speed, and calf circumference in 5/14 studies. The most commonly tool used for dysphagia and/or swallowing dysfunction was the food level intake scale (5/14 of studies) followed by the functional oral intake scale (3/14). The 100-mL water swallow test was used in 2 of the 14 included SD studies. Fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, EAT-10 questionnaire, and standardized swallow assessment were each used in only one SD study. Further research is required to validate SD diagnostic tools, establish cut-offs in different populations, and investigate their role in screening of dysphagia and swallowing dysfunction in the elderly.
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Wang Z, Yan L, Dai Y, Lu F, Zhang J, Hou M, Liu X. Attention graph convolutional nets for esophageal contraction pattern recognition in high-resolution manometries. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Wakabayashi H, Kishima M, Itoda M, Fujishima I, Kunieda K, Ohno T, Shigematsu T, Oshima F, Mori T, Ogawa N, Nishioka S, Yamada M, Ogawa S. Diagnosis and Treatment of Sarcopenic Dysphagia: A Scoping Review. Dysphagia 2021; 36:523-531. [PMID: 33620563 DOI: 10.1007/s00455-021-10266-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sarcopenic dysphagia is a swallowing disorder due to sarcopenia involving the whole-body skeletal muscles and swallowing muscles. This scoping review aimed to explore the currently known information on the diagnosis and treatment of sarcopenic dysphagia and to clarify the types of research required to develop the field. METHODS We searched the PubMed, MEDLINE, CINAHL, and Cochrane databases from their inception to October 2020, using the search terms "(sarcopenia or sarcopenic or myopenia or dynapenia) and (dysphagia or swallowing or deglutition) and (diagnosis or treatment)". Articles reporting diagnosis method and treatment of sarcopenic dysphagia were included. RESULTS Twenty-one and eight articles reported on the diagnostic and treatment method, respectively. A diagnostic algorithm for sarcopenic dysphagia was most frequently used (n = 10). Other diagnostic methods included consensus diagnostic criteria for sarcopenic dysphagia (n = 4), sarcopenia and dysphagia without other causes of dysphagia (n = 4), and both sarcopenia and dysphagia (n = 3). The medical treatments for patients with sarcopenic dysphagia were described in single-patient case reports (n = 8) only. There were six articles reporting on a combination of rehabilitation and nutritional support. These reports showed the importance of interdisciplinary rehabilitation nutrition for improving patients' nutritional status and sarcopenia. CONCLUSIONS A reliable and validated diagnostic algorithm was the most widely used diagnostic method for sarcopenic dysphagia. Only case reports have been published for the medical treatment of patients with sarcopenic dysphagia. Interdisciplinary rehabilitation nutrition may be useful for treating patients with sarcopenic dysphagia.
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Affiliation(s)
- Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan.
| | - Masako Kishima
- Department of Dentistry, Wakakusa-Tatsuma Rehabilitation Hospital, Osaka, Japan
| | - Masataka Itoda
- Department of Oral Rehabilitation, Osaka Dental University Hospital, Osaka, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
- Department of Neurology, Gifu University Hospital, Gifu, Japan
| | - Tomohisa Ohno
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
- Department of Rehabilitation Medicine, Seirei Awaji Hospital, Awaji, Japan
| | - Fumiko Oshima
- Department of Rehabilitation, Japanese Red Cross Society Suwa Hospital, Suwa, Japan
| | - Takashi Mori
- Department of Oral and Maxillofacial Surgery, Southern Tohoku General Hospital, Koriyama, Japan
| | - Nami Ogawa
- Department of Dysphagia Rehabilitation, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Minoru Yamada
- Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Sumito Ogawa
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Aoyagi Y, Inamoto Y, Shibata S, Kagaya H, Otaka Y, Saitoh E. Clinical Manifestation, Evaluation, and Rehabilitative Strategy of Dysphagia Associated With COVID-19. Am J Phys Med Rehabil 2021; 100:424-431. [PMID: 33657028 PMCID: PMC8032217 DOI: 10.1097/phm.0000000000001735] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
ABSTRACT Dysphagia is the difficulty in swallowing because of the presence of certain diseases; it particularly compromises the oral and/or pharyngeal stages. In severe acute respiratory syndrome coronavirus 2 infection, neuromuscular complications, prolonged bed rest, and endotracheal intubation target different levels of the swallowing network. Thus, critically ill patients are prone to dysphagia and aspiration pneumonia. In this review, we first discuss the possible cause and pathophysiology underlying dysphagia associated with coronavirus disease 2019, including cerebrovascular events, such as stroke, encephalomyelitis, encephalopathy, peripheral neuropathy, and myositis, that may lead to the dysphagia reported as a complication associated with the coronavirus disease 2019. Next, we present some recommendations for dysphagia evaluation with modifications that would allow a safe and comprehensive assessment based on available evidence to date, including critical considerations of the appropriate use of personal protective equipment and optimization individual's noninstrumental swallowing tasks evaluation, while preserving instrumental assessments for urgent cases only. Finally, we discuss a practical managing strategy for dysphagia rehabilitation to ensure safe and efficient practice in the risks of severe acute respiratory syndrome coronavirus 2 exposure, in which swallowing therapy using newer technology, such as telerehabilitation system or wearable device, would be considered as a useful option.
