Dysphagia in neurological diseases: a literature review

Look at me! An exploratory study of supported eating interactions in long-term neurological care

INTRODUCTION

Care homes are synonymous with aged care; however, many younger people also reside in care homes, often because they have complex needs caused by neurological conditions. Of this population, some people require support to eat. People in care homes consider mealtimes as central to their care experience but repeatedly report dissatisfaction with them. This paper examines what makes for positive or negative supported eating interactions (SEI) between care staff and people with neurological conditions aged 18-65.

METHODS

The paper draws upon semi-structured interviews conducted with residents and healthcare staff exploring the role of food in the care of adults with neurological conditions in long-term care settings.

RESULTS

Six core themes (1. Time and timing, 2. Individualized support and care(ing), 3. Choice and autonomy; 4. Core clinical knowledge and skills; 5. De-humanizing Practices; and 6. Environment) drawn through reflexive thematic analysis were identified.

CONCLUSIONS

There was significant parity between resident and staff considerations regarding the essence of what makes up a positive or negative SEI. Most core principles for delivering positive SEI's fall within the knowledge and skills of individual healthcare staff. However, the findings on time and environment require organizational support to enable staff to deliver the best SEI.

Innovative implications of botulinum toxin in head and neck cancer: Exploring novel opportunities and future prospects

Head and neck cancer (HNC) represents a significant global health challenge, with over 660,000 annual diagnoses and a mortality rate exceeding 49 %, making it the seventh most common cancer worldwide. Current standard treatments, including surgery, radiation, and chemotherapy, often result in significant side effects, underscoring the need for innovative and personalized therapeutic approaches. In recent years, botulinum toxin (BoNT) has emerged as a transformative adjunctive therapy in HNC management. Initially recognized for its neuromuscular blocking properties, BoNT has expanded its applications to alleviate complications such as sialorrhea, gustatory sweating, and neuropathic pain associated with HNC treatment. Beyond symptomatic relief, emerging evidence suggests that BoNT may influence tumor biology by modulating the tumor microenvironment, disrupting nerve-cancer interactions, and altering key molecular pathways to inhibit tumor growth and metastasis. This article explores BoNT's achievements and therapeutic potential in treating HNC, examining its molecular mechanisms, clinical efficacy, and implications for future research. By elucidating BoNT's role in symptom management and its potential as an anti-tumor agent, this review highlights a promising avenue for advancing personalized medicine and improving outcomes for HNC patients.

Consciousness Disorders and Swallowing Difficulties

With the advancement of medicine, the survival rate of patients with brain injuries has significantly increased. Among these patients, some remain in a chronic state of altered consciousness and experience difficulties in swallowing. Swallowing difficulties can lead to clinical issues such as aspiration and malnutrition. Since swallowing function is closely related to the level of consciousness, effective oral swallowing is an early sign of consciousness recovery. The relationship between swallowing difficulties and the prognosis and quality of life of patients with consciousness disorders is increasingly recognized by scholars. However, patients with consciousness disorders often find it difficult to cooperate with treatments for swallowing difficulties, resulting in a lack of effective treatment options for swallowing difficulties associated with altered consciousness. This article discusses the correlation between consciousness disorders and swallowing difficulties, the physiology of swallowing, the main issues faced by patients with consciousness disorders regarding swallowing difficulties. Specifically the lack of an effective oral swallowing phase, as well as the available assessment tools and treatment methods for swallowing difficulties in these patients.

Evaluation of Quality of Life in Patients Presenting with Dysphagia Pre and Post Swallowing Therapy

To assess the quality of life and severity of dysphagia in patients utilizing the Gugging Swallowing Screen (GUSS) and the Swallowing Quality of Life (SWAL-QOL) questionnaire. This longitudinal study evaluated individuals before swallowing therapy and after one week, two weeks, and one month after the procedure. Data collection included validated assessment instruments, with statistical analysis utilizing chi-square tests for categorical variables and repeated measures ANOVA for SWAL-QOL scores over time intervals. The study population primarily consisted of patients aged 61-80, with a marginal male predominance. Cerebrovascular accident was the most common diagnosis, followed by bronchopneumonia and traumatic brain injury. Preliminary GUSS scores revealed moderate to severe dysphagia in the majority of subjects. Following the intervention, GUSS ratings showed a gradual transition to less severe categories, whereas SWAL-QOL scores revealed statistically significant enhancement, signifying improved quality of life. Notable connections were observed between initial GUSS scores and diagnosis, hypertension, and alcohol intake. The study underscores the significant influence of dysphagia on quality of life and illustrates the efficacy of swallowing therapy in enhancing food selection, sleep, and fatigue. Psychological support from family, healthcare professionals, and colleagues is essential, especially around mealtimes. Social assistance mitigates patients' anxiety and alleviates loneliness. Early identification and intervention in high-risk groups are critical for optimal outcomes. An integrated treatment strategy that includes both medical and emotional assistance improves the well-being of dysphagia patients.

Spatio-temporal segregation between sensory relay and swallowing pre-motor population activities by optical imaging in the rat nucleus of the solitary tract

The nucleus tractus solitarius (NTS) contains neurons that relay sensory swallowing commands information from the oropharyngeal cavity and swallowing premotor neurons of the dorsal swallowing group (DSG). However, the spatio-temporal dynamics of the interplay between the sensory relay and the DSG is not well understood. Here, we employed fluorescence imaging after microinjection of the calcium indicator into the NTS in an arterially perfused brainstem preparation of rat (n = 8) to investigate neuronal population activity in the NTS in response to superior laryngeal nerve (SLN) stimulation. Respiratory and swallowing motor activities were determined by simultaneous recordings of phrenic and vagal nerve activity (PNA, VNA). The analysis of SLN stimulation near the threshold triggering a swallowing allowed us to analyze Ca2+ signals related to the sensory relay and the DSG. We show that activation of sensory relay neurons triggers spatially confined Ca2+ signals exclusively unilateral to the stimulated SLN at short latencies (114.3 ± 94.4 ms). However, SLN-evoked swallowing triggered Ca2+ signals bilaterally at longer latencies (200 ± 145.2 ms) and engaged anatomically distributed DSG activity across the dorsal medulla oblongata. The Ca2+ signals originating from the DSG preceded evoked VNA swallow motor bursts, thus the swallowing premotor neurons that drive laryngeal motor pools are located outside the DSG. In conclusion, the study illuminates the spatial-temporal features of sensory-motor integration of swallowing in the NTS and further supports the hypothesis that the NTS harbors swallowing pre-motor neurons that may generate the swallowing motor activity, while first-order pre-motor pools are located outside the DSG.

Factors influencing oropharyngeal dysphagia in individuals with chronic neurological disorders presenting to the outpatient swallowing disorder clinic

BACKGROUND

This study aims to evaluate neurogenic dysphagia in individuals with various neurological disorders.

METHOD

A prospective cross-sectional study was conducted adults with Multiple Sclerosis (MS), stroke, or Parkinson's Disease (PD) who presented with dysphagia. Assessments included the Functional Oral Intake Scale (FOIS) for dietary status, the Flexible Endoscopic Evaluation of Swallowing (FEES) with Penetration-Aspiration Scale (PAS) for swallowing function, and the Eating Assessment Tool (EAT-10) and Swallow Quality of Life Questionnaire (SWAL-QOL) for dysphagia severity and swallowing/eating-related quality of life (SRQoL), respectively. Statistical analyses included ANOVA.

RESULTS

The study included 105 participants with MS, stroke, and PD groups. SWAL-QOL scores were significantly higher in the MS and PD groups compared to the stroke group (p = 0.001). Stroke patients had the most severe overall swallowing difficulties, while MS patients experienced the highest rate of aspiration (37 %). Fatigue levels were significantly higher in the MS and PD groups (p = 0.001), and social function scores were lowest in the stroke group (p = 0.041). No significant differences were observed in eating desire, fear of eating, sleep quality, communication, or EAT-10 scores across the groups.

