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Zhang L, Hou R, Liu L, Liu Y, Yu Q. Evaluation of the performance of screening tools for dysphagia in older adults: A diagnostic meta-analysis. Geriatr Nurs 2025; 61:629-641. [PMID: 39778425 DOI: 10.1016/j.gerinurse.2024.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 11/05/2024] [Accepted: 12/27/2024] [Indexed: 01/11/2025]
Abstract
This systematic review evaluated the diagnostic accuracy of multiple screening tools for dysphagia in older adults. The analysis covered 30 studies involving 13 tools and 2,697 participants. The results showed that the volume viscosity swallow test performed best in sensitivity, specificity, and area under the curve, making it a recommended screening tool. Other tools have low sensitivity, unstable results or insufficient research and need to be further validated. Overall, this study provides an important reference for the screening of dysphagia in older adults.
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Affiliation(s)
- Lingli Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Ran Hou
- Department of Otolaryngology Head and Neck Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China.
| | - Lin Liu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Yan Liu
- School of Nursing, Shanxi Medical University, Taiyuan, China
| | - Qinqin Yu
- School of Nursing, Shanxi Medical University, Taiyuan, China
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2
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Steele CM, Bayley MT, Bohn MK, Higgins V, Peladeau-Pigeon M, Kulasingam V. Reference Values for Videofluoroscopic Measures of Swallowing: An Update. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3804-3824. [PMID: 37669617 PMCID: PMC10713020 DOI: 10.1044/2023_jslhr-23-00246] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE It is essential that clinicians have evidence-based benchmarks to support accurate diagnosis and clinical decision making. Recent studies report poor reliability for diagnostic judgments and identifying mechanisms of impairment from videofluoroscopy (VFSS). Establishing VFSS reference values for healthy swallowing would help resolve such discrepancies. Steele et al. (2019) released preliminary reference data for quantitative VFSS measures in healthy adults aged < 60 years. Here, we extend that work to provide reference percentiles for VFSS measures across a larger age span. METHOD Data for 16 VFSS parameters were collected from 78 healthy adults aged 21-82 years (39 male). Participants swallowed three comfortable sips each of thin, slightly, mildly, moderately, and extremely thick barium (20% w/v). VFSS recordings were analyzed in duplicate by trained raters, blind to participant and task, using the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) Method. Reference percentiles (p2.5, 5, 25, 50, 75, 95, and 97.5) were determined as per Clinical and Laboratory Standards Institute EP28-A3c guidelines. RESULTS We present VFSS reference percentile tables, by consistency, for (a) timing parameters (swallow reaction time; the hyoid burst-to-upper esophageal sphincter (UES)-opening interval; UES opening duration; time-to-laryngeal vestibule closure (LVC); and LVC duration) and (b) anatomically scaled pixel-based measures of maximum UES diameter, pharyngeal area at maximum pharyngeal constriction and rest, residue (vallecular, pyriform, other pharyngeal locations, total), and hyoid kinematics (X, Y, XY coordinates of peak position; speed). Clinical decision limits are proposed to demarcate atypical values of potential clinical concern. CONCLUSION These updated reference percentiles and proposed clinical decision limits are intended to support interpretation and reliability for VFSS assessment data. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24043041.
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Affiliation(s)
- Catriona M. Steele
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Canada Research Chair in Swallowing and Food Oral Processing, Canada Research Chairs Secretariat, Ottawa, Ontario
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mary Kathryn Bohn
- Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
| | - Victoria Higgins
- DynaLIFE Medical Labs, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | | | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
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Maamar A, Parent V, Prudhomme E, Guérot E, Berneau P, Frérou A, Le Tulzo Y, Jégoux F, Gacouin A, Tadié JM. Fiberoptic endoscopic validation of a clinical screening test of swallowing function in critically ill patients performed within 24 h after extubation. J Crit Care 2022; 72:154119. [PMID: 35917723 DOI: 10.1016/j.jcrc.2022.154119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/07/2022] [Accepted: 07/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND A bedside screening tool of swallowing dysfunction (SD) (BSSD) after extubation would be useful to identify patients who are at risk of SD. We aimed to evaluate the accuracy of our BSSD in comparison with fiberoptic endoscopic evaluation of swallowing (FEES) in critically ill patients after extubation. METHODS We conducted a 1-year prospective monocentric study to evaluate the accuracy of our BSSD to diagnose SD following endotracheal intubation in comparison with FEES (gold standard). Patients intubated for longer than 48 h were included. Both tests were assessed within 24 h after extubation. Primary endpoint was the accuracy of the BSSD. Secondary endpoint was to assess risk factors of SD. RESULTS Seventy-nine patients were included in the study. Thirty-three patients (42%) presented with a SD. The BSSD showed a sensitivity of 88% (95% CI 0.72-0.97) and a specificity of 91% (95% CI 0.79-0.98), a positive predictive value of 88% (95% CI 0.72-0.97) and a negative predictive value of 91% (95% CI 0.79-0.97). The AUC reached 0.83 (95% CI 0.74-0.92). CONCLUSION Our study describes an accurate clinical screening tool to detect SD after extubation in critically ill patients. Screening-positive cases should be confirmed by instrumental tests, ideally using FEES.
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Affiliation(s)
- Adel Maamar
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
| | - Valentine Parent
- Service d'Oto-Rhino-Laryngologie, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - Emmanuelle Prudhomme
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - Emmanuel Guérot
- Service de Réanimation Médicale, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Pauline Berneau
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - Aurélien Frérou
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - Yves Le Tulzo
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France; Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Franck Jégoux
- Service d'Oto-Rhino-Laryngologie, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France
| | - Arnaud Gacouin
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France; Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
| | - Jean-Marc Tadié
- Service de Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Université de Rennes 1, 2, rue Henri Le Guilloux, 35033 Rennes cedex 9, France; Faculté de Médecine, Université de Rennes 1, Unité INSERM CIC 1414, IFR 140, Rennes, France
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Park HY, Park D, Kang HS, Kim H, Lee S, Im S. Post-stroke respiratory complications using machine learning with voice features from mobile devices. Sci Rep 2022; 12:16682. [PMID: 36202829 PMCID: PMC9537337 DOI: 10.1038/s41598-022-20348-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
Abnormal voice may identify those at risk of post-stroke aspiration. This study was aimed to determine whether machine learning algorithms with voice recorded via a mobile device can accurately classify those with dysphagia at risk of tube feeding and post-stroke aspiration pneumonia and be used as digital biomarkers. Voice samples from patients referred for swallowing disturbance in a university-affiliated hospital were collected prospectively using a mobile device. Subjects that required tube feeding were further classified to high risk of respiratory complication, based on the voluntary cough strength and abnormal chest x-ray images. A total of 449 samples were obtained, with 234 requiring tube feeding and 113 showing high risk of respiratory complications. The eXtreme gradient boosting multimodal models that included abnormal acoustic features and clinical variables showed high sensitivity levels of 88.7% (95% CI 82.6–94.7) and 84.5% (95% CI 76.9–92.1) in the classification of those at risk of tube feeding and at high risk of respiratory complications; respectively. In both cases, voice features proved to be the strongest contributing factors in these models. Voice features may be considered as viable digital biomarkers in those at risk of respiratory complications related to post-stroke dysphagia.
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Affiliation(s)
- Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - DoGyeom Park
- Graduate School of Artificial Intelligence, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea
| | - Hye Seon Kang
- Department of Pulmonary, Allergy and Critical Care Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - HyunBum Kim
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungchul Lee
- Graduate School of Artificial Intelligence, Pohang University of Science and Technology (POSTECH), Pohang, Republic of Korea. .,Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), 223, 5th Engineering Building, 77 Cheongam-Ro, Nam-Gu, Pohang, 37673, Gyeongbuk, Republic of Korea.
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, Catholic University of Korea, 327 Sosa-ro, Seoul, Bucheon-si, 14647, Gyeonggi-do, Republic of Korea.
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Welden K, Kelchner L, Silbert N, Rule DW. Listening for Dysphagia: Voice Quality Sequelae of Material in the Airway. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:3337-3364. [PMID: 35998282 DOI: 10.1044/2022_jslhr-22-00120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Postswallow voice abnormality is often assumed to indicate the presence of material in the laryngeal airway (MIA), but prior research has not shown definitive evidence of a causal relationship. This study investigated if endoscopically confirmed MIA (prandial material or secretions) generates specific voice quality attributes that can be perceptually identified by experienced listeners. METHOD Forty-four dysphagic adults underwent endoscopic evaluation of swallowing. Time-linked audiovisual recordings of pre- and postswallow phonation were analyzed to determine the presence, amount, and location of prandial material or secretions in the larynx during phonation. Expert listeners completed auditory-perceptual ratings of phonation samples. RESULTS Voice quality ratings did not differ significantly when there was MIA during postswallow phonation. However, judgments of voice quality abnormality for MIA samples were elevated when analyses controlled for effects of baseline dysphonia. Listeners were most likely to perceive voice quality abnormality when larger amounts of secretions were present, as compared to prandial material. Interrater reliability was variable and ranged from low to moderate across perceptual parameters. CONCLUSIONS MIA during phonation occurred for many participants, but perception of voice quality abnormality was variable when MIA was present. Baseline dysphonia is common among individuals with dysphagia and may limit perception of voice quality abnormalities generated by MIA. Secretions in the laryngeal airway may have a greater impact on voice quality parameters.
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Affiliation(s)
- Kathy Welden
- Cincinnati Veterans Affairs Medical Center, OH
- Department of Communication Sciences & Disorders, College of Allied Health, University of Cincinnati, OH
| | - Lisa Kelchner
- Department of Communication Sciences & Disorders, College of Allied Health, University of Cincinnati, OH
| | | | - David W Rule
- Department of Otolaryngology, College of Medicine, University of Cincinnati, OH
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Zhang D, Li Y, Li H, Fu W, Zeng J, Zeng X. Analysis of Factors That Influence the Prognosis of Swallowing Function Rehabilitation Therapy in Patients with Dysphagia After Medullary Infarction. Neuropsychiatr Dis Treat 2022; 18:97-107. [PMID: 35079218 PMCID: PMC8776725 DOI: 10.2147/ndt.s341353] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/29/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE This study investigated the factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. PATIENTS AND METHODS This retrospective study was conducted using the clinical data of 51 patients who were diagnosed with dysphagia after medullary infarction and hospitalized at our institution between January 2019 and January 2021. As per the water swallow test (WST) grade at 1 month after rehabilitation treatment, patients were classified into the good prognosis group and the poor prognosis group. Univariate analysis as well as univariate and multivariate logistic regression analysis were used to analyze factors that influence the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction. Receiver operating characteristic (ROC) curves were then used to test the predictive ability of the significant parameters to predict the prognosis of the rehabilitation therapy in these patients. RESULTS Univariate analysis and univariate logistic regression analysis showed that previous stroke (odds ratio [OR] = 1.361), dysarthria (OR = 3.771), disease course (OR = 1.112), National Institutes of Health Stroke Scale (NIHSS) score at admission (OR = 2.596), and infarct site (OR = 11.071) were all significantly correlated with the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction (P < 0.05). Multivariate logistic regression analysis showed that dysarthria (OR = 5.519, 95% confidence interval (CI) 1.413-21.566), infarct site (OR = 18.634, 95% CI 1.696-204.73), and the NIHSS score (OR = 1.001, 95% CI 1.536-4.820) were independent influencing factors of the prognosis of swallowing function rehabilitation therapy in these patients. The ROC curve showed that the area under the curve for the combined prediction of the three indicators was 0.943. CONCLUSION The NIHSS score, dysarthria, and infarct site are independent influencing factors for the prognosis of swallowing function rehabilitation therapy in patients with dysphagia after medullary infarction.
