Expanding Rehabilitation Options for Dysphagia: Skill-Based Swallowing Training

Swallowing Safety after Remote sub-total Esophagectomy: How Important is Tongue Pressure?

The factors related to oropharyngeal dysphagia after remote esophagectomy (greater than five months) remain unclear. This study aimed to assess patient perception of dysphagia, maximum anterior isometric pressure (MAIP), maximum posterior isometric pressure (MPIP), lingual swallowing pressure (LSP) and radiographic physiological components of the oral and pharyngeal phases of swallowing in patients who are post remote sub-total esophagectomy (SE). Patient perception of dysphagia was assessed using the Eating Assessment Tool (EAT-10). MAIP, MPIP, and LSP were measured using the Iowa Oral Performance Instrument. Videofluoroscopy was used to assess the physiologic components of swallowing with the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Ten patients were included in the study (53.2% male; mean age 54.5 ± 18.0). The mean postoperative time was 30 months (range, 5.0-72 months). Seven patients had elevated EAT-10 scores (> 3). All patients demonstrated impaired oropharyngeal swallowing on at least three MBSImP components (range 3-12) and two patients aspirated (PAS 8). There was a significant difference in MAIP values when comparing patients with normal versus impaired laryngeal elevation and epiglottic movement (p < 0.001). MPIP values were significantly different in patients with normal versus impaired epiglottic movement as well as normal versus elevated PAS scores (p < 0.001). Decreased lingual pressure and physiological changes in swallowing coexist after SE. Our results indicate that the decrease in tongue strength may be one of the factors related to unsafe swallow. The assessment of lingual pressure provides diagnostic value and should be incorporated as part of a comprehensive assessment in this population.

Effect of Rest Interval Length on Oral Swallowing Pressure During Effortful Swallowing Exercises in Healthy Adults: A Crossover Design

Evidence supporting the prescription of effortful swallowing (ES) as a rehabilitation exercise remains lacking. This study aimed to evaluate the effect of rest interval length between sets on oral swallowing pressure during ES exercises in healthy adults. This study was a randomized trial of participants using a crossover design. Forty-three healthy adults (25.0 ± 3.7 years; 32 women and 11 men) without swallowing difficulties were recruited and participated in all four conditions (rest intervals between sets: 0-, 1-, 3-, and 5-min intervals) in a random order. The exercise constituted five sets, each comprising 10 ES repetitions. ES was performed with saliva swallows. The rest interval between each repetition was fixed at 10 s, and the oral swallowing pressure during ES was measured using a tongue pressure measuring device. Oral swallowing pressures were significantly lower in the fifth set than in the first set at the 0-min rest condition. In the comparison by condition, oral swallowing pressures were significantly higher in the 5-min than in the 0-min rest conditions in the fourth set and in the 3- and 5-min rest conditions than in the 0-min rest condition in the fifth set. A rest interval of appropriate length between sets during ES exercises may consistently maintain the targeted high swallowing pressures during the exercises. Further studies using more diverse equipment and targeting older patients and those with dysphagia are required to determine the effect of the rest interval length between sets on the degree of exercise intensity to improve the swallowing-related muscle strength.

The Efficacy of Outpatient Swallowing Therapy: A Retrospective Longitudinal Cohort Study

Oropharyngeal dysphagia is an independent predictor of poor outcomes in many health conditions and can be targeted directly through swallowing therapy. This study aims to explore the outcomes of outpatient swallowing therapy in clinical practice across a diverse cohort of patients. This was a retrospective, single-site longitudinal cohort study. Patients 18 years or older with dysphagia who completed 7-8 weeks of outpatient swallowing therapy with a pre- and post-treatment videofluoroscopy were included. Therapy employed a progressive swallowing exercise regimen based on the Systematic Exercise for Treatment of Swallowing (SETS) protocol. Outcome measures included the pharyngeal components of the Modified Barium Swallow Impairment Profile, penetration-aspiration scale scores, and diet recommendations using the International Dysphagia Diet Standardization Initiative. 152 patients were included. Swallowing therapy improved all MBSImP component scores except 1, 7, and 13. Therapy improved total pharyngeal impairment scores by 2.66 points (p < .001) and total oral impairment score by 1.41 points (p < .001). Odds of elevated aspiration risk were reduced by 49% (p < .001). Patients were more likely to be on an unmodified food consistency after completion of therapy (OR 26, p = .004), but liquid consistency was not altered (OR 2.0, p = .57). Overall, 44% of patients in the cohort with an efficiency issue improved, and 50% of patients at risk for aspiration pre-therapy improved. Completing a 7-8 week course of exercise-based outpatient swallowing therapy is effective at improving multiple measures of swallowing physiology, safety and efficiency. It can also enable relaxation of diet consistency restrictions based on the IDDSI framework.