CONCLUSION

This study highlights the differential impact of neurogenic dysphagia on swallowing function and SRQoL. Although dysphagia is a known issue in acute neurological conditions such as strokes, individuals with progressive diagnoses such as MS should be referred to swallowing clinics at an early stage, keeping in mind that it can lead to serious consequences that can affect their quality of life.

Histopathologic Marks of Tongue in a Mouse Model of Oculopharyngeal Muscular Dystrophy Suggest Biomechanical Defects

Difficulty swallowing (dysphagia) is common in the elderly population and in patients with adult-onset neuromuscular disease. In oculopharyngeal muscular dystrophy (OPMD), dysphagia is often the first symptom. OPMD is an autosomal-dominant myopathy caused by a trinucleotide-expansion mutation in the gene encoding poly(A) binding protein nuclear 1 (PABPN1). Expanded-mutant PABPN1 forms insoluble nuclear aggregates that reduce the levels of the soluble form. Clinical tongue involvement in OPMD has been documented but is poorly understood. Histopathologic analysis of the tongue in an OPMD mouse model was done by light and electron microscopy combined with RNA sequencing. PABPN1 nuclear aggregates were found at moderate levels, whereas deposition of insoluble PABPN1 in blood vessels was prominent already at 4 months of age. Muscle wasting of the tongue was age associated. RNA signatures of the OPMD tongue were enriched for mitochondrial and cytoskeletal genes. Electron microscopy revealed abnormalities in sarcomere and mitochondria organization in A17/+ mice, suggesting an energy and contractile deficit in OPMD tongue. This detailed analysis of the histopathology of the tongue in the A17/+ mouse model opens new avenues for understanding the mechanisms of dysphagia.

Exploring the potential of 3D-printed texture-modified diets for the management of dysphagia

Dysphagia is a swallowing disorder characterized by mild to severe pain during food ingestion. Patients with dysphagia require special care and food that meet the patient's requirements of nutrition and ease of swallowing which can be achieved by texture-modified diets. Texture modification is important for improving swallow safety and control and preventing aspiration, pneumonia, and choking. 3D printing is the leading technology in today's era and is widely used for the texture modification of food for patients with swallowing disorders. 3D printing is fast, reliable, and customizable and has the potential to fabricate unappealing and tasteless food into different colours, textures, and shapes. Our discussion brings to review the present and future of 3D printing in preparing texture-modified diets for dysphagia. The challenges associated with dysphagia diets that can be overcome by 3D printing have also been discussed. The review also focuses on the IDDSI framework for determining the suitability of food for dysphagic patients. The key factors such as the material used, and viscosity have been discussed along with various pre-existing literature. The key challenges with the food industry and future research areas have also been discussed.

The Validation of the Italian Version of the Munich Swallowing Score (IT-MUCSS) Against the Fiberoptic Endoscopic Evaluation of Swallowing and Food Intake Modalities in Patients with Neurogenic Dysphagia: A Cross-Sectional Study

Background/Objectives: Oral intake and secretions need to be assessed separately, especially in patients with tracheal tubes, as they are vital for dysphagia treatment and may require different management strategies. This study aims to validate the Italian version of the Munich Swallowing Score (IT-MUCSS) by examining its content and construct validity in relation to the fiberoptic endoscopic evaluation of swallowing (FEES) and oral intake in adults with neurogenic dysphagia, as well as assessing intra- and inter-rater reliability. This tool is clinically and scientifically useful as it includes two subscales: IT-MUCSS-Saliva, which assesses saliva/secretion management and the presence of a tracheal tube, and IT-MUCSS-Alimentazione, which evaluates feeding methods. Methods: In this prospective cross-sectional study, a total of 50 dysphagic patients with a neurological diagnosis were recruited from a neuro-rehabilitation hospital and underwent both clinical and instrumental assessments. The main outcome measures included evaluating food and liquid intake using the Italian versions of the Functional Oral Intake Scale (FOIS-It) and the IT-MUCSS. Pharyngeal residues were assessed using the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and airway penetration/aspiration were evaluated using the Penetration-Aspiration Scale (PAS) during FEES. Results: The IT-MUCSS demonstrated excellent reproducibility (K = 0.91) and internal consistency (Cronbach's alpha = 0.72). Strong correlations were found between IT-MUCSS and the FOIS-It scale, indicating the effective assessment of dysphagia. Test-retest reliability was high (ICC = 0.96 for total score). Construct validity was confirmed through significant correlations with instrumental measures during FEES. Conclusions: The IT-MUCSS is a valid tool for assessing functional oral intake and the management of saliva/secretions, specifically in relation to the level of saliva/secretions management compared to FEES measures of swallowing safety and efficiency in patients with neurogenic dysphagia.

A Functional Larynx Dissection Utilizing Mandibular Rotation: A Technical Report

In gross anatomy labs, the larynx is usually visualized with either a sagittal hemisection or a posterior disarticulation approach. Both fail to maintain the functional in-situ relationships between the intact larynx and adjacent structures. This makes it challenging for students to understand how suprahyoid and infrahyoid muscles, pharyngeal muscles, the tongue, epiglottis, and intrinsic laryngeal muscles are all involved with airway protection and swallowing. We describe a novel approach to cadaveric larynx exposure using a pharyngotomy and mandibular rotation technique, which keeps the laryngeal relationships to the laryngopharynx, oropharynx, tongue, and soft palate intact.

Dysphagia

Dysphagia, or difficulty swallowing, has significant impacts on patients' quality of life. A thorough history and physical examination can provide important information to determine if dysphagia is originating from oropharyngeal or esophageal causes. Identifying the underlying pathology contributing to dysphagia allows for optimal treatment and improved quality of life.

Analysis of risk factors for dysphagia in patients after laparoscopic radical gastrectomy

BACKGROUND

Gastric cancer is among the most prevalent malignancies worldwide. Despite significant advancements in chemoradiotherapy, targeted therapy, and neoadjuvant therapy, conventional surgical intervention remains the cornerstone of gastric cancer management. Improvements in surgical techniques, coupled with the use of staplers and other advanced instruments, have substantially reduced the incidence of complications and mortality following gastric cancer surgery. However, dysphagia remains a common postoperative complication.

AIM

To retrospectively investigate the potential factors contributing to dysphagia in patients who have undergone laparoscopic radical gastrectomy for gastric cancer and to explore effective strategies for its postoperative management.

METHODS

In this retrospective study, we analyzed data from patients who underwent elective laparoscopic total gastrectomy at Lihuili Hospital, Ningbo University, between January 2018 and May 2022. A total of 115 eligible postoperative patients were included. Postoperatively, patients completed questionnaires and were categorized into two groups based on their responses: The dysphagia group (Eating Assessment Tool-10 score ≥ 3) and the non-dysphagia group (Eating Assessment Tool-10 score < 3). Risk factors associated with dysphagia following total gastrectomy were assessed using χ² tests, Fisher’s exact tests, t-tests, Pearson correlation coefficients, and univariate and multivariate regression analyses.

RESULTS

Multivariate analysis further identified anastomotic style, prolonged intubation time, advanced age, and low albumin (ALB) levels as independent risk factors for postoperative dysphagia. Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life.

CONCLUSION

Univariate analysis revealed that anastomotic style, low serum ALB levels, advanced age, and prolonged intubation time were significantly associated with postoperative dysphagia in gastric cancer patients. Multivariate analysis further identified anastomotic style, prolonged intubation time, advanced age, and low ALB levels as independent risk factors for postoperative dysphagia. Implementing targeted preventive measures for high-risk groups may significantly enhance postoperative quality of life.

Dysphagia and its impact on quality of life in rare neuromuscular disorders

BACKGROUND

 Patients with neuromuscular diseases (NMDs) often face swallowing difficulties (dysphagia) as part of their condition.

OBJECTIVE

 To determine the prevalence of self-reported swallowing disorders in patients with rare NMDs and examine their correlation with related quality of life (QoL).