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Affiliation(s)
- Di Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Yi Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Heping Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Weifeng Fu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Jing Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
| | - Xi Zeng
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, People's Republic of China
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7
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Chang J, Brown SK, Hwang C, Kirke DN, Goldberg L. Predictive values of static endoscopic evaluation of swallowing in adults. Laryngoscope Investig Otolaryngol 2021; 6:1383-1388. [PMID: 34938878 PMCID: PMC8665454 DOI: 10.1002/lio2.615] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Static endoscopic evaluation of swallowing (SEES) is an instrumental evaluation developed for in-office identification of patients who may benefit from a modified barium swallow study (MBSS). We aim to determine the predictive value of SEES for evaluating dysphagia. METHODS A retrospective case series was performed on adults evaluated for dysphagia using SEES followed by MBSS at a single tertiary care center. Studies were evaluated by two blinded expert raters. RESULTS Fifty-eight patients were included. Thin liquid penetration on SEES had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.86 (95% CI 0.70-0.95), 0.63 (95% CI 0.24-0.91), 0.91 (95% CI 0.76-0.98), and 0.5 (0.19-0.81), respectively, for predicting thin liquid penetration on MBSS, and 1.0 (95% CI 0.59-1.0), 0.29 (95% CI 0.15-0.47), 0.23 (95% CI 0.10-0.41), and 1.0 (95% CI 0.69-1.0) for predicting thin liquid aspiration on MBSS. Thin liquid aspiration on SEES had a sensitivity, specificity, PPV, and NPV of 0.67 (95% CI 0.09-0.99), 0.85 (95% CI 0.66-0.96), 0.33 (95% CI 0.04-0.78), and 0.96 (95% CI 0.79-1.0), respectively, for predicting thin liquid aspiration on MBSS. CONCLUSIONS SEES may be used as an objective in-office test to screen for aspiration and penetration. Thin liquid penetration on SEES is moderately sensitive for predicting penetration on MBSS. Absence of thin liquid penetration or aspiration on SEES has a high NPV for excluding aspiration on MBSS. Abnormalities on SEES or the need to view the entire swallowing mechanism should prompt an MBSS for a more complete evaluation of dysphagia.Level of Evidence: 4.
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Affiliation(s)
- Joseph Chang
- The Permanente Medical Group, Department of Head and Neck Surgery, Kaiser Permanente Santa ClaraSanta ClaraCaliforniaUSA
| | - Sarah K. Brown
- Department of Otolaryngology—Head and Neck Surgery, Division of Laryngology, Mount Sinai Health SystemNew YorkNew YorkUSA
| | - Chaewon Hwang
- Rutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Diana N. Kirke
- Department of Otolaryngology—Head and Neck Surgery, Division of Laryngology, Mount Sinai Health SystemNew YorkNew YorkUSA
| | - Leanne Goldberg
- Department of Otolaryngology—Head and Neck Surgery, Division of Laryngology, Mount Sinai Health SystemNew YorkNew YorkUSA
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Black RJ, Novakovic D, Plit M, Miles A, MacDonald P, Madill C. Swallowing and laryngeal complications in lung and heart transplantation: Etiologies and diagnosis. J Heart Lung Transplant 2021; 40:1483-1494. [PMID: 34836605 DOI: 10.1016/j.healun.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/29/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Despite continued surgical advancements in the field of cardiothoracic transplantation, post-operative complications remain a burden for the patient and the multidisciplinary team. Lesser-known complications including swallowing disorders (dysphagia), and voice disorders (dysphonia), are now being reported. Such disorders are known to be associated with increased morbidity and mortality in other medical populations, however their etiology amongst the heart and lung transplant populations has received little attention in the literature. This paper explores the potential mechanisms of oropharyngeal dysphagia and dysphonia following transplantation and discusses optimal modalities of diagnostic evaluation and management. A greater understanding of the implications of swallowing and laryngeal dysfunction in the heart and lung transplant populations is important to expedite early diagnosis and management in order to optimize patient outcomes, minimize allograft injury and improve quality of life.
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Affiliation(s)
- Rebecca J Black
- Speech Pathology Department, St Vincent's Hospital, Darlinghurst, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Daniel Novakovic
- Faculty of Medicine and Health, The University of Sydney, Australia
| | | | | | - Peter MacDonald
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Catherine Madill
- Faculty of Medicine and Health, The University of Sydney, Australia
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9
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Boaden E, Burnell J, Hives L, Dey P, Clegg A, Lyons MW, Lightbody CE, Hurley MA, Roddam H, McInnes E, Alexandrov A, Watkins CL. Screening for aspiration risk associated with dysphagia in acute stroke. Cochrane Database Syst Rev 2021; 10:CD012679. [PMID: 34661279 PMCID: PMC8521523 DOI: 10.1002/14651858.cd012679.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Stroke can affect people's ability to swallow, resulting in passage of some food and drink into the airway. This can cause choking, chest infection, malnutrition and dehydration, reduced rehabilitation, increased risk of anxiety and depression, longer hospital stay, increased likelihood of discharge to a care home, and increased risk of death. Early identification and management of disordered swallowing reduces risk of these difficulties. OBJECTIVES Primary objective • To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke Secondary objectives • To assess the influence of the following sources of heterogeneity on the diagnostic accuracy of bedside screening tools for dysphagia - Patient demographics (e.g. age, gender) - Time post stroke that the study was conducted (from admission to 48 hours) to ensure only hyperacute and acute stroke swallow screening tools are identified - Definition of dysphagia used by the study - Level of training of nursing staff (both grade and training in the screening tool) - Low-quality studies identified from the methodological quality checklist - Type and threshold of index test - Type of reference test SEARCH METHODS: In June 2017 and December 2019, we searched CENTRAL, MEDLINE, Embase, CINAHL, and the Health Technology Assessment (HTA) database via the Centre for Reviews and Dissemination; the reference lists of included studies; and grey literature sources. We contacted experts in the field to identify any ongoing studies and those potentially missed by the search strategy. SELECTION CRITERIA We included studies that were single-gate or two-gate studies comparing a bedside screening tool administered by nurses or other healthcare professionals (HCPs) with expert or instrumental assessment for detection of aspiration associated with dysphagia in adults with acute stroke admitted to hospital. DATA COLLECTION AND ANALYSIS Two review authors independently screened each study using the eligibility criteria and then extracted data, including the sensitivity and specificity of each index test against the reference test. A third review author was available at each stage to settle disagreements. The methodological quality of each study was assessed using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) tool. We identified insufficient studies for each index test, so we performed no meta-analysis. Diagnostic accuracy data were presented as sensitivities and specificities for the index tests. MAIN RESULTS Overall, we included 25 studies in the review, four of which we included as narratives (with no accuracy statistics reported). The included studies involved 3953 participants and 37 screening tests. Of these, 24 screening tests used water only, six used water and other consistencies, and seven used other methods. For index tests using water only, sensitivity and specificity ranged from 46% to 100% and from 43% to 100%, respectively; for those using water and other consistencies, sensitivity and specificity ranged from 75% to 100% and from 69% to 90%, respectively; and for those using other methods, sensitivity and specificity ranged from 29% to 100% and from 39% to 86%, respectively. Twenty screening tests used expert assessment or the Mann Assessment of Swallowing Ability (MASA) as the reference, six used fibreoptic endoscopic evaluation of swallowing (FEES), and 11 used videofluoroscopy (VF). Fifteen screening tools had an outcome of aspiration risk, 20 screening tools had an outcome of dysphagia, and two narrative papers did not report the outcome. Twenty-one screening tests were carried out by nurses, and 16 were carried out by other HCPs (not including speech and language therapists (SLTs)). We assessed a total of six studies as low risk across all four QUADAS-2 risk of bias domains, and we rated 15 studies as low concern across all three applicability domains. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing combined water swallow and instrumental tool was the Bedside Aspiration test (n = 50), the best performing water plus other consistencies tool was the Gugging Swallowing Screen (GUSS; n = 30), and the best water only swallow screening tool was the Toronto Bedside Swallowing Screening Test (TOR-BSST; n = 24). All tools demonstrated combined highest sensitivity and specificity and low risk of bias for all domains. However, clinicians should be cautious in their interpretation of these findings, as these tests are based on single studies with small sample sizes, which limits the estimates of reliability of screening tests. AUTHORS' CONCLUSIONS We were unable to identify a single swallow screening tool with high and precisely estimated sensitivity and specificity based on at least one trial with low risk of bias. However, we were able to offer recommendations for further high-quality studies that are needed to improve the accuracy and clinical utility of bedside screening tools.
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Affiliation(s)
- Elizabeth Boaden
- Faculty of Health and Care , University of Central Lancashire , Preston, UK
| | - Jane Burnell
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Lucy Hives
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Paola Dey
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | - Andrew Clegg
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Mary W Lyons
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Margaret A Hurley
- Faculty of Health and Care, University of Central Lancashire , Preston, UK
| | - Hazel Roddam
- Faculty of Allied Health and Well-being, University of Central Lancashire, Preston, UK
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Anne Alexandrov
- University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee, USA
| | - Caroline L Watkins
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
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10
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Accuracy of Acoustic Evaluation of Swallowing as a Diagnostic Method of Dysphagia in Individuals Affected by Stroke: Preliminary Analysis. Dysphagia 2021; 37:724-735. [PMID: 34586494 DOI: 10.1007/s00455-021-10358-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
After a stroke, more than half of the patients have some kind of disability, and dysphagia is frequently found. Cervical auscultation by Doppler sonar is an innovative technique with gain of credibility in the clinical evaluation of swallowing. To verify the diagnostic accuracy of Doppler sonar along with the DeglutiSom® software as an auxiliary method in the evaluation of oropharyngeal dysphagia in patients after stroke. The research is a cross-sectional, uncontrolled, blind, quantitative study with systematic random sampling. Patients from inpatient and outpatient units of a reference hospital with a stroke care unit were concomitantly submitted to both Doppler sonar and Fiberoptic Endoscopic Evaluation of Swallowing (FEES®). Seventy-three audio files collected from 26 patients through Doppler sonar were analyzed using DeglutiSom® software and confronted with the FEES® report, regarding three food consistencies offered to them during the exam. The study showed that the Doppler sonar correctly identified, among all the analyzed files, those that actually presented tracheal aspiration as well as it effectively identified patients who did not aspirate. The Youden index of 0.91 corroborates this information, showing a promising accuracy in detecting tracheal aspiration in the studied sample. The study evaluates the diagnostic accuracy of Doppler sonar, showing that it can be used as a valuable tool in the diagnosis of tracheal aspiration in patients after stroke. It is important to emphasize that the identification of residue by this method requires further studies. Also, larger sample size and more than one blind evaluator should be considered in future researches to increase the reliability of the proposed method.
