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Behavioral Interventions Targeting Base of Tongue to Posterior Pharyngeal Wall Approximation: A Scoping Review. Dysphagia 2022; 38:768-784. [PMID: 36163399 PMCID: PMC10182935 DOI: 10.1007/s00455-022-10519-0] [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: 03/22/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
Pharyngeal pressure generated by approximation of the base of tongue to the posterior pharyngeal wall (BOT-PPW approximation) is critical for efficient pharyngeal bolus passage and is a frequent goal of dysphagia management. This scoping review evaluated behavioral interventions available to improve BOT-PPW approximation. We searched MEDLINE, CINAHL, Ovid Emcare, Web of Science, SCOPUS, and ProQuest for studies that met the following criteria: (i) behavioral interventions targeting BOT-PPW approximation, which (ii) were assessed using BOT-PPW-specific outcome measures, and (iiia) performed over a period of time (Review Part 1) or (iiib) studied immediate effects (Review Part 2). Study quality was rated using the GRADE framework. Data were extracted and synthesized into dominant themes. Of the 150 studies originally identified, three examined long-term effects (two single cases studies of individuals with dysphagia, and a third study evaluating effortful swallowing in healthy individuals). BOT-PPW approximation only increased in the two single case studies. Twenty-one studies evaluating immediate effects were categorized as follows: (1) effortful swallowing, (2) Mendelsohn maneuver, (3) tongue-hold maneuver, (4) super supraglottic swallowing maneuver, and (5) non-swallowing exercises. Across all studies, varying levels of success in increasing BOT-PPW approximation were reported. Four of 21 immediate effects studies evaluated patients with demonstrated swallowing impairment, whereas 17 studies evaluated healthy adults. Quality assessment revealed low strength of the existing evidence base. The evidence base for rehabilitative interventions targeting BOT-PPW approximation is severely limited and translation is hindered by small sample sizes and methodological limitations. Further clinical research is warranted.
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Yang W, Nie W, Zhou X, Guo W, Mou J, Yong J, Wu T, Liu X. Review of prophylactic swallowing interventions for head and neck cancer. Int J Nurs Stud 2021; 123:104074. [PMID: 34536908 DOI: 10.1016/j.ijnurstu.2021.104074] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Head and neck cancer treatment destroys nerves and/or organs associated with swallowing. Previous studies have investigated the efficacy of exercises for muscles used in swallowing before treatment in reducing disuse atrophy and delaying the occurrence of muscle fibrosis. However, the rehabilitation effects of training and the optimal intervention strategy are unknown. OBJECTIVES To establish evidence for the efficacy of prophylactic swallowing interventions in reducing aspiration and restoring oral intake in patients with head and neck cancer with dysphagia. METHODS We searched electronic databases (PubMed, Embase, Cochrane and MEDLINE) for studies published up to June 2021 reporting outcomes following prophylactic swallowing interventions in patients with head and neck cancer with dysphagia and the related influencing factors. The methodological quality of the literature was assessed using the Joanna Briggs Institute appraisal tools. RESULTS The search identified 1468 articles, and 13 studies were eventually included. Four categories involving 12 different swallowing interventions were classified. Regarding the descriptive analysis of the rehabilitation effects across all studies, in terms of oropharyngeal safety, five studies showed that swallowing interventions reduced the risk of aspiration, penetration or residue. In terms of oral intake and tube feeding dependence, four studies demonstrated reduced time to return to oral intake in the intervention group compared with the control group. In terms of intervention adherence, three studies showed that speech-language pathologist- and nurse-supervised training was a potential promoter of adherence, and five studies showed that the negative factors affecting adherence included pain, fatigue, forgetting, smoking, decreased exercise motivation, side effects of radiotherapy and distance to the rehabilitation site. CONCLUSIONS Preventive swallowing interventions may be effective at reducing aspiration, improving swallowing function, and restoring oral intake. However, due to the lack of standardization and consistency of interventions and measurement results, which prevented the production of a best practice guide, future rigorous methodological trials will be needed to determine the most effective interventions for maximizing exercise adherence over the long term.
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Affiliation(s)
- Wenwen Yang
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Wenbo Nie
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, Jilin 130000, China.
| | - Xue Zhou
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Wenjie Guo
- Henan Vocational College of Nursing, No.480 Zhonghua Street, Anyang, Henan 455000, China.
| | - Jingjing Mou
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Jun Yong
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Tianxing Wu
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
| | - Xinmei Liu
- The First Hospital of Jilin University, No.71 Xinmin street, Changchun, Jilin 130021, China.