METHODS

 The study included 103 patients with confirmed rare NMDs. Dysphagia risk was assessed using the validated Eating Assessment Tool-10 (EAT-10), and QoL related to swallowing was measured with the SWAL-QoL survey. Correlations between EAT-10 and SWAL-QoL scores were analyzed. Additionally, the mean questionnaire scores were compared among patients classified as dysphagic, dysphagic with high aspiration risk, and nondysphagic.

RESULTS

 The estimated prevalence of dysphagia in the cohort, based on EAT-10, was 52.4%. Higher scores were significantly correlated with poorer swallowing-related QoL, except for the sleep domain. The most affected SWAL-QoL domains were burden, eating desire, eating duration, food selection, communication, fear, mental health, social functioning, and dysphagia battery score (DBS), with significant differences observed among the classifications (p < 0.001 for most domains, and p = 0.015 for eating desire). No statistically significant difference in swallowing QoL was found between sitters and walkers.

CONCLUSION

 Dysphagia is a prevalent symptom in patients with rare NMDs, affecting 52.4% of the cohort and significantly impacting QoL in nearly all domains except sleep.

Validity and Reliability of the M.D. Anderson Dysphagia Inventory in Turkish Patients with Neurological Disease

INTRODUCTION

Dysphagia is a prevalent symptom of various neurological diseases and is associated with decreased quality of life. The M.D. Anderson Dysphagia Inventory (MDADI) is globally utilized tool to assess the impact of dysphagia on quality of life. However, a Turkish version of the scale is not yet available. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Turkish version of the MDADI.

METHODS

One hundred twenty-four patients who were diagnosed with definite neurological disease completed the study. The cross-cultural adaptation and translation process of the MDADI adhered to the World Health Organization's guidelines using the forward-backward translation method. The feasibility and the floor and ceiling effects were evaluated. Cronbach's alpha was used to assess internal consistency. The Bland and Altman method and interclass correlation coefficient (ICC) were used to evaluate test-retest reliability. Absolute reliability was determined using the standard error of the measurement (SEM) and minimal detectable change (MDC). Construct validity was assessed using Pearson's correlation coefficient between the MDADI and the Turkish Swallowing Quality of Life (T-SWAL-QOL) questionnaire.

RESULTS

Our study had a feasibility rate of 100%. No floor or ceiling effects were determined for any subscale or composite scores of the T-MDADI. The T-MDADI demonstrated excellent reliability, with Cronbach's alpha coefficients ranging from 0.89 to 0.96 and ICC values from 0.81 to 0.95, confirming strong internal consistency and test-retest reliability. Measurement precision was supported by a SEM of 3.96 and an MDC of 10.97 for the composite score. In terms of validity, significant correlations were observed between T-MDADI subdomains and T-SWAL-QOL subdomains (r = 0.61-0.80 for food selection, mental health, and social functioning; r = 0.41-0.60 for eating duration and communication; p < 0.01), demonstrating good to very good convergent validity.

CONCLUSION

The T-MDADI demonstrates validity and reliability as a questionnaire for assessing dysphagia-related quality of life in Turkish patients with neurological diseases.

Velopharyngeal Insufficiency and Impaired Tongue Movement Indicate Neuromuscular Disorders: A 10-Year Statistical Study in a Single Tertiary Institution

Objectives: This study aimed to determine the positive predictive value of our NMD Suspicion Criteria in the diagnosis of NMDs. Other clinical factors routinely examined in our voice and swallowing examinations were also investigated to see if they had a significant association with the diagnosis of NMDs. Methods: This study retrospectively investigated the medical charts of patients who visited our Voice and Swallowing outpatient clinic between 2013 and 2022. Patients with previously diagnosed NMDs were excluded from the analysis. Among the remaining patients, we included those that were referred to neurologists for further evaluation due to suspicion of having an NMD based on the NMD Suspicion Criteria. The patients were then divided into groups according to the status of their diagnosis within 2 years of referral as "diagnosed", "denied", or "observed". These three groups of patients were then compared according to the following clinical findings; velopharyngeal insufficiency (VPI), tongue atrophy, impaired tongue movement, dysarthria, vocal fold mobility impairment, dysphagia, involuntary movement, gait disturbances, weight loss, and a sense of fatigue in order to see if they were significantly associated with the diagnosis of NMDs. Results: Of 3769 outpatients without a confirmed diagnosis of NMDs, 37 were referred to neurologists for suspected NMDs, and 19 (51%) were diagnosed with NMDs. VPI and impaired tongue movement were significant diagnostic factors for NMDs (p = 0.014, 0.033). VPI during speech (p = 0.045) was more strongly associated with the diagnosis of NMDs than VPI during swallowing (p = 0.076). Fatigue was a significant related factor for other diseases (non-NMDs) causing Voice and Swallowing problems (p = 0.049). Conclusions: In the outpatient clinic setting, suspicion of NMD should be raised, particularly when VPI and impaired tongue movement are observed, prompting a thorough assessment of velopharyngeal closure during both speech and swallowing.

Impact of early swallowing rehabilitation on oral feeding in patients with dysphagia following traumatic brain injury

OBJECTIVE

This study aimed to evaluate the effects of early swallowing rehabilitation on safe oral feeding in dysphagia patients following traumatic brain injury.

METHODS

Sixty-nine patients were divided into intervention and control groups, with the intervention group receiving swallowing rehabilitation therapy. The severity of swallowing disorders, cognitive function, and level of consciousness were assessed using the Mann Assessment of Swallowing Ability (MASA), Rancho Los Amigos (RLA), and Glasgow Coma Scale (GCS) before and after the intervention. Additionally, data on ventilator use duration and hospital stay length were collected.

RESULT

The intervention group exhibited a significant improvement in MASA scores (68.58) compared to the control group (38.10). No significant differences were observed in GCS and RLA scores post-intervention, indicating similar levels of consciousness and cognitive function between groups. While the duration of ventilator use was comparable, the intervention group achieved safe oral swallowing 12.12 days earlier than the control group.

DISCUSSION

The findings demonstrate that early swallowing rehabilitation significantly enhances recovery dysphagia post-brain injury, as evidenced by improved MASA scores and earlier achievement of safe oral feeding, despite no notable changes in cognition or consciousness. This underscores the importance of implementing early rehabilitation strategies in clinical practice.

Influencing factors of elderly hospitalized psychiatric patients complicated with physical disease: a cross-sectional study of 332 patients in Guangzhou China

OBJECTIVE

To investigate the influencing factors of the number of physical diseases in elderly hospitalized psychiatric patients.

METHODS

A total of 332 hospitalized elderly patients with mental illness were enrolled in this study. The number of combined physical diseases was divided into three groups, which were 0, 1 ~ 2, and ≥ 3. Data collected included sociodemographic characteristics, depressive symptoms, anxiety symptoms, delirium status, social support, medication adherence, social functioning, ability to perform daily living, and swallowing function.

RESULTS

The sample included 64.2% of female patients, mainly concentrated in 60 ~ 69 years old (48.2%). The length of hospital stay of patients was mainly 15 ~ 30 days (55.7%), and the course of disease was mainly 2 ~ 10 years (38.3%). After adjusting for confounding factors such as gender, poor lifestyle habits, course of disease, length of hospital stay, psychiatric symptoms, depressive symptoms, anxiety symptoms, delirium, social functioning, social support, and drug therapy compliance, we found that the number of physical disorders in elderly patients with mental illness was related to age, ability of daily living, and swallowing function. The increase of age, the decrease of the ability of daily living, and poor swallowing function contribute to a higher number of comorbid medical disorders in elderly patients with mental illness (P < 0.05).

CONCLUSION

According to the results, age, ability of daily living and swallowing function were the main influencing factors in the number of complicated physical diseases in elderly patients with mental illness. Future research should focus on improving the daily living ability and swallowing function of elderly patients with mental illness, in order to reduce the prevalence of other physical diseases in elderly patients with mental illness.