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Namasivayam-MacDonald AM, Alomari N, Attner L, Benjamin RD, Chill A, Doka S, Guastella R, Marchese J, Oppedisano S, Ressa K, Rider BE, Sandoval GK, Soyfer A, Thompson R, Walshe CM, Riquelme LF. A Retrospective Analysis of Swallowing Function and Physiology in Patients Living with Dementia. Dysphagia 2021; 37:900-908. [PMID: 34374860 DOI: 10.1007/s00455-021-10350-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Dysphagia is commonly diagnosed in patients living with dementia, but we lack understanding of changes in swallowing physiology and the resulting relationship to impairments of safety and efficiency. The purpose of this study was to describe the pathophysiology of dysphagia in a retrospective sample of patients living with dementia. Videofluoroscopy data from 106 adults (mean age: 84) diagnosed with dementia were scored by blinded raters. Raters analyzed 412 thin liquid swallows for safety [Penetration-Aspiration Scale (PAS)], efficiency [% of (C2-C4)2], timing [Pharyngeal Transit Time (PTT), Swallow Reaction Time (SRT), Laryngeal Vestibule Closure Reaction Time (LVCrt), Upper Esophageal Sphincter Opening Duration (UESO)], and kinematics (pharyngeal constriction). Impairment thresholds from existing literature were used to characterize swallowing. Chi-square tests and Pearson's correlations were used to determine associations between swallowing physiology and function. Compared to published norms, we identified significant differences in PTT, SRT, LVCrt, UESO, and degree of maximum pharyngeal constriction. Unsafe swallowing (PAS > 2) was seen in 17% of swallows. Clinically significant residue (i.e., % of (C2-C4)2 > 0.54 vallecular; > 0.34 pyriforms) was seen in most patients. Chi-square tests revealed significant associations between LVCrt and unsafe swallowing. There was a weak positive association between post-swallow residue in the pyriforms and poor pharyngeal constriction. Detailed analysis of swallowing physiology in this sample provides insight into the pathophysiological mechanisms associated with dysphagia in patients living with dementia. Further work is needed to explore additional bolus consistencies and to identify how physiology changes based on type and severity of dementia diagnosis.
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Affiliation(s)
- Ashwini M Namasivayam-MacDonald
- School of Rehabilitation Science, McMaster University, 1280 Main St. West, IAHS 420, Hamilton, ON, L8S 4L8, Canada. .,Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA.
| | - Naga Alomari
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Lauren Attner
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Rebecca D Benjamin
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Alexandra Chill
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Samantha Doka
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Rebekah Guastella
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Jena Marchese
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Stefania Oppedisano
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Kathryn Ressa
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Brianna E Rider
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Gracelynn K Sandoval
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Alexandra Soyfer
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Riesa Thompson
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Caitlin M Walshe
- Communication Sciences and Disorders, Adelphi University, Garden City, NY, USA
| | - Luis F Riquelme
- Speech-Language Pathology, New York Medical College, Valhalla, NY, USA.,NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
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Benfield JK, Wilkinson G, Everton LF, Bath PM, England TJ. Diagnostic accuracy of the Dysphagia Trained Nurse Assessment tool in acute stroke. Eur J Neurol 2021; 28:2766-2774. [PMID: 33960075 DOI: 10.1111/ene.14900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Comprehensive swallow screening assessments to identify dysphagia and make early eating and drinking recommendations can be used by trained nurses. This study aimed to validate the Dysphagia Trained Nurse Assessment (DTNAx) tool in acute stroke patients. METHODS Participants with diagnosed stroke were prospectively and consecutively recruited from an acute stroke unit. Following a baseline DTNAx on admission, participants underwent a speech and language therapist (SLT) bedside assessment of swallowing (speech and language therapist assessment [SLTAx]), videofluoroscopy (VFS) and a further DTNAx by the same or a different nurse. RESULTS Forty-seven participants were recruited, of whom 22 had dysphagia. Compared to SLTAx in the identification of dysphagia, DTNAx had a sensitivity of 96.9% (95% confidence interval [CI] 83.8-99.9) and specificity of 89.5% (95% CI 75.2-97.1). Compared to VFS in the identification of aspiration, DTNAx had a sensitivity of 77.8% (95% CI 40.0-97.2) and a specificity of 81.6% (95% CI 65.7-92.3). Over 81% of the diet and fluid recommendations made by the dysphagia trained nurses were in absolute agreement compared to SLTAx. Both DTNAx and SLTAx had low diagnostic accuracy compared to the VFS-based definition of dysphagia. CONCLUSIONS Nurses trained in DTNAx showed good diagnostic accuracy in identifying dysphagia compared to SLTAx and in identifying aspiration compared to VFS. They made appropriate diet and fluid recommendations in line with SLTs in the early management of dysphagia.
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Affiliation(s)
- Jacqueline K Benfield
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK.,Derbyshire Community Health Services NHS Trust, Derby, UK
| | - Gwenllian Wilkinson
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
| | - Lisa F Everton
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Division of Mental Health and Clinical Neuroscience, School of Medicine, University of Nottingham, Derby, UK.,Department of Stroke, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Dos Santos KW, da Cunha Rodrigues E, Rech RS, da Ros Wendland EM, Neves M, Hugo FN, Hilgert JB. Using Voice Change as an Indicator of Dysphagia: A Systematic Review. Dysphagia 2021; 37:736-748. [PMID: 34019177 DOI: 10.1007/s00455-021-10319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/13/2021] [Indexed: 10/21/2022]
Abstract
Voice change post-swallow, observed during a clinical swallow examination, is often used as a clinical indicator of dysphagia risk. However, there has been limited research that evaluated the level of agreement between voice change and swallow dysfunction reported to date. This systematic review aims to investigate existing evidence relating to the relationship between vocal change post-swallow and swallow deficits identified on a Videofluoroscopic Swallow Study (VFSS). The studies were selected by two independent evaluators for inclusion, without restriction on language or date of publication and the methodological quality and the risk of bias were assessed using QUADAS-2. Following the PRISMA recommendation, 271 articles were analyzed, of which 17 were included in the study. Of these, the methodology described in five studies employed voice analyses using only acoustic methods, seven others conducted only auditory-perceptual analyses, and five other studies used both. Across the studies there was no homogeneity in the voice quality parameters assessed, analytic methods used, and results obtained. Forty seven per cent of the studies presented a high risk of bias in the analysis of vocal quality due to lack of clarity and blinding of VFSS. There was no homogeneity in the choice of consistencies evaluated during swallowing, as well as standardization of the outcome investigated in VFSS without a vocal parameter attributable to accurate detection in each outcome. It is not possible to obtain a consensus regarding the recommendation of the use of vocal evaluation as an accurate method for identifying swallowing alterations due to heterogeneity of the vocal evaluation methods, the outcomes evaluated in the VFSS examination, heterogeneity in food and liquid consistencies, and the methodological quality of the studies.
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Affiliation(s)
- Karoline Weber Dos Santos
- Cristo Redentor Hospital/Conceição Hospital Group, 20, Domingos Rubbo Street, Porto Alegre, Rio Grande do Sul, 91040-000, Brazil.
| | - Esther da Cunha Rodrigues
- Federal University of Health Sciences of Porto Alegre (UFCSPA), 245, Sarmento Leite Street, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil
| | - Rafaela Soares Rech
- Federal University of Health Sciences of Porto Alegre (UFCSPA), 245, Sarmento Leite Street, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil
| | - Eliana Márcia da Ros Wendland
- Federal University of Health Sciences of Porto Alegre (UFCSPA), 245, Sarmento Leite Street, Porto Alegre, Rio Grande do Sul, 90050-170, Brazil
| | - Matheus Neves
- Federal University of Rio Grande do Sul (UFRGS), 110, Paulo Gama, Street, Porto Alegre, Rio Grande do Sul, 90040-060, Brazil
| | - Fernando Neves Hugo
- Federal University of Rio Grande do Sul (UFRGS), 110, Paulo Gama, Street, Porto Alegre, Rio Grande do Sul, 90040-060, Brazil
| | - Juliana Balbinot Hilgert
- Federal University of Rio Grande do Sul (UFRGS), 110, Paulo Gama, Street, Porto Alegre, Rio Grande do Sul, 90040-060, Brazil
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Braun T, Juenemann M, Viard M, Meyer M, Reuter I, Mausbach S, Doerr JM, Schirotzek I, Prosiegel M, Schramm P, Kaps M, Tanislav C. Flexible endoscopic evaluation of swallowing (FEES) to determine neurological intensive care patients' oral diet. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:83-91. [PMID: 32245331 DOI: 10.1080/17549507.2020.1744727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Dysphagia is common in critically ill neurological patients and is associated with a high mortality and morbidity. Data on the usefulness of flexible endoscopic examination of swallowing (FEES) in neurological intensive care unit (ICU) patients are lacking, raising the need for evaluation. METHOD FEES was performed in neurological intensive care patients suspected of dysphagia. We correlated findings with baseline data, disability status, pneumonia and duration of hospitalisation, as well as a need for mechanical ventilation or tracheotomy. RESULT This analysis consisted of 125 patients with suspected dysphagia. Most of the patients (81; 64,8%) suffered from acute stroke. Dysphagia was diagnosed using FEES in 90 patients (72%). FEES results led to dietary modifications in 80 patients (64%). The outcome at discharge was worse in dysphagic stroke patients diagnosed by FEES as compared to non-dysphagic stroke patients (p = 0.009). Patients without oral diet had higher need for intubation (p = 0.007), tracheotomy (p = 0.032) and higher mortality (p < 0.001) in comparison to patients with at least small amounts of oral intake. CONCLUSION As the clinical assessment of the patients often classified the dysphagia incorrectly, the broad use of FEES in ICU patients might help to adequately adjust patients' oral diet. This knowledge might contribute to lower mortality and morbidity.