The Influence of Strength and Skill Parameters on the Evolution of Dysphagia Post Stroke: A Prospective Study

The role of pathophysiological deficits in the evolution of dysphagia post-stroke is unclear. This observational, longitudinal study aimed to document the evolution and relationship between strength and precision of submental contraction, and swallowing outcomes at six months. Participants were recruited from a tertiary acute hospital after a first acute stroke. Sociodemographic data and stroke typology were documented. Outcome measures were collected five times across six months. These included: oral diet (FOIS, IDDSI), functional ingestion (TOMASS, TWST), self-reported swallowing-related quality of life (SWAL-QOL), and submental muscle strength and precision contraction as assessed using surface electromyography coupled with biofeedback during saliva swallowing and jaw-opening tasks. Mixed effects models and multiple regressions analyses were conducted. Participants (N = 22, mean age 73.9 ± 14.4 years, 9 males) were recruited at a mean time of 2.8 ± 1.5 days after stroke. Strength parameters (effortful swallow hit rate) improved between ten days and one month post-stroke (p = 0.04). Swallowing temporal precision improved significantly between one and six months (p < 0.01). At six months, participants with decreased swallowing precision also had decreased quality of life (p = 0.04) and increased ingestion time of fluids (p = 0.002). This study is a novel step in exploring the nature and evolution of strength and precision parameters of swallowing muscle activation, and their impact on dysphagia recovery. As swallowing precision was associated with poorer functional outcomes, further studies are warranted to improve early differential diagnosis of patients at risk of chronic dysphagia.

Relationship between skeletal muscle mass change and swallowing function improvement among stroke patients with dysphagia during rehabilitation

OBJECTIVES

The purpose of this study was to evaluate the relationship between changes in skeletal muscle mass and improvements in swallowing function in stroke patients with dysphagia during rehabilitation.

METHODS

The study included 145 patients with a stroke or dysphagia. The two groups were divided into two groups: those with improved skeletal muscle mass index (SMI) at discharge and those without. Clinical data, including SMI, and Mann Assessment of Swallowing Ability (MASA), were collected from the database.

RESULTS

The increase in MASA was significantly higher in the group with increased SMI than in the group with no increase in SMI. In the multivariate analysis, the duration of rehabilitation and the group with increased SMI were associated with increased MASA.

CONCLUSION

SMI gain and the duration of rehabilitation per day were associated with improved swallowing function in patients with stroke.

Changes in the Activation Level of the Floor of the Mouth Muscles during Pressing and Swallowing Tasks According to the Degree of Tongue Pressure

The suprahyoid muscles play an important role in protecting the airway by elevating both the hyoid bone and larynx superior-anteriorly during swallowing. However, providing systematic external resistance when performing exercises to improve suprahyoid muscle strength is practically difficult. This study attempted to confirm whether systematic resistance can be provided to the suprahyoid muscles using the Iowa Oral Performance Instrument (IOPI)-a representative tongue pressure measurement device. Thirty-one healthy adults participated in this study (20.6 ± 0.96 y, 19 females). The participants performed 16 exercise tasks using the IOPI three times each in random order (Anterior/posterior tongue × pressing/swallowing task × 40/60/80/100% maximum tongue pressure). Furthermore, the floor of the mouth (FOM) muscle activity during exercise was simultaneously measured using surface electromyography. During the pressing task, there were significant differences in FOM maximal muscle activity among the four exercise intensities for both the anterior and posterior oral tongue. For the swallowing task, a significant difference was found in FOM muscle activity among the four exercise intensities for the anterior tongue. For the posterior tongue, significant differences were identified among all conditions except for the comparison between 80% and 100% maximum tongue pressure. Significant correlations between the degree of tongue pressure and maximal FOM muscle activity were found in both the pressing and swallowing tasks at the anterior and posterior oral tongue. Overall, these results indicate that objective and systematic external resistance can be applied using the IOPI-a standard tongue pressure measurement device-during the program to improve suprahyoid muscle function.