Elevating Patient Care With Deep Learning: High-Resolution Cervical Auscultation Signals for Swallowing Kinematic Analysis in Nasogastric Tube Patients

Patients with nasogastric (NG) tubes require careful monitoring due to the potential impact of the tube on their ability to swallow safely. This study aimed to investigate the utility of high-resolution cervical auscultation (HRCA) signals in assessing swallowing functionality of patients using feeding tubes. HRCA, capturing swallowing vibratory and acoustic signals, has been explored as a surrogate for videofluoroscopy image analysis in previous research. In this study, we analyzed HRCA signals recorded from patients with NG tubes to identify swallowing kinematic events within this group of subjects. Machine learning architectures from prior research endeavors, originally designed for participants without NG tubes, were fine-tuned to accomplish three tasks in the target population: estimating the duration of upper esophageal sphincter opening, estimating the duration of laryngeal vestibule closure, and tracking the hyoid bone. The convolutional recurrent neural network proposed for the first task predicted the onset of upper esophageal sphincter opening and closure for 67.61% and 82.95% of patients, respectively, with an error margin of fewer than three frames. The hybrid model employed for the second task successfully predicted the onset of laryngeal vestibule closure and reopening for 79.62% and 75.80% of patients, respectively, with the same error margin. The stacked recurrent neural network identified hyoid bone position in test frames, achieving a 41.27% overlap with ground-truth outputs. By applying established algorithms to an unseen population, we demonstrated the utility of HRCA signals for swallowing assessment in individuals with NG tubes and showcased the generalizability of algorithms developed in our previous studies. Clinical impact: This study highlights the promise of HRCA signals for assessing swallowing in patients with NG tubes, potentially improving diagnosis, management, and care integration in both clinical and home healthcare settings.

Nutritional support for stroke patients: an overview of international data and Russian experience

According to current data, the annual absolute number of strokes and deaths from them increased significantly from 1990 to 2019. In 2019, 12.2 million strokes were registered, while the total number of people who suffered a stroke in the world exceeded 100 million, of whom 6.55 million died. Worldwide, stroke remains the second leading cause of death (11.6%) and the third leading cause of death and disability combined (5.7%). Stroke patients are at high risk of developing malnutrition: its incidence upon admission to the hospital is about 20%, and the overall prevalence of this condition varies widely — from 6.1 to 62%. Both the previous and the resulting malnutrition is the reason for a longer stay in the hospital, deterioration of functional parameters and an increase in mortality 3–6 months after the stroke. Thus, adequate nutritional support for stroke patients should be considered as an integral component of their treatment and rehabilitation. This literature review is intended to summarize the foreign and Russian experience of nutritional support in stroke patients in order to develop an optimal algorithm of actions in the implementation of clinical nutrition in stroke patients and the use of the most effective dietary strategies that improve the prognosis, functional state and quality of life of this category of patients.

Outcome of Surgery to Improve Swallowing in Patients with Lateral Medullary Syndrome: A Retrospective Cohort Study

The study investigated surgical interventions to improve dysphagia in patients with lateral medullary syndrome (LMS), along with optimal scheduling of surgery and prognostic factors. In this retrospective, single-center cohort study, dysphagia patients with LMS who underwent surgery between January 2010 and December 2021 were enrolled. The National Outcomes Measurement System (NOMS) was used to classify swallowing function (level 1: only tube feeding, level 5: without tube feeding). Patients were divided into four groups. Groups 1 and 2, LMS onset within 1 year, and groups 3 and 4, onset after 1 year. Groups 1 and 3 had infarctions confined to the oblongata. Groups 2 and 4 had infarctions extending to the cerebellum. The primary outcome was the time to achieve NOMS ≥ 5. The final NOMS level and pathological findings were considered. Nineteen cases were included. Group 4 comprised one case and was excluded. The mean overall preoperative NOMS was 1.11. The mean time to NOMS ≥ 5 was 9.6 months (95% confidence interval: 5.04-14.2), and that to NOMS ≥ 5 was 1.67 (1.07-2.26), 11.4 (4.71-18.1), and 7.6 (5.15-10.1) months for groups 1, 2, and 3, respectively. Group 1 achieved NOMS ≥ 5 earlier than groups 2 and 3 (P = 0.01 and 0.03, respectively). The overall final NOMS value was 4.68. Fourteen patients had atrophy or fibrosis of the cricopharyngeal muscle. In conclusion, surgery was effective for effective for treating dysphagia in LMS patients. However, improvement is prolonged if > 1 year has passed since onset or the infarction extended to the cerebellum.

Ophthalmic Presentation of Diffuse Intrinsic Pontine Glioma in Children (Case Series and Literature Review)

Diffuse intrinsic pontine glioma (DIPG) is a rare aggressive brainstem lesion, affecting mainly young children. This report describes sixth cranial nerve palsy as the initial ophthalmic presentation in children with this pathology. Case series and literature review. All children presented with sixth nerve palsy were consecutively recruited from the pediatric clinic at the East Sussex NHS Healthcare Trust within the last 10 years. Full ophthalmic examination, orthoptic assessment, and refraction check were done in three patients. Magnetic Resonance Imaging was carried out using 1.5 Tesla (Siemens Symphony, Erlangen, Germany) to establish the diagnosis. The patients' age ranged from 5 to 14 years at the time of presentation. All presented with sudden onset esotropia and limited abduction, suggestive of presence of sixth nerve palsy, requiring urgent medical attention. On detailed questioning and assessment, all children showed various neurological symptoms including nystagmus, liquid dysphagia, balance problems, and nocturnal enuresis. Two out of three patients died within 7 months following diagnosis. Sudden onset esotropia, especially due to sixth nerve palsy in children, should be considered a red flag symptom, prompting proper urgent specialist assessment. Sixth nerve palsy in patients with DIPG was associated with severely reduced life expectancy in this case series of three patients, shorter than in reported non-ophthalmic presentations.

Variability in quantitative outcomes of instrumental swallowing assessments in adults: a scoping review

PURPOSE

To map scientific evidence on the variability of quantitative parameters extracted by instrumental swallowing assessment tests in adults, using the coefficient of variation.

RESEARCH STRATEGIES

The methodological procedures recommended by the Joanna Briggs Institute and the extension for scoping reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA-ScR) were followed.

SELECTION CRITERIA

The search was carried out in the Pubmed/Medline, Lilacs, Cochrane Library, Embase, Web of Science, Scopus and CINAHL databases, as well as in Google Scholar to consult the gray literature.

DATA ANALYSIS

Two blind and independent reviewers screened the articles by title and abstract. Subsequently, the articles were read in full and selected according to the eligibility criteria. Data were extracted according to a standardized instrument.

RESULTS

363 studies were found, 13 of which were eligible. Most studies had a sample size of less than 30 participants and were made up of healthy individuals. The instrumental exams used were diverse: videofluoroscopy, electrical impedance tomography, laryngeal sensors, high-resolution manometry and surface electromyography. The studies searched for intra-individual variability and the coefficient of variation ranged from low to high variability, as the instruments, parameters and collection procedures were very heterogeneous and non-standardized.

CONCLUSION

Intra-individual variability of the quantitative outcomes of instrumental swallowing assessments in adults ranged from low to high according to the exam, outcome, presence or absence of underlying disease, consistency and volume of the bolus.

Model based on clinical characteristics to identify patients with neurogenic oropharyngeal dysphagia

Introduction

Neurogenic oropharyngeal dysphagia is a form of functional dysphagia usually caused by neurological and neuromuscular diseases, which produces several secondary complications. To improve its detection and characterization, models are emerging that integrate clinical variables to complement the physical examination of swallowing.

Objective

Develop an explanatory model to differentiate patients with neurogenic oropharyngeal dysphagia.

Materials and Methods

Case control study based on a set ofdata derived from the clinical examination of swallowing with neurological emphasis carried out in a sample of patients with neurogenic oropharyngeal dysphagia of neurological and neuromuscular causes (cases), and in healthy people (controls).

Results

158 clinical variables were compared between both groups, where those with the greatest classification capacity were identified, integrated into an explanatory binary logistic regression model made up of nine variables: two history, two symptoms, three physical examination signs and two signs after consistency/volume test with food. The dependent variable was the category of being healthy or patient and the covariates were the clinical variables. Parameters reached by the model: Akaike information criterion 102 and Nagelkerke R2 0.78.