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Affiliation(s)
- Tobias Braun
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Maxime Viard
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Marco Meyer
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
- Department of Neurology/Geriatrics, Diakonie Klinikum Jung-Stilling, Siegen, Germany
| | - Iris Reuter
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Stefan Mausbach
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Johanna M Doerr
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Ingo Schirotzek
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Mario Prosiegel
- Faculty of Languages and Literatures, Department I, Ludwig-Maximilians-University (LMU), Munich, Germany, and
| | - Patrick Schramm
- Department of Anaesthesiology, University Hospital Mainz, Mainz, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Christian Tanislav
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
- Department of Neurology/Geriatrics, Diakonie Klinikum Jung-Stilling, Siegen, Germany
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16
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Moss M, White SD, Warner H, Dvorkin D, Fink D, Gomez-Taborda S, Higgins C, Krisciunas GP, Levitt JE, McKeehan J, McNally E, Rubio A, Scheel R, Siner JM, Vojnik R, Langmore SE. Development of an Accurate Bedside Swallowing Evaluation Decision Tree Algorithm for Detecting Aspiration in Acute Respiratory Failure Survivors. Chest 2020; 158:1923-1933. [PMID: 32721404 DOI: 10.1016/j.chest.2020.07.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/06/2020] [Accepted: 07/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The bedside swallowing evaluation (BSE) is an assessment of swallowing function and airway safety during swallowing. After extubation, the BSE often is used to identify the risk of aspiration in acute respiratory failure (ARF) survivors. RESEARCH QUESTION We conducted a multicenter prospective study of ARF survivors to determine the accuracy of the BSE and to develop a decision tree algorithm to identify aspiration risk. STUDY DESIGN AND METHODS Patients extubated after ≥ 48 hours of mechanical ventilation were eligible. Study procedures included the BSE followed by a gold standard evaluation, the flexible endoscopic evaluation of swallowing (FEES). RESULTS Overall, 213 patients were included in the final analysis. Median time from extubation to BSE was 25 hours (interquartile range, 21-45 hours). The FEES was completed 1 hour after the BSE (interquartile range, 0.5-2 hours). A total of 33% (70/213; 95% CI, 26.6%-39.2%) of patients aspirated on at least one FEES bolus consistency test. Thin liquids were the most commonly aspirated consistency: 27% (54/197; 95% CI, 21%-34%). The BSE detected any aspiration with an accuracy of 52% (95% CI, 45%-58%), a sensitivity of 83% (95% CI, 74%-92%), and negative predictive value (NPV) of 81% (95% CI, 72%-91%). Using recursive partitioning analyses, a five-variable BSE-based decision tree algorithm was developed that improved the detection of aspiration with an accuracy of 81% (95% CI, 75%-87%), sensitivity of 95% (95% CI, 90%-98%), and NPV of 97% (95% CI, 95%-99%). INTERPRETATION The BSE demonstrates variable accuracy to identify patients at high risk for aspiration. Our decision tree algorithm may enhance the BSE and may be used to identify patients at high risk for aspiration, yet requires further validation. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT02363686; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO.
| | - S David White
- University of Colorado Denver Rehabilitation Therapy Services, University of Colorado Hospital, Aurora, CO
| | - Heather Warner
- Section of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT; Department of Communication Disorders, Southern Connecticut State University, New Haven, CT
| | - Daniel Dvorkin
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO; The Bioinformatics CRO, Inc, Niceville, FL
| | - Daniel Fink
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO
| | | | - Carrie Higgins
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Gintas P Krisciunas
- Department of Otolaryngology, Boston Medical Center, Boston, MA; Department of Otolaryngology, Boston University School of Medicine, Boston, MA
| | - Joseph E Levitt
- Division of Pulmonary and Critical Care, Stanford University, Stanford, CA
| | - Jeffrey McKeehan
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver, Aurora, CO
| | - Edel McNally
- Department of Otolaryngology, Boston Medical Center, Boston, MA; Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
| | - Alix Rubio
- Department of Otolaryngology, Boston Medical Center, Boston, MA
| | - Rebecca Scheel
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA; Division of Speech Language Pathology, Massachusetts General Hospital, Boston, MA
| | - Jonathan M Siner
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Rosemary Vojnik
- Division of Pulmonary and Critical Care, Stanford University, Stanford, CA
| | - Susan E Langmore
- Department of Otolaryngology, Boston Medical Center, Boston, MA; Department of Otolaryngology, Boston University School of Medicine, Boston, MA; Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA
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17
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de Sire A, Giachero A, DE Santi S, Inglese K, Solaro C. Screening dysphagia risk in 534 older patients undergoing rehabilitation after total joint replacement: a cross-sectional study. Eur J Phys Rehabil Med 2020; 57:131-136. [PMID: 32594668 DOI: 10.23736/s1973-9087.20.06321-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older people affected by severe osteoarthritis could need to undergo total joint replacement, with a consequent hospitalization and rehabilitation. In this postacute phase, they might suffer from other symptoms, including dysphagia, defined as a dysfunction of the digestive system, characterized by an objective difficulty or a sensation of difficulty in swallowing. It is considered as a very challenging problem in older people and early detection is fundamental for a prompt and effective management. However, up to date, there is a lack of data on dysphagia risk screening in orthopedic rehabilitation inpatients. AIM The aim of this study was to evaluate dysphagia risk through Eating Assessment Tool (EAT-10) in older people undergoing rehabilitation after total hip or knee arthroplasty. DESIGN Cross-sectional study. SETTING Rehabilitation Unit. POPULATION All consecutive patients undergone total hip or knee arthroplasty, aged ≥65 years, referring to Orthopedics Rehabilitation Unit "Mons. Luigi Novarese" Hospital, Moncrivello, Italy, for a 24-month period (from 1st January 2018 to 31st December 2019). We excluded patients with: 1) diagnosis of neurological diseases; 2) pharyngeal or esophageal cancer; 3) maxillofacial cancer; 4) tracheotomy. METHODS Dysphagia risk was assessed through EAT-10. The cohort was divided into two groups, according to water swallowing test (WST), in order to evaluate differences in terms of different EAT-10 scores. Furthermore, based on pathological WST, we have stratified study participants by the American Speech-Language-Hearing Association (ASHA)'s National Outcomes Measurement System (NOMS) swallowing scale in order to evaluate differences in terms of the different EAT-10 scores. RESULTS We included 534 participants (180 men, 357 women), mean aged 74.8±5.6 years. Thirty-one patients (5.8%) had pathological WST and 34 (6.4%) reported EAT-10 ≥3. There were significant differences (P<0.001) between groups (pathological WST vs. normal WST) in terms of all EAT-10 total scores. EAT-10 reported a high specificity (96.8% if ≥3 and 98.4% if ≥4), but a low sensitivity (58.1% if ≥3 and 54.8% if ≥4). CONCLUSIONS EAT-10 might be considered as useful screening tools for dysphagia in older people, considering the high specificity of EAT-10≥4. CLINICAL REHABILITATION IMPACT Screening dysphagia risk should be recommended also in patients undergoing rehabilitation in order to set up an early diagnosis and management.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy -
| | - Alice Giachero
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Shara DE Santi
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Katia Inglese
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Claudio Solaro
- Unit of Rehabilitation, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
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Cimoli M, Oates J, McLaughlin E, Langmore SE. Exploring Consistency and Variation in Fibreoptic Endoscopic Evaluation of Swallowing Practice in Australia. Folia Phoniatr Logop 2019; 72:429-441. [PMID: 31639815 DOI: 10.1159/000503132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fibreoptic endoscopic evaluation of swallowing (FEES) is an imaging technique used by speech-language pathologists (SLPs) and some other health professionals to assess swallowing. OBJECTIVES The primary aim was to gain an insight into FEES practices in Australia by characterising SLPs who use FEES and identifying areas of consistency and variation in practice. The secondary aim was to explore factors associated with variation in practice. METHOD Cross-sectional survey methodology was used. The link to a web-based survey was e-mailed to 351 SLPs who practised in adult dysphagia. RESULTS The participation rate for the study was 18.8% (n = 66). Twenty-two SLPs (38.6%) used FEES. These SLPs represented a cross-section of workplace settings, caseloads, clinical and training experiences. Consistency and variation in FEES procedural and assessment practices were identified. Some procedural aspects of FEES varied according to whether a medical practitioner was present, type of FEES training, and number of FEES conducted per month. CONCLUSION This research represents a benchmark in the knowledge of how FEES is used in Australia. Despite the small number of participants, the findings provide a foundation from which future research questions can be generated. More extensive examination of the use of FEES by SLPs is warranted. Further research is also required to establish methods for attaining and maintaining competency and to achieve consensus on which aspects of swallowing are assessed when using FEES and how the examination should be conducted.
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Affiliation(s)
- Michelle Cimoli
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia, .,Speech Pathology Department, Austin Health, Heidelberg, Victoria, Australia,
| | - Jennifer Oates
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Emma McLaughlin
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Speech Pathology Department, Castlemaine Health, Castlemaine, Victoria, Australia
| | - Susan E Langmore
- Department of Otolaryngology, School of Medicine, Boston University, Boston, Massachusetts, USA
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Mavrea S, Regan J. The Diagnostic Accuracy of the Pitch Glide to Identify Aspiration in Patients with Respiratory Diseases: A Pilot Study. Folia Phoniatr Logop 2019; 72:331-340. [PMID: 31514185 DOI: 10.1159/000501451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Initial research has been conducted to determine the diagnostic accuracy of the pitch glide during the clinical swallow evaluation to identify aspiration in adults after stroke. Findings suggest that reduced pitch glide can predict aspiration in patients with dysphagia after stroke. This study aimed to identify the diagnostic accuracy of the pitch glide in detecting aspiration, pharyngeal residue and hyo-laryngeal excursion during swallowing in adults with respiratory diseases. MATERIAL AND METHODS 17 adults (9 males and 8 females) with dysphagia who had a background of respiratory diseases (chronic obstructive pulmonary disease = 11; lower respiratory tract infection = 6) were consecutively recruited in an acute hospital setting. Participants completed two pitch glide tasks (/a/ and /i/) immediately before a videofluoroscopic swallowing study (VFSS). Pitch glide recordings were analysed by blinded researchers both acoustically (Praat software) to obtain maximum F0, pitch range and auditory-perceptually using a binary scale ("normal" or "abnormal"). Clinicians blinded to pitch glide ratings rated 5 mL, 10 mL and a sip of liquid swallows during VFSS using the Penetration-Aspiration Scale, Bolus Residue Scale and hyolaryngeal component of the MBS Measurement Tool for Swallow Impairment. Receiver operating characteristic curve, Pearson correlations and independent sample t tests were used to address the research questions. RESULTS Maximum F0 of sound /a/ had high sensitivity and specificity in identifying aspiration on 10 mL of liquids during VFSS. Both pitch glides (/a/ and /i/) had moderate sensitivity and specificity in predicting aspiration on a sip of liquids. However, auditory-perceptual measures of pitch glide had weak accuracy in identifying people who were aspirating during VFSS. Finally, all pitch glide measures (acoustic and auditory-perceptual) had low accuracy in predicting pharyngeal residue and hyolaryngeal excursion. CONCLUSION Based on this initial pilot study, acoustic pitch glide of sound /a/ is an accurate way to predict aspiration on 10 mL of liquids in patients with respiratory diseases. Based on findings from this study, both auditory-perceptual and acoustic analyses of pitch glide could not identify residue and hyolaryngeal excursion.
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Affiliation(s)
- Sofia Mavrea
- Department of Clinical Speech and Language Studies,Trinity College Dublin, Dublin, Ireland,
| | - Julie Regan
- Department of Clinical Speech and Language Studies,Trinity College Dublin, Dublin, Ireland
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Pacheco-Castilho AC, Vanin GDM, Dantas RO, Pontes-Neto OM, Martino R. Dysphagia and Associated Pneumonia in Stroke Patients from Brazil: A Systematic Review. Dysphagia 2019; 34:499-520. [PMID: 31111249 DOI: 10.1007/s00455-019-10021-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 01/15/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023]
Abstract
Dysphagia and its associated complications are expected to be relatively more frequent in stroke patients in Brazil than in similar patients treated in developed countries due to the suboptimal stroke care in many Brazilians medical services. However, there is no estimate of dysphagia and pneumonia incidence for the overall stroke population in Brazil. We conducted a systematic review of the recent literature to address this knowledge gap, first screening citations for relevance and then rating full articles of accepted citations. At both levels, judgements were made by two independent raters according to a priori criteria. Fourteen accepted articles underwent critical appraisal and data extraction. The frequency of dysphagia in stroke patients was high (59% to 76%). Few studies assessed pneumonia and only one study stratified patients by both dysphagia and pneumonia, with an increased Relative Risk for pneumonia in patients with stroke and dysphagia of 8.4 (95% CI 2.1, 34.4). Across all articles, we identified bias related to: heterogeneity in number and type of stroke; no rater blinding; and, assessments that were not reproducible, reliable or validated. Despite the high frequency of dysphagia and associated pneumonia in stroke patients in Brazil, the quality of the available literature is low and that there is little research focused on these epidemiologic data. Future rigorously designed studies are in dire need to accurately determine dysphagia incidence and its impact on stroke patients in Brazil. These data will be critical to properly allocate limited national resources that maximize the quality of stroke care.