Dysphagia-Specific Instrument Based on Item Response Theory and International Classification of Functioning, Disability and Health

This study aimed to identify functional challenges faced by individuals with non-esophageal dysphagia and to offer a tool for quantitatively evaluating the person abilities within the framework of the International Classification of Functioning, Disability and Health (ICF). Additionally, this study attempted to differentiate the personal abilities of individuals with dysphagia and hierarchize item difficulties using the ICF-based Item Response Theory (IRT) modeling approach. This cross-sectional study enrolled a cohort of 150 patients with dysphagia (105 male and 45 female) from a tertiary hospital in China. Participants were assigned to evaluate the 114-item ICF dysphagia questionnaire. To further assess their swallowing capabilities, eating patterns, quality of life, and nutritional status, participants underwent a battery of five additional scales. The ICF qualifiers underwent data shaping including dichotomization and missing value imputation, Mokken scale analysis (MSA) for checking unidimensionality, local independence, monotonicity, and invariant item ordering (IIO), and parametric IRT modeling for identifying an optimal model from the 1-parametric logistic model (1PLM), 2PLM, 3PLM, and 4PLM. Finally, we tested the robustness of the optimal model via Monte Carlo simulation and illustrated the usefulness of the model by its person-item map. The 1PLM emerged as the optimal model with a total of 50 ICF items (12 'd-Activities and Participation', 33 'b-Body Functions', and 5 'e-environmental' items). The final scale presented strong reliability with Cronbach's Alpha = 0.967. Furthermore, the scale showed good validity with a significant positive correlation (p < 0.001,r ^ Winsorized = 0.60) between model-estimated person abilities and swallowing-quality of life (SWAL-QoL) scores. The findings also demonstrated measurement equivalence of the final model for individuals with different genders or across various age groups. The utilization of the person-item map can effectively compare the difficulty levels of items with the abilities of patients, thereby facilitating the delivery of tailored care and precise rehabilitation strategies that match the individual competency of those suffering from dysphagia. This study developed a parsimonious dysphagia-specific ICF outcomes tool derived from the IRT, named iSWAL-Performance Scale. The findings complement quantitative information on the psychometric characteristics of this 50-item scale.

Task-Based Eating and Drinking Interventions in Animal Models: A Narrative Review of Functional Improvements and Neuromuscular Adaptations in Age-Related Dysphagia

BACKGROUND/OBJECTIVES

Age-related dysphagia involves sarcopenia and nervous system changes affecting ingestion. The ACT-ING program, a novel task-based occupational therapy intervention, has been developed to improve strength, endurance, and ingestive skills using real-world eating and drinking tasks for older adults with age-related dysphagia. This narrative review evaluates the outcomes and neuromuscular adaptations of task-based eating and drinking interventions in aging animal models to inform potential refinements of the ACT-ING program and interpret results from an ongoing proof-of-concept study.

METHODS

Publications were obtained from PubMed, SCOPUS, CINAHL, and EMBASE, and selected following the PRISMA guideline. Thirteen randomized trials investigated a task-based fluid-licking intervention in rats, combining strength, endurance, and skill training.

RESULTS

Results suggested benefits in improving muscle strength, endurance, and swallowing skills in terms of quantity and speed. Although neuromuscular adaptations were less conclusive, the intervention appeared to induce cortical plasticity and increase fatigue-resistant muscle fibers in the involved muscles.