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26
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Shimizu A, Fujishima I, Maeda K, Wakabayashi H, Nishioka S, Ohno T, Nomoto A, Shigematsu T, Kayashita J. Effect of low tongue pressure on nutritional status and improvement of swallowing function in sarcopenic dysphagia. Nutrition 2021; 90:111295. [PMID: 34107332 DOI: 10.1016/j.nut.2021.111295] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effect of low tongue pressure on the improvement of swallowing function in people with sarcopenic dysphagia and ongoing dysphagia or physical rehabilitation. In addition, we investigated whether sarcopenic dysphagia at admission was associated with severity of malnutrition. METHODS This was a prospective cohort study of 146 people with sarcopenic dysphagia (mean age 84.6 ± 7.4 y; 68.4% women, 31.6% men) in a postacute rehabilitation hospital. Sarcopenic dysphagia was defined as the presence of both sarcopenia and dysphagia but not neurogenic dysphagia, such as dysphagia due to stroke. Low tongue pressure was classified as "probable" and normal tongue pressure as "possible" sarcopenic dysphagia. Swallowing function was assessed using the Food Intake Level Scale. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition criteria. Study outcomes included the amount of change in Food Intake Level Scale score during the rehabilitation period and the association between probable sarcopenic dysphagia and the severity of malnutrition on admission. Statistical significance was set at P < 0.05. RESULTS There were 83 participants (58.6%) with probable sarcopenic dysphagia. The severity of malnutrition (moderate malnutrition: adjusted odds ratio, 3.388; P = 0.042) and severe malnutrition (adjusted odds ratio, 3.663; P = 0.015) was a contributing factor to probable sarcopenic dysphagia. Probable sarcopenic dysphagia (regression coefficient, -0.384; P = 0.017) was negatively associated with the amount of change in Food Intake Level Scale score. CONCLUSIONS Probable sarcopenic dysphagia with low tongue pressure was associated with poorer improvement in swallowing function and severe malnutrition during postacute rehabilitation. Patients with probable sarcopenic dysphagia may require aggressive nutritional therapy.