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Affiliation(s)
- Aline Cristina Pacheco-Castilho
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil.
| | - Gabriela de Martini Vanin
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Octávio Marques Pontes-Neto
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, SP, Zip Code: 14049-900, Brazil
| | - Rosemary Martino
- Department of Speech Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Buhmann C, Flügel T, Bihler M, Gerloff C, Niessen A, Hidding U, Nienstedt JC, Pflug C. Is the Munich dysphagia Test–Parkinson's disease (MDT-PD) a valid screening tool for patients at risk for aspiration? Parkinsonism Relat Disord 2019; 61:138-143. [DOI: 10.1016/j.parkreldis.2018.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/16/2022]
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Current approaches to instrumental assessment of swallowing in children. Curr Opin Otolaryngol Head Neck Surg 2019; 26:349-355. [PMID: 30325754 DOI: 10.1097/moo.0000000000000492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF THE REVIEW This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. RECENT FINDINGS Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. SUMMARY Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging.
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Perren A, Zürcher P, Schefold JC. Clinical Approaches to Assess Post-extubation Dysphagia (PED) in the Critically Ill. Dysphagia 2019; 34:475-486. [PMID: 30684017 DOI: 10.1007/s00455-019-09977-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
Swallowing disorders and respective consequences (including aspiration-induced pneumonia) are often observed in extubated ICU patients with data indicating that a large number of patients are affected. We recently demonstrated in a large-scale analysis that the incidence of post-extubation dysphagia (PED) is 12.4% in a general ICU population and about 18% in emergency admissions to the ICU. Importantly, PED was mostly sustained until hospital discharge and independently predicted 28- and 90-day mortality. Although oropharyngeal/laryngeal trauma, neuromuscular ICU-acquired weakness, reduced sensation/sensorium, dyssynchronous breathing, and gastrointestinal reflux, are all considered to contribute to PED, little is known about the underlying pathomechanisms and risk factors leading to PED in critically ill patients. Systematic screening of all potential ICU patients for oropharyngeal dysphagia (OD) seems key for early recognition and follow-up, as well as the design and testing of novel therapeutic interventions. Today, screening methods and clinical investigations for dysphagia differ considerably. In the context of a recently proposed pragmatic screening algorithm introduced by us, we provide a concise review on currently available non-instrumental techniques that could potentially serve for non-instrumental OD assessment in critically ill patients. Following systematic literature review, we find that non-instrumental OD assessments were mostly tested in different patient populations with only a minority of studies performed in critically ill patients. Due to little available data on non-instrumental dysphagia assessment in the ICU, future investigations should aim to validate respective approaches in the critically ill against an instrumental (gold) standard, for example, flexible endoscopic evaluation of swallowing. An international expert panel is encouraged to addresses critical illness-related definitions, screening and confirmatory assessment approaches, treatment recommendations, and identifies optimal patient-centered outcome measures for future clinical investigations.
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Affiliation(s)
- Andrea Perren
- Department of Physiotherapy, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Patrick Zürcher
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, University Hospital of Bern, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
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Min SW, Oh SH, Kim GC, Sim YJ, Kim DK, Jeong HJ. Clinical Importance of Peak Cough Flow in Dysphagia Evaluation of Patients Diagnosed With Ischemic Stroke. Ann Rehabil Med 2018; 42:798-803. [PMID: 30613072 PMCID: PMC6325319 DOI: 10.5535/arm.2018.42.6.798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 07/11/2018] [Indexed: 11/06/2022] Open
Abstract
Objective To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke. Methods This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups. Results The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups. Conclusion Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.
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Affiliation(s)
- Sang Won Min
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Se Hyun Oh
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ghi Chan Kim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Young Joo Sim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Dong Kyu Kim
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
| | - Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University College of Medicine, Busan, Korea
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Vose AK, Kesneck S, Sunday K, Plowman E, Humbert I. A Survey of Clinician Decision Making When Identifying Swallowing Impairments and Determining Treatment. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2735-2756. [PMID: 30458527 PMCID: PMC7242916 DOI: 10.1044/2018_jslhr-s-17-0212] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 06/19/2018] [Indexed: 05/11/2023]
Abstract
PURPOSE Speech-language pathologists (SLPs) are the primary providers of dysphagia management; however, this role has been criticized with assertions that SLPs are inadequately trained in swallowing physiology (Campbell-Taylor, 2008). To date, diagnostic acuity and treatment planning for swallowing impairments by practicing SLPs have not been examined. We conducted a survey to examine how clinician demographics and swallowing complexity influence decision making for swallowing impairments in videofluoroscopic images. Our goal was to determine whether SLPs' judgments of swallowing timing impairments align with impairment thresholds available in the research literature and whether or not there is agreement among SLPs regarding therapeutic recommendations. METHOD The survey included 3 videofluoroscopic swallows ranging in complexity (easy, moderate, and complex). Three hundred three practicing SLPs in dysphagia management participated in the survey in a web-based format (Qualtrics, 2005) with frame-by-frame viewing capabilities. SLPs' judgments of impairment were compared against impairment thresholds for swallowing timing measures based on 95% confidence intervals from healthy swallows reported in the literature. RESULTS The primary impairment in swallowing physiology was identified 67% of the time for the easy swallow, 6% for the moderate swallow, and 6% for the complex swallow. On average, practicing clinicians mislabeled 8 or more swallowing events as impaired that were within the normal physiologic range compared with healthy normative data available in the literature. Agreement was higher among clinicians who report using frame-by-frame analysis 80% of the time. A range of 19-21 different treatments was recommended for each video, regardless of complexity. CONCLUSIONS Poor to modest agreement in swallowing impairment identification, frequent false positives, and wide variability in treatment planning recommendations suggest that additional research and training in healthy and disordered swallowing are needed to increase accurate dysphagia diagnosis and treatment among clinicians.
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Affiliation(s)
- Alicia K. Vose
- Rehabilitation Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
- Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
- Breathing Research and Therapeutics Training Program (T32 HL134621), Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville
| | - Sara Kesneck
- Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
| | - Kirstyn Sunday
- Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
| | - Emily Plowman
- Rehabilitation Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
- Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
| | - Ianessa Humbert
- Rehabilitation Sciences, College of Public Health and Health Professions, University of Florida, Gainesville
- Swallowing Systems Core, Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville
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Checklin M, Pizzari T. Impaired Tongue Function as an Indicator of Laryngeal Aspiration in Adults with Acquired Oropharyngeal Dysphagia: A Systematic Review. Dysphagia 2018; 33:778-788. [DOI: 10.1007/s00455-018-9902-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/19/2018] [Indexed: 01/03/2023]
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Ihalainen T, Rinta-Kiikka I, Luoto TM, Thesleff T, Helminen M, Korpijaakko-Huuhka AM, Ronkainen A. Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury. Spine J 2018; 18:81-87. [PMID: 28673831 DOI: 10.1016/j.spinee.2017.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/18/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laryngeal penetration-aspiration, the entry of material into the airways, is considered the most severe subtype of dysphagia and is common among patients with acute cervical spinal cord injury (SCI). PURPOSE The aim of this study was to investigate risk factors for penetration-aspiration in patients with acute traumatic cervical spinal cord injury (TCSCI). STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE Thirty-seven patients with TCSCI were included in the study. OUTCOME MEASURES The highest Rosenbek penetration-aspiration scale (PAS; range 1-8) score of each patient was the primary outcome measure. The risk factors consisted of patient characteristics, demographics, and clinical signs observed during a clinical swallowing trial. MATERIALS AND METHODS A clinical swallowing trial and videofluoroscopic swallowing study (VFSS) was performed on all patients within 28 days post injury. For group comparisons, the patients were divided into two groups: (1) penetrator-aspirators (PAS score ≥3) and (2) non-penetrator-aspirators (PAS score ≤2). RESULTS Of the 37 patients, 83.8% were male. The mean age at the time of the injury was 61.2 years. Most patients had an incomplete TCSCI (78.4%) caused by a fall (75.7%). In the VFSS, 51.4% of the patients were penetrator-aspirators, and 71.4% had silent aspiration. The risk factors for predicting penetration-aspiration were (1) necessity of bronchoscopies, (2) lower level of anterior cervical operation, (3) coughing, throat clearing, choking related to swallowing, and (4) changes in voice quality related to swallowing. Binary logistic regression identified coughing, throat clearing, choking, and changes in voice quality related to swallowing as independent risk factors for penetration-aspiration. CONCLUSIONS The necessity of bronchoscopies, postinjury lower cervical spine anterior surgery, coughing, throat clearing, choking, and changes in voice quality related to swallowing was a markedrisk factor for aspiration and penetration following a cervical SCI. These factors and signs should be used to suspect injury-related pharyngeal dysfunction and to initiate preventive measures to avoid complications. The clinical swallowing evaluation is a relevant adjunct in the management of these patients and can improve the detection of penetration and aspiration.
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Affiliation(s)
- Tiina Ihalainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland; Faculty of Social Sciences, University of Tampere, Kalevantie 4, Tampere FI-33014, Finland.
| | - Irina Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
| | - Tuomo Thesleff
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
| | - Mika Helminen
- Science Center, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland; Health Sciences, Faculty of Social Sciences, University of Tampere, P.O. Box 100, Tampere FI-33104, Finland
| | | | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
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Santos KWD, Scheeren B, Maciel AC, Cassol M. Postswallow voice modification: compatibility with videofluoroscopy findings. Codas 2017; 29:e20170004. [PMID: 29211112 DOI: 10.1590/2317-1782/20172017004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/27/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Verify whether voice modification after swallowing is associated with videofluoroscopic examination data. METHODS 27 patients with oropharyngeal dysphagia underwent recording of sustained phonation of vowel /a/ before and after swallowing during videofluoroscopy. The GRBAS scale and the wet voice parameter were used to evaluate the data. Videofluoroscopy results showed stasis of food in the valleculae and piriform recesses, laryngeal penetration, tracheal aspiration, and degree of dysphagia. RESULTS Decreased dysphonia grade and asthenia and increased strain were observed after swallowing, with no difference for the wet voice parameter. Sensitivity and specificity of ± 50% were observed for food stasis in the valleculae and piriform recesses. Sensitivity values of 80 and 66-75% were observed for detection of laryngeal penetration and tracheal aspiration and modification of vocal strain, respectively. Negative predictive values of 77-91% were found for the three assessment parameters with no correlation with the degree of oropharyngeal dysphagia. CONCLUSION Modification of the GRBAS scale parameters after swallowing showed good compatibility with videofluoroscopy findings.