CONCLUSIONS

While these findings are promising, methodological concerns and potential biases were identified. Therefore, further research is necessary to refine the ACT-ING program, including both clinical studies in humans and preclinical studies in aging animal models that clearly define interventions targeting all aspects of ingestion-related skills within a motor learning and strength training framework.

Effect of Stellate Ganglion Block on Dysphagia and Cognitive Impairment in Cerebral Small Vessel Disease: A Randomized Controlled Study

BACKGROUNDS

Cerebral small vessel disease (CSVD) can potentially and frequently lead to dysphagia and cognitive impairment. Stellate ganglion block (SGB) can alleviate the symptoms by regulating neural pathways and improving cerebral blood circulation.

OBJECTIVES

This study aimed to explore the clinical effect of SGB on airway protection, dysphagia, cognitive impairment, and activities of daily living (ADL) in CSVD patients.

METHOD

This was a randomized controlled study conducted from February 2021 to May 2023, including 84 CSVD patients with dysphagia and cognitive impairment. The participants were randomly divided into the SGB group (n = 42) and the untreated group (n = 42). All received standard-of-care rehabilitation for 20 days. The SGB group received SGB once a day additionally. Assessments were conducted on Day 1 and Day 20, respectively. The Penetration-Aspiration Scale (PAS) was primary outcome. Modified Barium Swallow Impairment (MBSImp), Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI) and adverse events were secondary outcomes. This study was registered at ClinicalTrials.gov, Identifier: NCT06176404.

RESULTS

There were two dropout cases in the untreated group. Time effect with statistical significance was observed in all assessments (p < .05). Group effect with statistical significance was observed in the PAS (z = -17.283, p < .001), MBSImp-Oral (z = -3.382, p = .001), MBSImp-Pharyngeal (z = -2.639, p = .008), MMSE (F = 7.450, p = .008), and MBI (F = 6.408, p = .013). During the treatment, there were no severe adverse events.

CONCLUSION

SGB can significantly and safely improve airway protection, dysphagia, cognitive function, and ADL in CSVD patients with dysphagia and cognitive impairment who received standard-of-care rehabilitation.

How enteral nutrition modes influence nasopharyngeal carcinoma survivors with late dysphagia after radiotherapy: a randomized controlled study

BACKGROUND

Palliation to late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC) continues to be a challenge. Intermittent oro-esophageal tube feeding (IOE) is an emerging enteral nutrition mode that can address nutrition and quality of life issues related to nasogastric tube feeding (NGT).

OBJECTIVES

This study aims to investigate the effect of IOE versus NGT in late dysphagia after radiotherapy for NPC.

METHODS

This randomized controlled study included 82 NPC survivors with late dysphagia after radiotherapy. The subjects were randomized divided into the IOE and NGT groups (n1 = n2 = 41). Both groups received standard-of-care rehabilitation. Enteral nutrition supports were administered through IOE or NGT accordingly. This study lasted 2 weeks for each participant. The primary outcome was nutritional status including albumin, hemoglobin, total serum protein, and body mass index. The secondary outcomes were (i) the functional oral intake scale (FOIS), (ii) the penetration-aspiration scale (PAS), (iii) oral transit time (OTT), (iv) hyoid pause time (HPT), (v) pharyngeal transport time (PTT), and (vi) swallowing-quality of life (SWAL-QoL).

RESULTS

Three cases quitted the study halfway and there were no significant baseline differences between the IOE (n = 40) and NGT (n = 39) groups. Both time and group effects were significant in all nutritional indicators. The time effect was significant in the FOIS levels, OTT and PTT, while the group effect was not. Either time or group effect were insignificant in the PAS levels and HPT. Both group and time effects were significant in the SWAL-QoL total scores (zGroup = 5.080, P < 0.001; zTime = 18.005, P < 0.001). The significance of time and group effects varied across different dimensions of the SWAL-QoL.

CONCLUSIONS

Rehabilitation interventions can improve swallowing function among NPC survivors with late dysphagia after radiotherapy. In this population who received standard-of-care rehabilitation, IOE is more conducive to the improvement of nutritional status, and swallowing-related quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06301763.