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Affiliation(s)
- Akio Shimizu
- Department of Nutrition, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan; Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Keisuke Maeda
- Department of Palliative and Supportive Medicine, Graduate School of Medicine, Aichi Medical University, Nagakute, Japan; Department of Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidetaka Wakabayashi
- Department of Rehabilitation Medicine, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Akiko Nomoto
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
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Suntrup-Krueger S, Muhle P, Kampe I, Egidi P, Ruck T, Lenze F, Jungheim M, Gminski R, Labeit B, Claus I, Warnecke T, Gross J, Dziewas R. Effect of Capsaicinoids on Neurophysiological, Biochemical, and Mechanical Parameters of Swallowing Function. Neurotherapeutics 2021; 18:1360-1370. [PMID: 33449304 PMCID: PMC8423940 DOI: 10.1007/s13311-020-00996-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 01/25/2023] Open
Abstract
Oropharyngeal dysphagia is prevalent in age-related neurological disorders presenting with impaired efficacy and safety of swallowing due to a loss of muscle force and sensory deficits. Stimulating the oropharynx with capsaicin that mediates Substance P release is an emerging pharmacological treatment option which needs further scientific evidence. Our aim was to comprehensively evaluate the effect of capsaicin on biochemical, neurophysiological, and biomechanical parameters of swallowing function. In a randomized study on healthy individuals, the impact of orally administered capsaicinoids at different dosages and application durations in comparison to non-carbonated water was evaluated. Time course and magnitude of salivary Substance P increase were monitored. Magnetoencephalography was used to detect cortical swallowing network alterations. Modifications in swallowing biomechanics were measured applying high-resolution pharyngeal manometry. Capsaicinoids at 10 μmol/L improved swallowing efficacy as seen by a significant increase of pharyngeal contractile integral and upper esophageal sphincter activation and relaxation times in manometry. Significant improvement of precision in a challenging swallow task accompanied by a reduction in swallowing-related submental electromyographic power was observed with capsaicinoids preconditioning at 10 μmol/L over 5 min, but not with continuous stimulation. The cortical activation pattern remained unchanged after any intervention. A significant increase of salivary Substance P was not detected with 10 μmol/L but with 50 μmol/L and lasted for 15 min after application. Capsaicinoids mediate dose-dependent Substance P release and positively alter swallowing biomechanics in healthy subjects. The results provide supportive evidence for the value of natural capsaicinoids to improve swallowing function.
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Affiliation(s)
- Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany.
| | - Paul Muhle
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Isabella Kampe
- Pediatrics Department, St. Franziskus-Hospital Ahlen, Robert-Koch-Straße 55, 59227, Ahlen, Germany
| | - Paula Egidi
- Department of Anesthesiology and Intensive Care Medicine, Clemenshospital Münster, Duesbergweg 124, 48153, Muenster, Germany
| | - Tobias Ruck
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Frank Lenze
- Department of Medicine B for Gastroenterology and Hepatology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Michael Jungheim
- Department of Phoniatrics and Pediatric Audiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Richard Gminski
- Institute for Infection Prevention and Hospital Epidemiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - Bendix Labeit
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Malmedyweg 15, 48149, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany
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Kunieda K, Sugi T, Ohno T, Nomoto A, Shigematsu T, Kanazawa H, Fujishima I. Incoordination during the pharyngeal phase in severe dysphagia due to lateral medullary syndrome. Clin Case Rep 2021; 9:1728-1731. [PMID: 33768924 PMCID: PMC7981674 DOI: 10.1002/ccr3.3890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/25/2020] [Accepted: 01/21/2021] [Indexed: 12/02/2022] Open
Abstract
One of the mechanisms of severe dysphagia due to lateral medullary syndrome may be a reversed pressure gradient caused by incoordination of pharyngeal contractility and UES opening during swallowing.
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Affiliation(s)
- Kenjiro Kunieda
- Department of NeurologyGifu University Graduate School of MedicineGifuJapan
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Takafumi Sugi
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Tomohisa Ohno
- Department of DentistryHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Akiko Nomoto
- Department of DentistryHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Takashi Shigematsu
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Hideaki Kanazawa
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
| | - Ichiro Fujishima
- Department of Rehabilitation MedicineHamamatsu City Rehabilitation HospitalHamamatsuJapan
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29
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Nagashima K, Kikutani T, Miyashita T, Yajima Y, Tamura F. Tongue muscle strength affects posterior pharyngeal wall advancement during swallowing: A cross-sectional study of outpatients with dysphagia. J Oral Rehabil 2020; 48:169-175. [PMID: 33112420 PMCID: PMC7983890 DOI: 10.1111/joor.13120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022]
Abstract
Background Tongue muscle strength is important for swallowing but decreases with age, in association with reduced skeletal muscle mass. However, the relationships between pharyngeal dynamics and both skeletal muscle mass and tongue muscle strength are unknown. Objective To investigate the effect of reductions in tongue muscle strength on pharyngeal movement during swallowing in patients with dysphagia. Methods Subjects were selected from male outpatients ≥65 years old who were examined for the main complaint of dysphagia. Patients with history of neurodegenerative disease affecting tongue movement, cerebrovascular disease or oral cancer were excluded. As a result, 82 men (mean age, 80.6 ± 6.8 years) participated. Skeletal muscle mass index (SMI) as physical parameters and maximum tongue pressure (MTP) as tongue muscles strength were measured. Status and dynamics of the pharyngeal organs, including change in posterior pharyngeal wall advancement (PPWA) when swallowing 3.0 mL of moderately thick liquid, were measured by analysing videofluoroscopic images. Simple bivariate correlation and multiple regression analysis were used to statistically analyse correlations between parameters. Results MTP showed a significant positive correlation with SMI (r = .43, P < .01). PPWA showed a significant negative correlation with MTP (r = −0.30, P < .01), but no association with SMI. Conclusions While tongue muscle strength is affected by skeletal muscle mass, posterior pharyngeal wall advancement is not readily affected by decreases in skeletal muscle mass. Posterior pharyngeal wall advancement may increase to compensate for swallowing function among individuals with reduced tongue muscle strength.