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Affiliation(s)
| | - Betina Scheeren
- Irmandade Santa Casa de Misericórdia de Porto Alegre - Porto Alegre (RS), Brasil
| | | | - Mauriceia Cassol
- Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
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Sassi FC, Medeiros GC, Zilberstein B, Jayanthi SK, de Andrade CR. Screening protocol for dysphagia in adults: comparison with videofluoroscopic findings. Clinics (Sao Paulo) 2017; 72:718-722. [PMID: 29319716 PMCID: PMC5738561 DOI: 10.6061/clinics/2017(12)01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/15/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To compare the videofluoroscopic findings of patients with suspected oropharyngeal dysphagia with the results of a clinical screening protocol. METHODS A retrospective observational cohort study was conducted on all consecutive patients with suspected oropharyngeal dysphagia between March 2015 and February 2016 who were assigned to receive a videofluoroscopic assessment of swallowing. All patients were first submitted to videofluoroscopy and then to the clinical assessment of swallowing. The clinical assessment was performed within the first 24 hours after videofluoroscopy. The videofluoroscopy results were analyzed regarding penetration/aspiration using an 8-point multidimensional perceptual scale. The accuracy of the clinical protocol was analyzed using the sensitivity, specificity, likelihood ratios and predictive values. RESULTS The selected sample consisted of 50 patients. The clinical protocol presented a sensitivity of 50% and specificity of 95%, with an accuracy of 88%. "Cough" and "wet-hoarse" vocal quality after/during swallowing were clinical indicators that appeared to correctly identify the presence of penetration/aspiration risk. CONCLUSION The clinical protocol used in the present study is a simple, rapid and reliable clinical assessment. Despite the absence of a completely satisfactory result, especially in terms of the sensitivity and positive predictive values, we suggest that lower rates of pneumonia can be achieved using a formal dysphagia screening method.
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Affiliation(s)
- Fernanda C. Sassi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gisele C. Medeiros
- Divisão de Fonoaudiologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Zilberstein
- Divisao de Cirurgia Digestiva, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Shri Krishna Jayanthi
- Instituto de Radiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudia R.F. de Andrade
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Pu D, Murry T, Wong MCM, Yiu EML, Chan KMK. Indicators of Dysphagia in Aged Care Facilities. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:2416-2426. [PMID: 28806819 DOI: 10.1044/2017_jslhr-s-17-0028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. METHOD A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating Assessment Tool score, oral motor assessment score, Mini-Mental State Examination, medical history, and various functional status ratings. Binomial logistic regression was used to identify independent variables associated with dysphagia in this cohort. RESULTS Two statistical models were constructed. Model 1 used variables from case files without the need for hands-on assessment, and Model 2 used variables that could be obtained from hands-on assessment. Variables positively associated with dysphagia identified in Model 1 were male gender, total dependence for activities of daily living, need for feeding assistance, mobility, requiring assistance walking or using a wheelchair, and history of pneumonia. Variables positively associated with dysphagia identified in Model 2 were Mini-Mental State Examination score, edentulousness, and oral motor assessments score. CONCLUSIONS Cognitive function, dentition, and oral motor function are significant indicators associated with the presence of swallowing in the elderly. When assessing the frail elderly, case file information can help clinicians identify frail elderly individuals who may be suffering from dysphagia.
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Affiliation(s)
- Dai Pu
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences, The University of Hong Kong, Pok Fu Lam
| | - Thomas Murry
- Voice and Swallowing Center, Loma Linda University, Redlands, CA
| | - May C M Wong
- Faculty of Dentistry, The University of Hong Kong, Pok Fu Lam
| | - Edwin M L Yiu
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences, The University of Hong Kong, Pok Fu Lam
| | - Karen M K Chan
- Swallowing Research Laboratory, Division of Speech and Hearing Sciences, The University of Hong Kong, Pok Fu Lam
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Baumann B, Byers S, Wasserman-Wincko T, Smith L, Hathaway B, Bhama J, Shigemura N, Hayanga JA, D'Cunha J, Johnson JT. Postoperative Swallowing Assessment After Lung Transplantation. Ann Thorac Surg 2017; 104:308-312. [DOI: 10.1016/j.athoracsur.2017.01.080] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/25/2022]
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Clinical assessment of dysphagia in neurodegeneration (CADN): development, validity and reliability of a bedside tool for dysphagia assessment. J Neurol 2017; 264:1107-1117. [DOI: 10.1007/s00415-017-8499-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 12/12/2022]
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Lynch YT, Clark BJ, Macht M, White SD, Taylor H, Wimbish T, Moss M. The accuracy of the bedside swallowing evaluation for detecting aspiration in survivors of acute respiratory failure. J Crit Care 2017; 39:143-148. [PMID: 28259057 DOI: 10.1016/j.jcrc.2017.02.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/25/2016] [Accepted: 02/01/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dysphagia with subsequent aspiration occurs in up to 60% of acute respiratory failure (ARF) survivors. Accurate bedside tests for aspiration can reduce aspiration-related complications while minimizing delay of oral nutrition. In a cohort of ARF survivors, we determined the accuracy of the bedside swallowing evaluation (BSE) and its components for detecting aspiration. METHODS Patients who were extubated after at least 24hours of mechanical ventilation were eligible for enrollment. Within 3 days of extubation, patients underwent comprehensive BSE including 3-oz water swallowing test (3-WST), followed by a criterion standard test for aspiration, flexible endoscopic evaluation of swallowing (FEES). RESULTS Forty-five patients were included in the analysis. Median patient age was 55years (interquartile range, 47-65). Median duration of mechanical ventilation was 3.3days (interquartile range 1.8-6.0). Fourteen patients (31%) aspirated on FEES. Physical examination findings on BSE and abnormal swallowing during trials of different consistencies were variably associated with aspiration. Compared with FEES, the 3-WST yielded a sensitivity of 77% (95% confidence interval [CI], 50%-92%), specificity of 65% (95% CI, 47%-79%), and an area under the receiver operating characteristic curve (AUC) of 0.71; a speech language pathologist's recommendation for altered diet yielded a sensitivity of 86% (95% CI, 60%-96%), a specificity of 52% (95% CI, 35%-68%), and an AUCof 0.69; an speech language pathologist's recommendation for nil per os (nothing by mouth) yielded a sensitivity of 50% (95% CI, 27%-73%), a specificity of 94% (95% CI, 79%-98%), and an AUCof 0.72. CONCLUSIONS The BSE and its components, including the 3-WST, demonstrated variable accuracy for aspiration in survivors of ARF. Investigation to determine the optimal noninvasive test for aspiration in ARF survivors is warranted. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier: NCT02363686, Aspiration in Acute Respiratory Failure Survivors.
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Affiliation(s)
- Ylinne T Lynch
- Division of Pulmonary and Critical Care, University of Washington, Seattle, WA
| | - Brendan J Clark
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO
| | - Madison Macht
- Critical Care, Pulmonary, and Sleep Associates, Lakewood, CO
| | - S David White
- Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO
| | - Heather Taylor
- Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO
| | - Tim Wimbish
- Rehabilitation Therapy, University of Colorado Hospital, Aurora, CO
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO.
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ICU-Related Dysphagia. Dysphagia 2017. [DOI: 10.1007/174_2017_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nakayama E, Tohara H, Sakai K, Hayata M, Ohnishi S, Sekino J, Tsuzuki H, Hirai T, Hayashi A, Ueda K. Predictive Factors Associated with Oral Intake Ability in Gastrostomy Patients Under Long-Term Care. J Nutr Health Aging 2017; 21:715-720. [PMID: 28537338 DOI: 10.1007/s12603-016-0796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the physical indicators associated with oral intake status and swallowing function in gastrostomy patients under long-term care. DESIGN Cross-sectional study. SETTING Thirty-one hospitals that perform gastrostomy insertion, replacement and management. PARTICIPANTS A total of 117 respondents from 31 hospitals in Japan underwent gastrostomy tube replacement and management between September 2012 and January 2014. Each participant underwent a gastrostomy at least 6 months prior to the study, and received long-term care either at home, a care facility, or a hospital. MEASUREMENTS We conducted a questionnaire survey at Japanese hospitals and used the data obtained from 117 respondents for analysis. The survey was conducted using a questionnaire form that collected information about the following items: oral intake status, sex, age, disease history, number of days elapsed since gastrostomy, residence status, modified Rankin Scale score, consciousness, oral hygiene status, articulation and phonation, voluntary saliva swallow, Modified Water Swallow Test, and Food Test. RESULTS Results revealed significant differences in modified Rankin Scale scores, sputum production, articulation and phonation, and voluntary saliva swallowing between patients who were orally fed and those who were not. Moreover, sputum production and voluntary saliva swallowing were strongly associated with oral intake status. Finally, sputum production, articulation and phonation, and voluntary saliva swallowing were strongly associated with swallowing function test results. CONCLUSION Results from this study suggested that sputum production, articulation and phonation, and voluntary saliva swallowing could be used as indicators for estimating oral intake status and swallowing function in gastrostomy patients under long-term care.
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Affiliation(s)
- E Nakayama
- Enri Nakayama, Nihon University School of Dentistry, Japan,
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A Supporting Platform for Semi-Automatic Hyoid Bone Tracking and Parameter Extraction from Videofluoroscopic Images for the Diagnosis of Dysphagia Patients. Dysphagia 2016; 32:315-326. [DOI: 10.1007/s00455-016-9759-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Frakking TT, Chang AB, O'Grady KAF, Yang J, David M, Weir KA. Acoustic and Perceptual Profiles of Swallowing Sounds in Children: Normative Data for 4-36 Months from a Cross-Sectional Study Cohort. Dysphagia 2016; 32:261-270. [PMID: 27830392 DOI: 10.1007/s00455-016-9755-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/18/2016] [Indexed: 12/12/2022]
Abstract
Limited data on cervical auscultation (CA) sounds during the transitional feeding period of 4-36 months in healthy children exist. This study examined the acoustic and perceptual parameters of swallowing sounds in children aged 4-36 months over a range of food and fluid consistencies. Using CA, swallowing sounds were recorded from a microphone as children ate or drank. Acoustic parameters of duration, peak frequency and peak intensity were determined. Perceptual parameters of swallowing/breath sounds heard pre-, during and post-swallow were rated ('present', 'absent', 'cannot be determined') for each texture. 74 children (35 males; mean age = 17.1 months [SD 10.0]) demonstrated mean swallow durations of <1 s. Increasing age correlated to reduced peak frequency on puree (r = -0.48, 95 % CI -0.66, -0.24). Age correlated to peak amplitude when swallowing puree (r = 0.27, 95 % CI 0.02, 0.49), chewable solids (r = 0.31, 95 % CI 0.02, 0.56) and thin fluids (r = 0.48, 95 % CI 0.27, 0.64). The bolus transit sound was present in all swallows. A majority of children had normal breathing sounds and coordinated swallows. A swallow duration of <1 s and the presence of a quick bolus transit sound with normal breathing sounds were found in healthy children. The normative data reported in this study provide a platform for future comparison to abnormal swallowing sounds in children.