Discussion

The nine variables that entered the model, together, largely explain the presence of neurogenic oropharyngeal dysphagia, and are accessible by physical examination of swallowing.

Conclusions

The model obtained can improve and/or complement the evaluation process carried out in patients with dysphagia of functional causes, neurological and neuromuscular diseases, in screening and diagnostic characterization processes.

The discriminant ability of the Eating Assessment tool-10 to detect swallowing efficiency in neurogenic dysphagia

PURPOSE

Neurogenic dysphagia causes complications such as malnutrition, dehydration, and aspiration pneumonia. Therefore, early detection with clinically valid tools is essential. This study aimed to investigate the Eating Assessment Tool-10 (EAT-10) ability to detect swallowing efficiency at three different consistencies in neurogenic dysphagia.

METHODS

One hundred twelve patients with neurogenic dysphagia (74 males and 38 females, mean ± SD age 61.83 ± 9.72 years) were included in the study. A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed in the clinic following EAT-10 to assess swallowing efficacy at International Dysphagia Diet Standardization Initiative (IDDSI) consistencies of 0, 3, and 7. The swallowing efficiency of the patients was assessed using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Area under the curve, sensitivity, and specificity values were calculated to evaluate the ability of EAT-10 to discriminate between participants with and without residue and between participants with and without moderate-to-severe residue.

RESULTS

The EAT-10 significantly detected participants with and without residues for three IDDSI consistent: for IDDSI 0 residue in the vallecula and pyriform sinus (cutoff score ≥ 14, p < 0.001), for IDDSI 3 residue in the vallecula and pyriform sinus (cutoff score ≥ 13, p < 0.001), for IDDSI 7 residue in the vallecula and pyriform sinus (respectively, cutoff score ≥ 13, cutoff score ≥ 14, p < 0.001). Additionally, the EAT-10 significantly detected those with and without moderate-to-severe residue.

CONCLUSIONS

The EAT-10, frequently used in swallowing clinics, can determine swallowing efficiency in individuals with neurogenic dysphagia. Additionally, it has the power to detect moderate-to-severe pharyngeal residue.

Physiological analyses of swallowing changes due to chronic obstructive pulmonary disease in anesthetized male rats

Chronic obstructive pulmonary disease (COPD) was previously known as chronic bronchitis and emphysema. It has various main symptoms, such as dyspnea, chronic cough, and sputum, and is often accompanied by dysphagia. Although many published clinical reports have described COPD-related dysphagia, the physiological mechanisms underlying swallowing changes due to COPD remain unclear. Therefore, we analyzed how COPD affects the swallowing reflex using COPD model rats. We performed an electrophysiological study of respiration and swallowing using COPD model induced by intratracheal administration of porcine pancreatic elastase and lipopolysaccharide in Sprague-Dawley male rats. To identify the respiration and swallowing responses, electromyographic activity was recorded from the diaphragm, digastric (Dig), and thyrohyoid (TH) muscles. We confirmed COPD using micro-computed tomography analysis and hematoxylin and eosin staining of the lungs. The duty cycle was defined as the ratio of the inspiration duration to the total respiratory duration. In COPD model rats, the duty cycle was significantly higher than that in control rats. The frequency of the swallowing reflex evoked by electrical stimulation of the superior laryngeal nerve during the inspiration phase was higher in COPD model rats than in control rats. Furthermore, long-term COPD altered Dig and TH muscle activity without pathological muscle change. Our results suggest that COPD increases the frequency of swallowing initiation during the inspiration phase. Furthermore, long-term COPD affects swallowing-related muscle activity without pathological muscle changes. These physiological changes may increase the risk of developing dysphagia. Further studies are necessary to clarify the mechanisms contributing to the functional changes in respiration and swallowing in COPD.

The relationship between accelerometer-based physical activity, sedentary behavior, and seven common geriatric syndromes: a two-sample Mendelian randomization study

Introduction

To investigate the causal associations between accelerometer-based physical activity (PA), sedentary behavior (SB), and seven common geriatric syndromes (GSs) (frailty, falls, delirium, urinary incontinence, dysphagia, hearing loss, and visual impairment) by Mendelian randomization (MR) analysis.

Methods

Instrumental variables from a genome-wide association study were used for MR analysis. The exposure factors were three PA phenotypes (average acceleration, overall activity, and moderate-intensity activity) and one SB phenotype (SB). The outcome variables were seven common GSs. The inverse variance weighted (IVW) method was utilized for the primary MR analysis. Additionally, sensitivity, pleiotropy, and heterogeneity analyses were subsequently conducted to assess the robustness of the present study's findings.

Results

According to the primary MR results obtained using the IVW method, genetically predicted PA (average acceleration) decreased the risk of two GSs (frailty, p = 0.01; dysphagia, p = 0.03). Similarly, overall activity decreased the risk of two GSs (frailty, p = 0.01; delirium, p = 0.03), and moderate-intensity activity reduced the risk of three GSs (urinary incontinence, p = 0.04; hearing loss, p = 0.02; visual impairment, p = 0.01). Furthermore, SB was causally correlated with a greater risk for three GSs (frailty, p = 0.03; fall, p = 0.01; dysphagia, p = 0.04).

Conclusion

This study provided evidence that accelerometer-based PA may be causally associated with a lower risk of GSs, while SB may increase the risk of GSs.

Neurogenic Dysphagia

This article provides an overview of neurogenic dysphagia, describing the evaluation and management of swallowing dysfunction in various neurologic diseases. The article will focus on stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis.

Effect of bolus property on swallowing dynamics in patients with dysphagia

BACKGROUND

Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture-modified food for patients with dysphagia.

OBJECTIVES

The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy.

MATERIALS AND METHODS

A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide (Jelly) and jelly made of pectin (Reset gel). Outcome measures of videofluoroscopic images, bolus transit time and hyoid movements were compared.

RESULTS

The frequency of chewing movements was highest for Jelly, followed by Reset gel and Thick liquid. While the probability of oral residue was the highest for Reset gel, pharyngeal residue after swallowing was high for Thick liquid as compared to Jelly and Reset gel. Oral transit time and pharyngeal transit time for Thick liquid were significantly smaller than that for Jelly and Reset gel. Pharyngeal delay time was significantly smaller for Thick liquid than that for Jelly and Reset gel. There was no difference in hyoid elevation time and hyoid movement time among the conditions.

CONCLUSION

Mildly thick liquid material may be optimal for patients with primarily oral motor function impairment and jelly, such as Reset gel, may be more suitable for patients with primarily pharyngeal motor function impairment or oral and pharyngeal coordinative motor function decline.

Dysphagia in neuromyelitis optica spectrum disorder and multiple sclerosis: A comparison of frequency, severity, and effects on quality of life

OVERVIEW

Dysphagia has been previously discussed as a potential life-threatening condition secondary to chronic neurological diseases such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, its impact on the quality of life (QoL) of patients with NMOSD has never been studied before. This study aims to determine the frequency of dysphagia and its impact on QoL in NMOSD patients in comparison with MS people and healthy individuals.

METHODS

Seventy-five MS and sixty-five NMOSD patients with an expanded disability status scale (EDSS) score ≥ 3.5 in addition to 106 healthy controls were enrolled in this cross-sectional study. All the participants completed the self-report dysphagia in MS (DYMUS) and 36-item short-form health survey (SF-36) questionnaires. In case of positive answers to at least one of the questions in DYMUS, they were asked to fill out the dysphagia handicap index (DHI) questionnaire.