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Affiliation(s)
- Keigo Nagashima
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan
| | - Takeshi Kikutani
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo, Japan
| | - Taishi Miyashita
- Division of Clinical Oral Rehabilitation, The Nippon Dental University Graduate School of Life Dentistry, Tokyo, Japan
| | - Yuri Yajima
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan
| | - Fumiyo Tamura
- Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Tama Oral Rehabilitation Clinic, Tokyo, Japan.,Division of Rehabilitation for Speech and Swallowing Disorders, The Nippon Dental University Hospital, Tokyo, Japan
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30
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Suzuki M, Kimura Y, Otobe Y, Kikuchi T, Masuda H, Taguchi R, Tanaka S, Narita Y, Shino S, Kusumi H, Yamada M. Relationship between Sarcopenia and Swallowing Capacity in Community-Dwelling Older Women. Gerontology 2020; 66:549-552. [PMID: 33075773 DOI: 10.1159/000511359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/05/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Swallowing disorders are a serious health concern among older adults. Previous studies reported that sarcopenia may affect swallowing disorders; however, whether sarcopenia is related to the capacity to swallow (measured according to swallowing speed) in community-dwelling older adults is unclear. OBJECTIVES The aim of this study was to investigate the relationship between sarcopenia and swallowing capacity in community-dwelling older women. METHODS This cross-sectional observational study was conducted among community-dwelling older women in Japan. The inclusion criteria were as follows: women aged ≥65 years, with the ability to walk independently, and without dysphagia. The exclusion criterion was a history of stroke or Parkinson's disease that directly caused dysphagia. The participants were divided into a sarcopenia and a healthy group based on the criteria of the Asian Working Group for Sarcopenia 2019. We measured swallowing speed (mL/s) as the swallowing capacity by conducting a 100-mL water-swallowing test. To assess the relationship between sarcopenia and swallowing capacity, we performed a multiple regression analysis. RESULTS Two-hundred and sixty participants were enrolled in the study. Their mean age was 82.3 ± 6.9 years, and 61 (23.5%) of them displayed sarcopenia. The mean swallowing speed was 11.5 ± 4.9 mL/s, and 17 women (6.5%) exhibited choking or a wet-hoarse voice. Multiple regression analysis revealed that sarcopenia was related to the swallowing capacity after adjusting for age, the Mini-Mental State Examination, and the number of comorbidities (β = -0.20, 95% CI -3.78 to -0.86, p = 0.002). CONCLUSIONS We found that sarcopenia was related to the swallowing capacity in older women in this study. Future research should clarify whether a similar relationship exists in older men as well as the effect of sarcopenia on the swallowing capacity in older adults over a period of time.
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Affiliation(s)
- Mizue Suzuki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan,
| | - Yosuke Kimura
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yuhei Otobe
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Tomoe Kikuchi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Hiroaki Masuda
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Ryota Taguchi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shu Tanaka
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Yuya Narita
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Shuhei Shino
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Haruhiko Kusumi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
| | - Minoru Yamada
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan
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31
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Affiliation(s)
- J E Morley
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500, 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA,
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