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Affiliation(s)
- Thuy T Frakking
- Centre for Children's Health Research, The University of Queensland, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia. .,Speech Pathology Department, Caboolture Hospital, McKean St, Caboolture, QLD, 4510, Australia.
| | - Anne B Chang
- Queensland Children's Respiratory Centre, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, QLD, 4101, Australia.,Child Health Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.,Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Julie Yang
- Centre for Children's Health Research, The University of Queensland, Level 7, 62 Graham St, South Brisbane, QLD, 4101, Australia
| | - Michael David
- School of Public Health, The University of Queensland, Herston Rd, Herston, QLD, 4029, Australia
| | - Kelly A Weir
- School of Medicine, The University of Queensland, St Lucia, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
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Abstract
BACKGROUND Stroke is the leading cause of mortality and disability worldwide. Important sequels are frequent, including dysphagia and communication disorders. OBJECTIVE to determine the prevalence of dysphagia and communication disorders following stroke, and to identify if communication disorders can predict dysphagia. METHODS Thirty-one prospective and consecutive patients were admitted to the Otolaryngology-Dysphagia Outpatient Clinic with diagnosis of ischemic or hemorrhagic stroke. Stroke was confirmed by computed tomography or magnetic resonance imaging, and medical evaluation. All patients had a swallowing and communication evaluation. We compared patients with and without dysphagia, and established the co-occurrence among dysphagia and communication disorders. RESULTS Twenty-five patients presented dysphagia. Aphasia occurred in 32.3% of the patients; dysarthria in 45.2%. Dysphagia and aphasia co-occurred in 29% of the population; dysphagia and dysarthria in 45.2%; the three conditions co-occurred in 22.6%. Dysarthria was a predictor of dysphagia, and it was associated with the presence of oral stage problems. CONCLUSIONS A comprehensive evaluation of dysphagia, aphasia, and dysarthria are important to improve clinical outcome following stroke. The identification of dysarthria as a predictor of dysphagia can help identify risk for dysphagia in stroke and assist in the therapeutic process of swallowing problems.
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Watts SA, Tabor L, Plowman EK. To Cough or Not to Cough? Examining the Potential Utility of Cough Testing in the Clinical Evaluation of Swallowing. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016; 4:262-276. [PMID: 28529824 DOI: 10.1007/s40141-016-0134-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The clinical swallowing evaluation (CSE) represents a critical component of a comprehensive assessment of deglutition. Although universally utilized across clinical settings, the CSE demonstrates limitations in its ability to accurately identify all individuals with dysphagia. There exists a need to improve assessment and screening techniques to improve health outcomes, treatment recommendations and ultimately mortality in individuals at risk for dysphagia. The following narrative review provides a summary of currently used validated CSE's and examines the potential role of cough testing and screening in the CSE. RECENT FINDINGS Recent evidence highlights a relationship between objective physiologic measurements of both voluntarily and reflexively induced cough and swallowing safety status across several patient populations. Although more research is needed across a wider range of patient populations to validate these findings; emerging data supports the consideration of inclusion of cough testing during the CSE as an index of airway defense mechanisms and capabilities in individuals at risk for aspiration. SUMMARY The sensorimotor processes of cough and swallowing share common neuroanatomical and functional substrates. Inclusion of voluntarily or reflexively induced cough testing in the CSE may aide in the identification of dysphagia and reduced airway protection capabilities.
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Affiliation(s)
- Stephanie A Watts
- Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida, 13330 USF Laurel Drive MDC Box 72, Tampa, FL 33612, USA.,Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA
| | - Lauren Tabor
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA.,Department of Speech, Language and Hearing Sciences, University of Florida, PO Box 117420, Gainesville, FL 32611, USA
| | - Emily K Plowman
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA.,Department of Speech, Language and Hearing Sciences, University of Florida, PO Box 117420, Gainesville, FL 32611, USA
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Calvo I, Conway A, Henriques F, Walshe M. Diagnostic accuracy of the clinical feeding evaluation in detecting aspiration in children: a systematic review. Dev Med Child Neurol 2016; 58:541-53. [PMID: 26862075 DOI: 10.1111/dmcn.13058] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
Abstract
The aim of this systematic review is to determine the diagnostic accuracy of clinical feeding evaluation (CFE) compared to instrumental assessments in detecting oropharyngeal aspiration (OPA) in children. This is important to support clinical decision-making and to provide safe, cost-effective, higher quality care. All published and unpublished studies in all languages assessing the diagnostic accuracy of CFE compared to videofluoroscopic swallowing study (VFSS) and/or fibre-optic endoscopic examination of swallowing (FEES) in detecting OPA in paediatric populations were sought. Databases were searched from inception to April 2015. Grey literature, citations, and references were also searched. Two independent reviewers extracted and analysed data. Accuracy estimates were calculated. Research reports were translated into English as required. Six studies examining the diagnostic accuracy of CFE using VFSS and/or FEES were eligible for inclusion. Sample sizes, populations studied, and CFE characteristics varied widely. The overall methodological quality of the studies, assessed with QUADAS-2, was considered 'low'. Results suggested that CFEs trialling liquid consistencies might provide better accuracy estimates than CFEs trialling solids exclusively. This systematic review highlights the critical lack of evidence on the accuracy of CFE in detecting OPA in children. Larger well-designed primary diagnostic test accuracy studies in this area are needed to inform dysphagia assessment in paediatrics.
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Affiliation(s)
- Irene Calvo
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland.,Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milano, Italy
| | - Aifric Conway
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Filipa Henriques
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
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Brodsky MB, Suiter DM, González-Fernández M, Michtalik HJ, Frymark TB, Venediktov R, Schooling T. Screening Accuracy for Aspiration Using Bedside Water Swallow Tests: A Systematic Review and Meta-Analysis. Chest 2016; 150:148-63. [PMID: 27102184 DOI: 10.1016/j.chest.2016.03.059] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/22/2016] [Accepted: 03/31/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be efficient and cost-effective for preventing additional comorbidities and mortality. We evaluated screening accuracy of bedside WSTs used to identify patients at risk for dysphagia-associated aspiration. METHODS Sixteen online databases, Google Scholar, and known content experts through May 2015 were searched. Only prospective studies with patients ≥ 18 years of age given WST screenings validated against nasoendoscopy or videofluoroscopy were included. Data extraction used dual masked extraction and quality assessment following Meta-analysis of Observational Studies in Epidemiology guidelines. RESULTS Airway response (eg, coughing/choking) with or without voice changes (eg, wet/gurgly voice quality) was used to identify aspiration during three different bedside WSTs. Pooled estimates for single sip volumes (1-5 mL) were 71% sensitive (95% CI, 63%-78%) and 90% specific (95% CI, 86%-93%). Consecutive sips of 90 to 100 mL trials were 91% sensitive (95% CI, 89%-93%) and 53% specific (95% CI, 51%-55%). Trials of progressively increasing volumes of water were 86% sensitive (95% CI, 76%-93%) and 65% specific (95% CI, 57%-73%). Airway response with voice change improved overall accuracy in identifying aspiration. CONCLUSIONS Currently used bedside WSTs offer sufficient, although not ideal, utility in screening for aspiration. Consecutive sips with large volumes in patients who did not present with overt airway responses or voice changes appropriately ruled out risk of aspiration. Small volumes with single sips appropriately ruled in aspiration when clinical signs were present. Combining these bedside approaches may offer improved screening accuracy, but further research is warranted.
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Affiliation(s)
- Martin B Brodsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD; Outcomes After Critical Illness and Surgery Research Group, Johns Hopkins University, Baltimore, MD.
| | - Debra M Suiter
- College of Health Sciences, Division of Communication Sciences and Disorders, University of Kentucky, Lexington, KY
| | | | - Henry J Michtalik
- Department of Medicine, Division of General Internal Medicine, Hospitalist Program, Johns Hopkins University, Baltimore, MD; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, MD
| | - Tobi B Frymark
- National Center for Evidence-Based Practice in Communication Disorders, American Speech-Language-Hearing Association, Rockville, MD
| | - Rebecca Venediktov
- National Center for Evidence-Based Practice in Communication Disorders, American Speech-Language-Hearing Association, Rockville, MD
| | - Tracy Schooling
- National Center for Evidence-Based Practice in Communication Disorders, American Speech-Language-Hearing Association, Rockville, MD
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Rangarathnam B, McCullough GH. Utility of a Clinical Swallowing Exam for Understanding Swallowing Physiology. Dysphagia 2016; 31:491-7. [DOI: 10.1007/s00455-016-9702-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/03/2016] [Indexed: 11/29/2022]
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Serrano Santos JM, Poland F, Wright D, Longmore T. Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice. Int J Pharm 2016; 512:416-421. [PMID: 26906457 DOI: 10.1016/j.ijpharm.2016.02.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In the UK, 69.5% of residents in care homes are exposed to one or more medication errors and 50% have some form of dysphagia. Hospital research identified that nurses frequently crush tablets to facilitate swallowing but this has not been explored in care homes. This project aimed to observe the administration of medicines to patients with dysphagia (PWD) and without in care homes. METHOD A convenient sample of general practitioners in North Yorkshire invited care homes with nursing, to participate in the study. A pharmacist specialised in dysphagia observed nurses during drug rounds and compared these practices with national guidelines. Deviations were classified as types of medication administration errors (MAEs). RESULTS Overall, 738 administrations were observed from 166 patients of which 38 patients (22.9%) had dysphagia. MAE rates were 57.3% and 30.8% for PWD and those without respectively (p<0.001). PWD were more likely to experience inappropriate prescribing (IP). Signs of aspiration were more frequently observed in PWD when IP occurred (p<0.001). CONCLUSION Observation of medication administration practices by independent pharmacists may enable the identification of potentially dangerous practices and be used as a method of staff support. Unidentified signs of aspiration suggest that nurses require training in dysphagia and need to communicate its presence to the resident's GP. Further research should explore the design of an effective training for nurses.
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Affiliation(s)
- Jose Manuel Serrano Santos
- Pharmacy Practice, School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia.
| | - Fiona Poland
- Social Research Methodology, School of Health Sciences, University of East Anglia, Norfolk NR4 7TJ, United Kingdom.
| | - David Wright
- Pharmacy Practice, School of Pharmacy, University of East Anglia, Norfolk NR4 7TJ, United Kingdom.
| | - Timothy Longmore
- York Road Surgery, Elvington, York, North Yorkshire YO41 4DY, United Kingdom.