RESULTS

The frequency of dysphagia in NMOSD, MS, and control groups was 61.54 %, 72.97 %, and 27 %, respectively. Patients with swallowing problems had reduced scores across different swallowing-related QoL domains compared to non-dysphagic patients (p < 0.05). NMOSD (1, IQR [0-3.5]) and MS patients (2, IQR [0-4]) had a significantly higher median total DYMUS score than control (0, IQR [0-1]) (p < 0.01). However, there was no discernible difference between the two patient groups. NMOSD had the highest mean total DHI score (21.22 ± 21), followed by MS (15.25 ± 18.94) and control (7.08 ± 5.12). A significant correlation was seen in the NMOSD group between the DHI total score and the SF-36 total score (r = 0.62, p < 0.05). The DHI and SF-36 subscales showed a strong association as well. The overall SF-36 scores in both the control and MS groups was not significantly correlated with DHI. The generalized linear model analysis showed that the NMOSD group's age (p-value = 0.005), EDSS (p-value < 0.001), and total DYMUS score (p-value = 0.018) significantly affected overall health status.

CONCLUSION

The presence of dysphagia significantly impacts the QoL in NMOSD patients, particularly in aspects related to swallowing. These findings underscore the critical need for diligent dysphagia screening and emphasize the importance of educating both caregivers and NMOSD patients about managing this challenging symptom.

Effect of acupuncture on post-stroke dysphagia: a randomized controlled trial

Introduction

Post-stroke dysphagia (PSD) is associated with various complications that increase morbidity and mortality rates. Acupuncture has been used extensively in China to treat these complications; however, its therapeutic efficacy remains uncertain. We therefore aimed to study the clinical effects of acupuncture on PSD.

Methods

Patients (n = 101) were randomly divided into acupuncture (n = 50) and rehabilitation training control (n = 51) groups based on the treatment used. Both groups were treated once daily, 6 days a week, for a total of 4 weeks. Pulse oxygen saturation (SpO2) and standardized swallowing assessment (SSA) were performed before the intervention, 2 weeks into treatment, after the intervention (4 weeks post-intervention), and at a 6-month follow-up (28 weeks). The levels of hemoglobin (Hb) and albumin (ALB), and 5-hydroxytryptamine (5-HT) and dopamine (DA) were measured before the intervention, 2 weeks into treatment, and after the intervention (4 weeks), as nutrition and swallowing function indices, respectively.

Results

Following the intervention, significant differences were observed between the acupuncture and control groups. The acupuncture group exhibited considerably superior enhancements in SpO2 and SSA scores at 4 weeks (p < 0.001). Moreover, this group demonstrated significantly greater improvements in Hb, ALB, 5-HT, and DA values 4 weeks post-treatment (p < 0.001). However, sex-based differences were not observed (P > 0.005).

Conclusion

Acupuncture treatment can improve the swallowing function and nutritional status of patients with PSD, and increase the levels of 5-HT and DA. These findings strongly support the efficacy of acupuncture as a therapeutic intervention in patients with PSD.Clinical trial registration: identifier, ChiCTR2100052201. (https://www.chictr.org.cn/).

The impact of physical therapy on dysphagia in neurological diseases: a review

A neurogenic dysphagia is dysphagia caused by problems with the central and peripheral nervous systems, is particularly prevalent in conditions such as Parkinson's disease and stroke. It significantly impacts the quality of life for affected individuals and causes additional burdens, such as malnutrition, aspiration pneumonia, asphyxia, or even death from choking due to improper eating. Physical therapy offers a non-invasive treatment with high efficacy and low cost. Evidence supporting the use of physical therapy in dysphagia treatment is increasing, including techniques such as neuromuscular electrical stimulation, sensory stimulation, transcranial direct current stimulation, and repetitive transcranial magnetic stimulation. While initial studies have shown promising results, the effectiveness of specific treatment regimens still requires further validation. At present, there is a lack of scientific evidence to guide patient selection, develop appropriate treatment regimens, and accurately evaluate treatment outcomes. Therefore, the primary objectives of this review are to review the results of existing research, summarize the application of physical therapy in dysphagia management, we also discussed the mechanisms and treatments of physical therapy for neurogenic dysphagia.

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

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

Oropharyngeal swallowing hydrodynamics of thin and mildly thick liquids in an anatomically accurate throat-epiglottis model

Understanding the mechanisms underlying dysphagia is crucial in devising effective, etiology-centered interventions. However, current clinical assessment and treatment of dysphagia are still more symptom-focused due to our limited understanding of the sophisticated symptom-etiology associations causing swallowing disorders. This study aimed to elucidate the mechanisms giving rise to penetration flows into the laryngeal vestibule that results in aspirations with varying symptoms. Methods: Anatomically accurate, transparent throat models were prepared with a 45° down flapped epiglottis to simulate the instant of laryngeal closure during swallowing. Fluid bolus dynamics were visualized with fluorescent dye from lateral, rear, front, and endoscopic directions to capture key hydrodynamic features leading to aspiration. Three influencing factors, fluid consistency, liquid dispensing site, and dispensing speed, were systemically evaluated on their roles in liquid aspirations. Results: Three aspiration mechanisms were identified, with liquid bolus entering the airway through (a) the interarytenoid notch (notch overflow), (b) cuneiform tubercle recesses (recess overflow), and (c) off-edge flow underneath the epiglottis (off-edge capillary flow). Of the three factors considered, liquid viscosity has the most significant impact on aspiration rate, followed by the liquid dispensing site and the dispensing speed. Water had one order of magnitude higher aspiration risks than 1% w/v methyl cellulose solution, a mildly thick liquid. Anterior dispensing had higher chances for aspiration than posterior oropharyngeal dispensing for both liquids and dispensing speeds considered. The effects of dispending speed varied. A lower speed increased aspiration for anterior-dispensed liquids due to increased off-edge capillary flows, while it significantly reduced aspiration for posterior-dispensed liquids due to reduced notch overflows. Visualizing swallowing hydrodynamics from multiple orientations facilitates detailed site-specific inspections of aspiration mechanisms.

Neuroanatomical frameworks for volitional control of breathing and orofacial behaviors

Breathing is the only vital function that can be volitionally controlled. However, a detailed understanding how volitional (cortical) motor commands can transform vital breathing activity into adaptive breathing patterns that accommodate orofacial behaviors such as swallowing, vocalization or sniffing remains to be developed. Recent neuroanatomical tract tracing studies have identified patterns and origins of descending forebrain projections that target brain nuclei involved in laryngeal adductor function which is critically involved in orofacial behavior. These nuclei include the midbrain periaqueductal gray and nuclei of the respiratory rhythm and pattern generating network in the brainstem, specifically including the pontine Kölliker-Fuse nucleus and the pre-Bötzinger complex in the medulla oblongata. This review discusses the functional implications of the forebrain-brainstem anatomical connectivity that could underlie the volitional control and coordination of orofacial behaviors with breathing.

Dysphagia in patients with sickle cell disease: An understudied problem

Dysphagia which is defined as disordered swallowing is well known as one of the most common and dangerous symptoms of many diseases, including neurological disorders such as Parkinson's disease, amyotrophic lateral sclerosis, myasthenia gravis, and most commonly, stroke. Strokes are a potentially devastating complication of sickle cell disease (SCD), the most common genetic hemoglobinopathy worldwide, yet little is known about dysphagia as it relates to SCD. Thus, the purposes of this article are to review briefly the primary causes and health consequences of dysphagia, to highlight the relevance of dysphagia to SCD, to review what little is known about dysphagia in SCD, to recommend, based on our consensus and the available literature, when to screen, evaluate, and monitor dysphagia in patients with SCD, and to outline unanswered questions where research on dysphagia in SCD might improve health outcomes.

Application of Intraoperative Neurophysiological Monitoring (IONM) for Preventing Dysphagia After Anterior Cervical Surgery: A Prospective Study

OBJECTIVE

To evaluate the clinical value of intraoperative nerve monitoring (IONM) for dysphagia after anterior cervical surgery with and without IONM.

METHODS

A prospective, randomized, controlled study was conducted on 46 patients who underwent anterior cervical spine surgery by an experienced orthopaedic surgeon. Twenty-three patients who underwent anterior cervical surgery did not undergo IONM (non-IONM group), while the other 23 patients who underwent anterior cervical surgery did ("IONM group"). The swallowing function of patients was evaluated using the EAT-10 and endoscopic evaluation of swallowing (FEES) after surgery.