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The upper esophageal sphincter in the high-resolution manometry era. Langenbecks Arch Surg 2021; 406:2611-2619. [PMID: 34462811 DOI: 10.1007/s00423-021-02319-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The evaluation of the upper esophageal sphincter (UES) has been neglected during routine manometric tests for decades, mostly due to the limitations of the conventional manometry which were eventually overcome by high-resolution manometry (HRM). METHODS This study reviewed the current knowledge of the manometric evaluation of the UES in health and disease in the HRM era. RESULTS We found that HRM allowed more precise measurements, in addition to the parameters as compared to conventional manometry, but most of them still need confirmation of the clinical significance. The parameters used to evaluate the UES were extension, basal pressure, residual pressure, relaxation duration, relaxation time to nadir, recovery time, intrabolus pressure, and deglutitive sphincter resistance. UES may be affected by different diseases: achalasia (UES is hypertonic with impaired relaxation), gastroesophageal reflux disease (UES is short and hypotonic), globus (UES ranges from normal to impaired relaxation to hypertonic), neurologic diseases (stroke and Parkinson - UES is hypotonic in early-stage to impaired relaxation in end-stage disease), and Zenker's diverticulum (UES has impaired relaxation). CONCLUSION This review shows that UES dysfunction is part of several disease processes and that the study of the UES is possible and valuable with the aid of HRM.
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Aihara K, Inamoto Y, Kanamori D, González-Fernández M, Shibata S, Kagaya H, Hirano S, Kobayashi H, Fujii N, Saitoh E. Effect of tongue-hold swallow on posterior pharyngeal wall using dynamic area detector computed tomography. J Oral Rehabil 2021; 48:1235-1242. [PMID: 34407238 PMCID: PMC9291453 DOI: 10.1111/joor.13246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/15/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
Purpose The purpose of this study was to elucidate the effects of the tongue‐hold swallow (THS) on the pharyngeal wall by quantifying posterior pharyngeal wall (PPW) anterior bulge during the THS. In addition, the effect of tongue protrusion length on the extent of pharyngeal wall anterior bulge was analysed. Methods Thirteen healthy subjects (6 males and 7 females, 23–43 years) underwent 320‐row area detector CT during saliva swallow (SS) and THS at two tongue protrusion lengths (THS1 protrude the tongue as much as 1/3 of premeasured maximum tongue protrusion length (MTP‐L) and THS2 protrude the tongue as much as 2/3 of MTP‐L). To acquire images of the pharynx at rest, single‐phase volume scanning was performed three times during usual breathing with no tongue protrusion (rest), protrusion of the tongue at 1/3 of MTP‐L (rTHS1) and protrusion of the tongue at 2/3 of MTP‐L (rTHS2). Length from cervical spine to PPW (PPW‐AP) and the volume of pharyngeal cavity was measured and was compared between rest, rTHS1 and rTHS2 and between SS, THS1 and THS2. Correlation between MTP‐L and PPW‐AP was calculated in three conditions, SS, THS1 and THS2. Results PPW‐AP at rest, rTHS1 and rTHS2 was 2.9 ± 0.6 mm, 3.0 ± 0.5 mm and 3.0 ± 0.5 mm, respectively, showing no significant differences across swallows. PPW‐AP at the maximum pharyngeal constriction was 8.1 ± 2.0 mm, 9.1 ± 2.4 mm and 8.7 ± 2.0 mm in SS, THS1 and THS2, respectively. Compared to SS, PPW‐AP in THS1 was significantly larger (p = 0.04) and PPW‐AP in THS2 was not significantly different (p = 0.09). Pharyngeal volume at rest, rTHS1 and rTHS2 was 16.4 ± 5.2 mm3, 18.4 ± 4.5 mm3 and 21.3 ± 6.2 mm3, respectively. It was significantly larger during rTHS2 compared with rest or rTHS1 (rTHS2‐rest p = 0.007, rTHS2‐rTHS1 p = 0.007). Pharyngeal volume was completely obliterated (zero volume) at maximum pharyngeal contraction in all except one subject. There was no correlation between MTP‐L and PPW‐AP in any of the three conditions (SS, THS1 and THS2). Discussion This study demonstrated that the expanded pharyngeal cavity due to the tongue protrusion was completely obliterated by the increase in anterior motion of pharyngeal wall during THS. It also became clear that the degree of tongue protrusion did not linearly correlate with the movement of PPW during THS. There was no relationship between PPW motion and the MTP‐L, suggesting that the effect of tongue protrusion is better determined in each subject by analysing the motion of PPW using imaging tools.