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Simpelaere IS, Van Nuffelen G, Vanderwegen J, Wouters K, De Bodt M. Oral health screening: feasibility and reliability of the oral health assessment tool as used by speech pathologists. Int Dent J 2016; 66:178-89. [PMID: 26853437 DOI: 10.1111/idj.12220] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility and reliability of the Oral Health Assessment Tool (OHAT) as used by speech pathologists, to become part of a comprehensive clinical swallowing examination. METHODS A multicentre study in 132 elderly subjects was conducted by speech pathologists. The inter-rater, test-retest and intra-rater reliabilities of the OHAT were assessed in R statistics, version 3.0.1. Intraclass correlation coefficients (ICCs) were used for the total OHAT, and Kappa statistics were used for the individual categories. RESULTS Total OHAT scores showed good inter-rater (ICC = 0.96), intra-rater (ICC ≥ 0.95) and test-retest (ICC ≥ 0.78) agreement. The inter-rater Kappa statistics were almost perfect (κ ≥ 0.83) for seven of the eight individual categories of the OHAT and perfect for 'dental pain' (κ = 1.00). The test-retest Kappa statistics indicated excellent agreement for 'natural teeth' and 'dentures' (κ ≥ 0.86). The intra-rater per cent agreement was excellent for all categories except 'gums and tissues'. CONCLUSIONS This is the first study to examine the feasibility and reliability of the OHAT as used by speech pathologists. As the results showed both good feasibility and reliability, the OHAT has the potential to add to the clinical swallowing examination. However, future research investigating actual referral strategies and adaptation of care strategies following assessment with OHAT is needed.
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Affiliation(s)
- Ingeborg S Simpelaere
- VIVES University College, Bruges, Belgium.,Department Speech-Language Pathology, AZ Delta Hospital, Menen, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Jan Vanderwegen
- Department of Otolaryngology, Head and Neck Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Kristien Wouters
- Department of Scientific Coordination and Biostatistics, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Department of Otolaryngology and Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Department of Speech, Language and Hearing Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium
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Dudik JM, Kurosu A, Coyle JL, Sejdić E. A statistical analysis of cervical auscultation signals from adults with unsafe airway protection. J Neuroeng Rehabil 2016; 13:7. [PMID: 26801236 PMCID: PMC4722771 DOI: 10.1186/s12984-015-0110-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 12/19/2015] [Indexed: 01/16/2023] Open
Abstract
Background Aspiration, where food or liquid is allowed to enter the larynx during a swallow, is recognized as the most clinically salient feature of oropharyngeal dysphagia. This event can lead to short-term harm via airway obstruction or more long-term effects such as pneumonia. In order to non-invasively identify this event using high resolution cervical auscultation there is a need to characterize cervical auscultation signals from subjects with dysphagia who aspirate. Methods In this study, we collected swallowing sound and vibration data from 76 adults (50 men, 26 women, mean age 62) who underwent a routine videofluoroscopy swallowing examination. The analysis was limited to swallows of liquid with either thin (<5 cps) or viscous (≈300 cps) consistency and was divided into those with deep laryngeal penetration or aspiration (unsafe airway protection), and those with either shallow or no laryngeal penetration (safe airway protection), using a standardized scale. After calculating a selection of time, frequency, and time-frequency features for each swallow, the safe and unsafe categories were compared using Wilcoxon rank-sum statistical tests. Results Our analysis found that few of our chosen features varied in magnitude between safe and unsafe swallows with thin swallows demonstrating no statistical variation. We also supported our past findings with regard to the effects of sex and the presence or absence of stroke on cervical ausculation signals, but noticed certain discrepancies with regards to bolus viscosity. Conclusions Overall, our results support the necessity of using multiple statistical features concurrently to identify laryngeal penetration of swallowed boluses in future work with high resolution cervical auscultation.
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Affiliation(s)
- Joshua M Dudik
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA.
| | - Atsuko Kurosu
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 4028 Forbes Tower, Pittsburgh, PA, 15260, USA.
| | - James L Coyle
- Department of Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, 4028 Forbes Tower, Pittsburgh, PA, 15260, USA.
| | - Ervin Sejdić
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA, 15261, USA.
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Festic E, Soto JS, Pitre LA, Leveton M, Ramsey DM, Freeman WD, Heckman MG, Lee AS. Novel Bedside Phonetic Evaluation to Identify Dysphagia and Aspiration Risk. Chest 2016. [PMID: 26203916 DOI: 10.1378/chest.15-0789] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is a need for improved clinical identification of hospitalized patients at risk of aspiration. We evaluated our novel phonetic test in a broad spectrum of patients at risk of aspiration in the ICU or intermediate care unit. METHODS We prospectively enrolled 60 hospitalized patients with aspiration risk, between December 2009 and September 2011, who subsequently underwent audio-recorded three-component phonetic bedside evaluation. The recordings were scored by two blinded speech-language pathologists. The institutional dysphagia admission screening test was performed by a bedside nurse. The primary outcomes, dysphagia and aspiration, were assessed by a videofluoroscopic swallowing study, fiber-optic endoscopic evaluation of swallowing, or both. We assessed the short- and long-term clinical outcomes (length of stay, subsequent aspiration pneumonia and respiratory failure, survival) and how these were associated with the phonetic and swallow assessments. RESULTS Statistically significant linear associations with dysphagia were noted for all three individual phonetic components. Also, there were statistically significant linear associations with aspiration for diadochokinesis (P = .050) and consensus auditory-perceptual evaluation of voice (P = .025). Diadochokinesis alone predicted dysphagia (area under the curve [AUC], 0.74; P = .001) and aspiration (AUC, 0.67; P = .012). Its predictive ability improved when combined with normalized dysphagia admission screening test results (AUC, 0.79; P = .001). The short- and long-term clinical outcomes were adversely affected by the worse phonetic/swallowing scores, although they were not statistically different. CONCLUSIONS Abnormal phonation among ICU and intermediate care unit patients is associated with dysphagia and aspiration. Future investigative efforts should uncover the most effective combination of evaluations for accurate bedside detection of dysphagia and aspiration risk in a broad spectrum of patients.
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Affiliation(s)
- Emir Festic
- Departments of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL.
| | - Jose Soto Soto
- Departments of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL
| | - Lisa A Pitre
- Department of Speech-Language Pathology, Mayo Clinic, Jacksonville, FL
| | - Marilu Leveton
- Department of Speech-Language Pathology, Mayo Clinic, Jacksonville, FL
| | | | - William D Freeman
- Departments of Neurology and Critical Care, Mayo Clinic, Jacksonville, FL
| | - Michael G Heckman
- Department of Health Sciences Research, Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Augustine S Lee
- Departments of Pulmonary and Critical Care, Mayo Clinic, Jacksonville, FL
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Boccardi V, Ruggiero C, Patriti A, Marano L. Diagnostic Assessment and Management of Dysphagia in Patients with Alzheimer's Disease. J Alzheimers Dis 2016; 50:947-955. [PMID: 26836016 DOI: 10.3233/jad-150931] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A growing concern in patients affected by Alzheimer's disease (AD) is dysphagia, or swallowing impairment, which leads to malnutrition, dehydration, weight loss, functional decline and fear of eating and drinking, as well as a decrease in the quality of life. Thus the diagnostic assessment of dysphagia in patients with AD is imperative to ensure that they receive effective management, avoiding complications, and reducing comorbidity and mortality in such a growing population. Dysphagia management requires a multidisciplinary approach considering that no single strategy is appropriate for all patients. However, evidence for clinical diagnostic assessment, interventions, and medical management of dysphagia in these patients are still limited: few studies are reporting the evaluation and the management among this group of patients. Here we analyzed the most recent findings in diagnostic assessment and management of swallowing impairment in patients affected by AD.
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Affiliation(s)
- Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Carmelinda Ruggiero
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Alberto Patriti
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi" Hospital, ASL Umbria 2, Spoleto, Italy
| | - Luigi Marano
- General, Minimally Invasive and Robotic Surgery, Department of Surgery, "San Matteo degli Infermi" Hospital, ASL Umbria 2, Spoleto, Italy
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49
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Curtis JA, Laus J, Yung KC, Courey MS. Static endoscopic evaluation of swallowing: Transoral endoscopy during clinical swallow evaluations. Laryngoscope 2015; 126:2291-4. [PMID: 26691853 DOI: 10.1002/lary.25828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/12/2015] [Accepted: 11/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the sensitivity and specificity for assessing pharyngeal residue, laryngeal penetration, and tracheal aspiration when comparing findings from the Static Endoscopic Evaluation of Swallowing (SEES) with findings from the Videofluoroscopic Swallow Study (VFSS). METHODS Retrospective study at a tertiary academic medical center. Records were reviewed consecutive outpatients who underwent both SEES and VFSS evaluations. Video segments from SEES and VFSS examinations were blindly judged by experienced clinicians on a categorical/ordinal rating form for the absence, quantitative presence, and location of postswallow residue, penetration, and aspiration. Statistical analysis was performed to identify intra- and interrater reliability and correlation between SEES and VFSS findings. RESULTS Thirty-nine patients were identified who met the above inclusion criteria, for a total of 206 video segments. Inter- and intrarater reliability was judged by Cronbach's alpha to be good to excellent. SEES findings revealed statistically significant correlations with VFSS findings (P < 0.001) with the absence, quantitative presence, and location of thin liquid and solid swallow residue, penetration, and aspiration. In addition, SEES was more sensitive to the presence of liquid residue, penetration, and aspiration than VFSS. CONCLUSION SEES is an endoscopic screening procedure that strengthens the clinical swallowing evaluation by documenting the presence or absence of postswallow residue, penetration, and aspiration. Accurate identification of a patient's risk for aspiration helps to direct further workup. It is an expedient, repeatable, and clinical relevant procedure that can be easily incorporated into a clinician's practice. LEVEL OF EVIDENCE 4. Laryngoscope, 126:2291-2294, 2016.
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Affiliation(s)
- James A Curtis
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A.
| | - Joey Laus
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Katherine C Yung
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Mark S Courey
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
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Almeida TMD, Cola PC, Pernambuco LDA, Magalhães Junior HV, Silva RGD. Instrumentos de rastreio para disfagia orofaríngea no acidente vascular encefálico. AUDIOLOGY: COMMUNICATION RESEARCH 2015. [DOI: 10.1590/2317-6431-2015-1571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo: Identificar os parâmetros presentes nos instrumentos de rastreio para a disfagia orofaríngea no acidente vascular encefálico, publicados na literatura. Estratégia de pesquisa: Para a seleção dos estudos, foram utilizados os descritores: transtornos de deglutição, acidente vascular cerebral, rastreio, screening, avaliação e disfagia. Foram consultadas as bases de dados MEDLINE, Embase, LILACS, SciELO e biblioteca Cochrane. Critérios de seleção: Foram selecionados artigos em inglês, português e espanhol, publicados até dezembro de 2014, cuja abordagem metodológica referisse instrumentos de rastreio para a disfagia orofaríngea, elaborados para indivíduos adultos com acidente vascular encefálico. Os parâmetros utilizados nos diferentes instrumentos de rastreio foram agrupados por igualdade e/ou semelhança. Foi realizada análise descritiva e calculada a frequência dos parâmetros encontrados. Resultados: Foram encontrados 688 artigos e, após consideração dos critérios de inclusão e exclusão, 23 artigos foram efetivamente analisados. Dos 20 instrumentos encontrados, 90% utilizaram algum tipo de oferta via oral no rastreio para a disfagia, sendo a maioria, a água. Foram encontrados 19 parâmetros distintos, não relacionados à oferta de alimento e 12 parâmetros relacionados à oferta de alimento. Conclusão: Não há consenso, entre os estudos, sobre os parâmetros mais sensíveis e específicos para compor o método de rastreio para disfagia orofaríngea na população com acidente vascular encefálico.
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