RESULTS

There was no difference in the incidence of swallowing difficulties between the intervention group and the control group on the third day or sixth week after surgery. At the 12th week after surgery, the incidence of swallowing difficulties in the intervention group and the control group was significantly different (43.5% vs. 13.0%, P = 0.024).

CONCLUSIONS

IONM is a promising tool for identifying and protecting the spinal cord and nerves during anterior cervical surgery. Our research revealed that IONM significantly reduced the occurrence of swallowing disorders 12 weeks after surgery, but the effect was not significant at the third or sixth week after surgery.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS)

The passing of the years of life physiologically leads to the accumulation of changes in tissues in the oral cavity, influencing dentition, chewing and swallowing mechanisms, and the oral microbiota. Some diseases and medications can aggravate oral symptoms and negatively influence eating behaviours, increasing the likelihood of becoming malnourished. This could make older individuals more vulnerable to complications when undergoing major orthopaedic surgery. Hidden infection foci in the oral cavity are a recognised cause of post-operative periprosthetic joint infections. Dysfunctional oral problems might also compromise feeding after surgery when good nutrition represents a fundamental aspect of a proper recovery. To manage these shortcomings, in this article, the authors hypothesise a multidisciplinary path of care named the Integrated Oral Health Network applied to major Orthopaedic Surgery (IOHN-OS). This peri-operative initiative would include pre-operative oral health screening and risk management by a dental team, patient education programmes before and after surgery, and bedside gerodontology actions like oral care and meal and eating support for fragile individuals. The IOHN-OS has the potential to reshape the concept of suitability for major orthopaedic surgery and generate momentum for designing community-based surveillance programmes that can keep the mouths of older subjects healthy for a long time.

Efficacy of non-invasive brain stimulation for post-stroke dysphagia: a meta-analysis

BACKGROUND

Given the potential harms of dysphagia after stroke, we noticed the possibility of non-invasive brain stimulation treatments in the management process.

METHODS

The meta-analysis search for articles published before May 2023 in databases. We used STATA 12.0 software to compute the standard mean difference (SMD) and 95% confidence intervals (CI).

RESULTS

The study showed a greater improvement in swallowing function in post-stroke dysphagia given transcranial direct current stimulation (tDCS) immediately after treatment, compared to those given sham tDCS (SMD = 2.99, 95% CI = 1.86-4.11). The study showed a greater improvement in swallowing function in post-stroke dysphagia given tDCS some days after treatment, compared to those given sham tDCS (SMD = 2.01, 95% CI = 0.87-3.16). The study showed a greater improvement in swallowing function in post-stroke dysphagia given repetitive transcranial magnetic stimulation (rTMS) immediately after treatment, compared to those given sham rTMS (SMD = 4.17, 95% CI = 3.11-5.23). The study showed a greater improvement in swallowing function in post-stroke dysphagia given rTMS some days after treatment, compared to those given sham rTMS (SMD = 1.77, 95% CI = 0.94-2.60).

CONCLUSIONS

In conclusion, our study showed the beneficial effects of non-invasive brain stimulation on difficulty swallowing for stroke patients and speculated about the potential application of non-invasive brain stimulation on post-stroke dysphagia improvement.

Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study

BACKGROUND

Delirium is prevalent in ischemic stroke patients, particularly those in the intensive care unit (ICU), and it poses a significant burden on patients and caregivers, leading to increased mortality rates, prolonged hospital stays, and impaired cognitive function. Dysphagia, a common symptom in critically ill patients with ischemic stroke, further complicates their condition. However, the association between dysphagia and delirium in this context remains unclear. The objective of this study was to investigate the correlation between dysphagia and delirium in ICU patients with ischemic stroke.

METHODS

A retrospective analysis was conducted on adult patients diagnosed with ischemic stroke at a medical center in Boston. Ischemic stroke cases were identified using the ninth and tenth revisions of the International Classification of Diseases. Dysphagia was defined as a positive bedside swallowing screen performed by medical staff on the day of ICU admission, while delirium was assessed using the ICU Confusion Assessment Method and review of nursing notes. Logistic regression models were used to explore the association between dysphagia and delirium. Causal mediation analysis was employed to identify potential mediating variables.

RESULTS

The study comprised 1838 participants, with a median age of approximately 70 years, and 50.5% were female. Among the total study population, the prevalence of delirium was 43.4%, with a higher prevalence observed in the dysphagia group (60.7% vs. 40.8%, p < 0.001) compared to the non-dysphagia group. After adjusting for confounding factors including age, sex, race, dementia, depression, sedative medications, history of falls, visual or hearing deficit, sequential organ failure score, and Glasgow coma score, multifactorial logistic regression analysis demonstrated a significant association between dysphagia and an increased likelihood of delirium (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.07-2.05; p = 0.018; E-value = 1.73). Causal mediation analysis revealed that serum albumin levels partially mediated the association between dysphagia and delirium in critically ill patients with ischemic stroke (average causal mediated effect [ACME]: 0.02, 95% CI: 0.01 to 0.03; p < 0.001).

CONCLUSION

ICU admission dysphagia may independently contribute to the risk of delirium in patients with ischemic stroke. Early identification and intervention in ischemic stroke patients with dysphagia may help mitigate the risk of delirium and improve patient prognosis.

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.

Gastrointestinal Issues in Depression, Anxiety, and Neurodegenerative Diseases: A Systematic Review on Pathways and Clinical Targets Implications

INTRODUCTION

Multiple illnesses commonly involve both the Central Nervous System (CNS) and the Gastrointestinal Tract (GI) simultaneously. Consistent evidence suggests that neurological disorders impair GI tract function and worsen the symptomatology and pathophysiology of digestive disorders. On the other hand, it has been proposed that early functional changes in the GI tract contribute to the genesis of several CNS illnesses. Additionally, the role played by the gut in these diseases can be seen as a paradigm for how the gut and the brain interact.

METHODS

We mentioned significant GI symptoms and discussed how the GI tract affects central nervous system illnesses, including depression, anxiety, Alzheimer's disease, and Parkinson's disease in this study. We also explored potential pathophysiological underpinnings and novel targets for the creation of future therapies targeted at gut-brain connections.

RESULTS & DISCUSSION

In this situation, modulating the gut microbiota through the administration of fecal microbiota transplants or probiotics may represent a new therapeutic option for this population, not only to treat GI problems but also behavioral problems, given the role that dysbiosis and leaky gut play in many neurological disorders.

CONCLUSION

Accurate diagnosis and treatment of co-existing illnesses also require coordination between psychiatrists, neurologists, gastroenterologists, and other specialties, as well as a thorough history and thorough physical examination.

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.

The Cost-Effectiveness of Chin Tuck Against Resistance Compared to Usual Care in Citizens with Oropharyngeal Dysphagia - An Economic Evaluation

Purpose

This study aims to evaluate the cost-effectiveness of chin tuck against resistance (CTAR) for citizens suffering from dysphagia compared to the standard municipal treatment in Denmark.

Patients and Methods

A cost-utility analysis, employing a municipal perspective, was conducted using cost data collected alongside clinical data of a randomized controlled trial evaluating the effect of CTAR training for citizens with dysphagia. The composition of the clinical randomized controlled trial, which included citizens with different diagnoses, means that participants had different disease courses. Ninety-two citizens from seven different Danish municipalities were enrolled, of whom 43 received standard care, and 49 received CTAR in addition to standard care. The effect outcome of the economic evaluation was quality-adjusted life years (QALY), estimated using the EQ-5D-5L questionnaire. Individual resource consumption of each citizen was determined based on the use of home care, home nursing care, physio- and occupational therapy, dietitian guidance, and hospital admissions. The incremental costs and QALYs between the intervention group (CTAR in addition to standard care) and standard care group were estimated using regression analysis, and sensitivity analyses were performed to investigate the robustness of the results.