Development of a tool for monitoring the jaw-opening pace and preliminary comparison the pace between young and old ages

BACKGROUND

Studies have demonstrated that high-speed jaw-opening exercises are effective in improving swallowing function. However, there has been no objective tool available for monitoring jaw-opening pace. This study aimed to develop an objective tool for monitoring and validating jaw-opening pace and compare it between young and old ages from different age groups.

MATERIALS AND METHODS

A load cell plug-in jaw pad connected to an automatic recording and analysis system was used to record jaw-opening motions for offline analysis. We recruited 58 healthy volunteers from different age groups (20-39 y/o; 40-59y/o; 60-79y/o). During a 2-min recording session, each participant was instructed to fully open and close their jaw as quickly as possible while wearing a sensor. Bland-Altman plot, paired t-test and Pearson's correlation test were used to compare the number of jaw-opening motions between manual counting and automatic software analysis. The number of jaw-opening motions during the 2-min recording was compared between the three age groups.

RESULTS

Automated analysis of jaw-opening pace was efficient and equally comparable with the traditional manual counting method across the three age groups. A declining trend in jaw-opening pace among the old age group was found but with no statistically significant difference.

CONCLUSION

A jaw-opening motion monitoring tool with reliable automatic pace analysis software was validated in young and old ages The jaw-opening pace demonstrated a tendency to decline with age.

Effect of Visual Biofeedback Obtained Using the Iowa Oral Performance Instrument on the Suprahyoid Muscle Activation Level During Effortful Swallowing Maneuver

Effortful swallowing (ES) is a maneuver prescribed for patients who experience pharyngeal residues after swallowing owing to weakness of the tongue and pharyngeal constrictor muscles. ES can increase the pharyngeal contraction force by intentionally increasing the degree of effort during swallowing. However, the effect is limited as the nature of swallowing makes it difficult to maintain a constant high-effort level. The aim of this study was to assess the effect of visual feedback, delivered by the Iowa Oral Performance Instrument (IOPI), a tongue pressure measurement device on ES maneuver effort. Overall, 34 healthy adults performed five sets of ten ES, once every 10 s. The ES maneuver was conducted under two conditions, ES with and without IOPI biofeedback in a crossover design. IOPI biofeedback was provided at 80% of the maximum posterior oral tongue pressure. The suprahyoid muscle activation level was assessed using surface electromyography during the ES maneuver. The mean suprahyoid muscle activation levels in all sets for which IOPI biofeedback was provided were significantly higher than those during ES maneuver without biofeedback (p < 0.05). IOPI biofeedback can help maintain the ES maneuver target effort, utilizing a constantly high swallowing pressure potentially promoting better pharyngeal pressures and muscle strength.

Post-Radiotherapy Dysphagia in Head and Neck Cancer: Current Management by Speech-Language Pathologists

OPINION STATEMENT

Dysphagia, difficulty in eating and drinking, remains the most common side effect of radiotherapy treatment for head and neck cancer (HNC) with devastating consequences for function and quality of life (QOL). Over the past decade, 5-year survival has improved due to multiple factors including treatment advances, reduction in smoking, introduction of the human papillomavirus (HPV) vaccine and more favourable prognosis of HPV-related cancers. Increased prevalence of HPV-positive disease, which tends to affect younger individuals, has led to an elevated number of people living for longer with the sequelae of cancer and its treatment. Symptoms are compounded by late effects of radiotherapy which may lead to worsening of dysphagia for some long-term survivors or new-onset dysphagia for others. Speech-language pathology (SLP) input remains core to the assessment and management of dysphagia following HNC treatment. In this article, we present current SLP management of dysphagia post-radiotherapy. We discuss conventional treatment approaches, the emergence of therapy adjuncts and current service delivery models. The impact of adherence on therapy outcomes is highlighted. Despite treatment advancements, patients continue to present with dysphagia which is resistant to existing intervention approaches. There is wide variation in treatment programmes, with a paucity of evidence to support optimal type, timing and intensity of treatment. We discuss the need for further research, including exploration of the impact of radiotherapy on the central nervous system (CNS), the link between sarcopenia and radiotherapy-induced dysphagia and the benefits of visual biofeedback in rehabilitation.