Results

The base case analysis showed that the intervention group was dominant compared to the standard care group, with a decrease in incremental costs of £542.38 and an increase in incremental QALYs of 0.0118. All sensitivity analyses demonstrated similar findings as the base case analysis, supporting the robustness of the results.

Conclusion

This study found that the intervention group was the dominant alternative, hence being more effective and cost-saving, compared to the standard care group in a Danish municipality perspective with a three-month time horizon. This study adds to the scarce evidence on the cost-effectiveness of CTAR in a Danish clinical setting, but further studies should focus on estimating long-term cost-effectiveness.

Hospital Malnutrition in the Medicine and Neurology Departments: A Complex Challenge

Hospital malnutrition is especially common among elderly patients with neurological deficits or dementia. These conditions can be exacerbated by unpalatable diets and issues such as dysphagia and presbyphagia. Our study aimed to investigate the prevalence of malnutrition in patients on a homogenized diet and to identify potential correlations with specific clinical variables. We conducted a retrospective observational study in compliance with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. The study encompassed 82 patients, mainly elderly and diagnosed with neurodegenerative diseases. Upon initial assessment, 46.34% of the sample displayed a risk of malnutrition based on the Malnutrition Universal Screening Tool (MUST), and 62.20% were classified as malnourished based on the Global Leadership Initiative on Malnutrition (GLIM) criteria. Only 45.12% retained autonomy in food intake. Weight loss identified prior to the study was closely tied to malnutrition and influenced BMI. Moreover, autonomy in food intake was strongly associated with a prolonged hospital stay (LOS), and a similar trend was observed for water intake. Our findings emphasize the importance of promptly recognizing patients at risk of malnutrition, especially within such a vulnerable population. Autonomy in food intake and hydration emerge as critical indicators in the clinical management of hospitalized patients.

Systematic review and meta-analysis of the efficacy and safety of electroacupuncture for poststroke dysphagia

Introduction

Optimal treatment strategies for post-stroke dysphagia (PSD) remain to be explored. Electroacupuncture (EA) has attracted widespread attention due to its simplicity, cheapness, and safety. However, the efficacy of EA in the treatment of PSD lacks high-level evidence-based medical support. This study aimed to systematically evaluate the clinical value of EA in the treatment of PSD.

Methods

A total of seven databases were searched for relevant literature. All randomized controlled trials (RCTs) on EA alone or EA combined with other interventions for the treatment of PSD were assessed using the modified Jadad scale. The studies with a score of ≥4 were included. The quality of the included studies was then assessed using the Cochrane Collaboration's tool. The meta-analysis was performed using Rev. Man 5.3 software.

Results

Twelve studies involving 1,358 patients were included in the meta-analysis. Meta-analysis results showed that the EA group was superior to the control group in terms of clinical response rate (OR = 2.63, 95% CI = 1.97 to 3.53) and videofluoroscopic swallowing study (VFSS) score (MD = 0.73, 95% CI = 0.29 to 1.16). There was no significant difference between the two groups in the standardized swallowing assessment (SSA) score (MD = -3.11, 95% CI = -6.45 to 0.23), Rosenbek penetration-aspiration scale (PAS) score (MD = -0.68, 95% CI = -2.78 to 1.41), Swallowing Quality of Life (SWAL-QOL) score (MD = 13.24, 95% CI = -7.74 to 34.21), or incidence of adverse events (OR = 1.58, 95% CI = 0.73 to 3.38).

Conclusion

This study shows that EA combined with conventional treatment or other interventions can significantly improve the clinical response rate and VFSS score in patients with PSD without increasing adverse reactions.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=396840.

Esophageal Radiography Interpretation: a Primer for the Gastroenterologist

PURPOSE OF REVIEW

Radiological studies can be helpful when evaluating patients with suspect esophageal disorders. From benign strictures to malignancy and motility disorders such as achalasia, imaging modalities play a significant role in diagnosis. This review explores the role of different imaging modalities in the most frequently encountered esophageal pathologies.

RECENT FINDINGS

Conventional barium esophagram has long been considered the primary imaging modality of the esophagus. In the same fashion, a timed barium esophagram is a valuable tool in the evaluation of achalasia and esophagogastric junction outlet obstruction. Over the last few decades there has been an increase in CT and MRI studies, which also play a role in the evaluation of esophageal pathologies. However, not infrequently, these newer imaging techniques can result in incidental esophageal findings. It is important that gastroenterologists appreciate the value of different modalities and recognize key imaging features. The diagnosis and management of esophageal disorders is evolving. A basic understanding of esophageal radiology is essential to any gastroenterologist caring for patients with esophageal complaints.

Clinical and Acoustic Alterations of Swallowing in Children Exposed to Zika Virus during Pregnancy in a Cohort in Amazonas, Brazil: A Case Series Study

Oropharyngeal dysphagia (OD) is a swallowing disorder that involves difficulty in safely passing the food bolus from the oral cavity to the stomach. OD is a common problem in children with congenital Zika virus syndrome (CZS). In this case series, we describe the clinical and acoustic alterations of swallowing in children exposed to the Zika virus during pregnancy in a cohort from Amazonas, Brazil. From July 2019 to January 2020, 22 children were evaluated, 6 with microcephaly and 16 without microcephaly. The mean age among the participants was 35 months (±4.6 months). All children with microcephaly had alterations in oral motricity, mainly in the lips and cheeks. Other alterations were in vocal quality, hard palate, and soft palate. Half of the children with microcephaly showed changes in cervical auscultation during breast milk swallowing. In children without microcephaly, the most frequently observed alteration was in lip motricity, but alterations in auscultation during the swallowing of breast milk were not observed. Regarding swallowing food of a liquid and pasty consistency, the most frequent alterations were incomplete verbal closure, increased oral transit time, inadequacy in capturing the spoon, anterior labial leakage, and increased oral transit time. Although these events are more frequent in microcephalic children, they can also be seen in non-microcephalic children, which points to the need for an indistinct evaluation of children exposed in utero to ZIKV.

[Introduction of fiberoptic endoscopic evaluation of swallowing and increase of the range of indications in our department]

Dysphagia is a disease resulting from preparatory or transport disorder of the swallowing process and it is divided into oropharyngeal and esophageal phases according to the site of the lesion. The ear, nose and throat assessment focuses on the oropharyngeal phase, but differential diagnosis, investigation, and treatment of the cause of dysphagia is often a complex task requiring multidisciplinary approach and collaboration. The method of fiberoptic endoscopic evaluation of swallowing (FEES) has been introduced at the Department of Ear, Nose and Throat and Head-Neck Surgery, University of Szeged, enabling the examination of otorhinolaryngological and neurological disorders of swallowing as well as objective analysis of patients' swallowing quality. The fiberoptic endoscopic evaluation of swallowing is a minimally invasive procedure that allows visualization of the oropharyngeal phase of swallowing. It can identify anatomical abnormalities or neurological disorders causing dysphagia, thus playing a significant role in later patient rehabilitation. We hereby present our experiences in examinations of patients who underwent partial laryngectomy and/or pharyngectomy due to head and neck tumors as well as of those who underwent airway surgery duo to upper airway stenosis. Thanks to our collaboration with the Neurology Department, we also share our experiences gained during the examinations of patients struggling with oropharyngeal swallowing problems of various neurological origins. Orv Hetil. 2023; 164(46): 1817-1823.

Quantitative Textural and Rheological Data on Different Levels of Texture-Modified Food and Thickened Liquids Classified Using the International Dysphagia Diet Standardisation Initiative (IDDSI) Guideline

Diet modification is a common compensation strategy to promote swallowing safety in patients with swallowing difficulties. The International Dysphagia Diet Standardisation Initiative (IDDSI) guideline provides qualitative descriptions on texture-modified food and thickened liquid. This study aimed to establish quantitative textural and rheological data on different IDDSI levels based on common Chinese ingredients and dishes. Textural and rheological properties of 226 samples of various food textures and 93 samples of various liquid consistencies were obtained using a texture profile analysis (TPA) and viscometer, respectively. The establishment of such quantitative data can be used for future texture-modified food product development and research purposes.