The use of color-changeable chewing gum in evaluating food masticability

PURPOSE

We assess masticatory performance using color-changeable chewing gum, which shifts from yellow-green to red upon chewing. Previous studies used a colorimeter to reveal the cut-off a* values of the gum's color (a* represents the degree of color between red and green) to determine which foods are masticable (masticable meat, masticable soft side dish, and inadequate masticatory performance). Since a more convenient method is required, we examined the validity and reliability of visual measurement using a color scale to indicate masticable foods by observing the chewing gum's color.

METHODS

Fifty patients (male, 48%), aged ≥ 65 (mean, 82.6) years were enrolled. Using color-changeable chewing gum, three groups were formed according to the cut-off a* values: masticable meat, masticable soft side dish, and inadequate masticatory performance. For the color scale classification, one physiatrist and one dietitian simultaneously, individually, and visually determined the chewing gum color and classified it into one of the three groups. Criterion-related validity was evaluated using the kappa coefficient of agreement between the results from the two methods. Inter-rater reliability was examined using the kappa coefficient of agreement between the three groups judged by the two raters on a color scale.

RESULTS

The kappa coefficients of the agreement for the classifications were 0.908 and 0.909 for the physiatrist and dietitian, respectively. The inter-rater agreement between two raters on the color scale was 0.938 for the kappa coefficient.

CONCLUSION

The color scale indicated masticable foods without a colorimeter. This method can be useful in older adult facilities and homes.

Technology acceptance of the video game-based swallowing function training system among healthcare providers and dysphagia patients: A qualitative study

Objective

Dysphagia is highly prevalent worldwide, causing serious complications. Video-game based rehabilitation training can increase dysphagia patient motivation and adherence. However, the acceptance of video game systems by patients and healthcare providers is still not fully explored. This study aimed to explore the acceptance of the video game swallowing training system among potential users.

Methods

The in-depth interviews were conducted face-to-face between July and October 2023 at a rehabilitation center in China, with a sample size based on the principle of information saturation. Interviews were audio-recorded and transcribed verbatim, and the data were analyzed using theory-driven thematic analysis methods based on the technology acceptance model.

Results

A total of 19 participants participated in the interviews, which included 11 hospitalized dysphagia patients, three rehabilitation therapists, one doctor, and four nurses. Three themes and seven subthemes were identified. Sufficient training content, interesting interaction between the game and the rehabilitation training, intuitive page design, and efficient training modes were related to the usefulness of the system; user-friendly page design and simple interface could make it easier for participants to use the system. Overall, the availability of the video game system for use without geographical or time limitations led to a high level of participant intention to use the system, but it is still challenging to use it in the real world.

Conclusions

The results of the study showed that participants were generally accepted and willing to use the video game system for dysphagia rehabilitation training. The video game-based swallowing function training system can be helpful in assisting with dysphagia rehabilitation.

Oropharyngeal Dysphagia Phenotypes Across Huntington's Disease Stages: Endoscopic Findings and Tongue Pressure Analysis

Background

Oropharyngeal dysphagia (OD) is a common symptom in Huntington's disease (HD) and is associated with severe health and psychosocial consequences. Different OD phenotypes are defined on the basis of characteristic patterns at fiberoptic endoscopic evaluation of swallowing (FEES), and they may vary during disease progression.

Objective

To describe OD phenotypes in different HD stages and to analyze their association with neurological data and tongue pressure measurements.

Methods

Twenty-four patients with HD at different stages of disease progression underwent a FEES. Data on penetration/aspiration, pharyngeal residue, and OD phenotypes were gained. Neurological examination was performed with the Unified Huntington's Disease Rating Scale (UHDRS). Patient Maximum tongue pressure (MTP) and tongue endurance were measured.

Results

We confirmed that the occurrence of penetration/aspiration increased with disease duration and pharyngeal residue increased from 16.7% to 100%, respectively. The most common OD phenotypes were oropharyngeal dyspraxia (91.7%), posterior oral incontinence (87.5%), and delayed pharyngeal phase (87.5%). These types of dysfunctions are already detectable in >80% of patients in the early disease stages. In more advanced stages, we also observed propulsion deficit (66.7%), resistive issue (54.2%), and protective deficit (37.5%). Propulsion deficit was associated with higher disease stage, greater motor dysfunction (UHDRS-I), and lower MTP and tongue endurance (p < 0.05).

Conclusions

OD in HD results from a combination of different swallowing phenotypes. Early assessment of swallowing and periodical follow-ups are necessary to monitor OD severity and phenotypes and to revise diet recommendations.

Management and Treatment for Dysphagia in Neurodegenerative Disorders

Patients with neurodegenerative disorders (NDDs) often experience functional dysphagia, which may involve dysfunction in a specific phase of swallowing or in the entire process. This review outlines the approach to dysphagia in the setting of NDDs. Distinguishing the etiology of dysphagia can be difficult, and it is important to always look out for signs pointing to NDD as the cause. Thorough diagnostic work-up is essential, and it includes a comprehensive history and physical examination, alongside swallowing function tests, such as fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallowing study, and high-resolution manometry. Management requires a multidisciplinary approach with a treatment plan tailored to each patient. This involves dietary guidance, swallowing rehabilitation, and surgery in cases in which improvement with rehabilitation is inadequate. Surgery may involve altering certain pharyngolaryngeal structures to facilitate swallowing and reduce the risk of aspiration (swallowing improvement surgery) or separating the airway and digestive tract while sacrificing laryngeal function, with the main goal of preventing aspiration (aspiration prevention surgery). Proper management stems from recognizing the impact of these disorders on swallowing and consistently finding ways to improve the quality of life of patients.

Could Plummer-Vinson Syndrome Be Associated with Celiac Disease?

A 16-year-old female presented to our hospital clinic with a main complaint of difficulty swallowing. She reported mild dizziness and frequent fatigue and denied weight loss, fever, joint pain, or a history of diarrhea. Lab and physical results showed low weight; low hemoglobin, ferritin, and vitamin D levels; and a low red blood cell count. Swallowing assessment showed esophageal webs and swallowing difficulty, especially in the pharyngeal stage, and aspiration. It was initially suspected that clinical manifestations, including esophageal webs, iron deficiency anemia (IDA), and swallowing difficulty, were related to Plummer-Vinson syndrome (PVS). However, further investigations and pathological findings revealed several gastrointestinal manifestations consistent with celiac disease (CD). Based on this finding, the patient began a gluten-free diet for the management of CD. Afterward, she began to gain weight, followed by a resolution of swallowing difficulty. Therefore, clinicians should be familiar with the symptoms of CD when conducting a thorough clinical examination and maintain a high level of suspicion to rule out other causes and reach an accurate diagnosis. It is also recommended to screen all patients presenting with IDA, esophageal web, and dysphagia for CD even in the absence of diarrhea.

Early Feasibility of an Activity-Based Intervention for Improving Ingestive Functions in Older Adults with Oropharyngeal Dysphagia

There is growing awareness about the use of combined strength- and skill-based swallowing training for improving swallowing physiology in the event of dysphagia. Such an approach involves focusing on coordination and timing as well as swallowing strengthening in the context of increased exercise complexity in eating and drinking activities. This study aimed to determine the early feasibility of a newly developed 12-week intervention, named the ACT-ING program (ACTivity-based strength and skill training of swallowing to improve INGestion), in older adults with dysphagia and generalized sarcopenia. In a multiple-case-study design, seven participants above 65 years of age (five women and two men) with slight to severe dysphagia and indications of sarcopenia underwent the intervention during hospitalization and in the community after discharge. The ACT-ING program met most of the feasibility marks in terms of demand (73.3% of those invited accepted participation), safety (100%), no reports of adverse events, tolerance (85.7%), usability (100%), and acceptability (100%). Three putative mediators of change (experienced autonomy support, in-therapy engagement, and perceived improvement in swallowing capacity) appeared to have been best accomplished in participants with slight to moderate dysphagia. The ACT-ING program showed preliminary evidence of early feasibility, warranting further early-phase dose articulation and proof-of-concept trials.