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Affiliation(s)
- Keiko Aihara
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoko Inamoto
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Daisuke Kanamori
- Department of Density and Oral-Maxillofacial Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Marlís González-Fernández
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seiko Shibata
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hitoshi Kagaya
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hiroko Kobayashi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Naoko Fujii
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Dziewas R, Allescher HD, Aroyo I, Bartolome G, Beilenhoff U, Bohlender J, Breitbach-Snowdon H, Fheodoroff K, Glahn J, Heppner HJ, Hörmann K, Ledl C, Lücking C, Pokieser P, Schefold JC, Schröter-Morasch H, Schweikert K, Sparing R, Trapl-Grundschober M, Wallesch C, Warnecke T, Werner CJ, Weßling J, Wirth R, Pflug C. Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology. Neurol Res Pract 2021; 3:23. [PMID: 33941289 PMCID: PMC8094546 DOI: 10.1186/s42466-021-00122-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).
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Affiliation(s)
- Rainer Dziewas
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany. .,Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrück, Germany.
| | - Hans-Dieter Allescher
- Zentrum für Innere Medizin, Klinikum Garmisch-Partenkirchen GmbH, Auenstraße 6, 82467, Garmisch-Partenkirchen, Germany
| | - Ilia Aroyo
- Klinik für Neurologie und Neurointensivmedizin, Klinikum Darmstadt, Grafenstr. 9, 64283, Darmstadt, Germany
| | | | | | - Jörg Bohlender
- Universitätsspital Zürich, ORL-Klinik, Abteilung für Phoniatrie und Klinische Logopädie, Frauenklinikstr. 24, 8091, Zürich, Schweiz
| | - Helga Breitbach-Snowdon
- Schule für Logopädie, Universitätsklinikum Münster, Kardinal-von-Galen-Ring 10, 48149, Münster, Germany
| | | | - Jörg Glahn
- Universitätsklinik für Neurologie und Neurogeriatrie, Johannes Wesling Klinikum Minden, Hans-Nolte Strasse 1, 32429, Minden, Germany
| | - Hans-Jürgen Heppner
- Private Universität Witten/Herdecke gGmbH, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Karl Hörmann
- University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Christian Ledl
- Abteilung Sprach-, Sprech- und Schlucktherapie, Schön Klinik Bad Aibling SE & Co. KG, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Christoph Lücking
- Schön Klinik München Schwabing, Parzivalplatz 4, 80804, München, Germany
| | - Peter Pokieser
- Medizinische Universität Wien, Teaching Center / Unified Patient Program, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Joerg C Schefold
- Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, 3010, Bern, Schweiz
| | | | - Kathi Schweikert
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Im Burgfelderhof 40, 4012, Basel, Schweiz
| | - Roland Sparing
- VAMED Klinik Hattingen GmbH, Rehabilitationszentrum für Neurologie, Neurochirurgie, Neuropädiatrie, Am Hagen 20, 45527, Hattingen, Germany
| | - Michaela Trapl-Grundschober
- Klinische Abteilung für Neurologie, Therapeutischer Dienst, Universitätsklinikum Tulln, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Alter Ziegelweg 10, 3430, Tulln an der Donau, Österreich
| | - Claus Wallesch
- BDH-Klinik Elzach gGmbH, Am Tannwald 1, 79215, Elzach, Germany
| | - Tobias Warnecke
- Klinik für Neurologie, Universitätsklinik Münster, 48149 Münster, Germany
| | - Cornelius J Werner
- Sektion Interdisziplinäre Geriatrie, Klinik für Neurologie, Medizinische Fakultät, Uniklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Johannes Weßling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenskrankenhaus Münster, Düesbergweg 124, 48153, Münster, Germany
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Katholische Kliniken Rhein-Ruhr, Hölkeskampring 40, 44625, Herne, Germany
| | - Christina Pflug
- Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Treatment for Adults. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lee K, Jung E, Choi Y. Effects of lingual exercises on oral muscle strength and salivary flow rate in elderly adults: a randomized clinical trial. Geriatr Gerontol Int 2020; 20:697-703. [DOI: 10.1111/ggi.13944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/15/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Kyeong‐Hee Lee
- Department of Dental HygieneCollege of Bioecological Health, Shinhan University Uijeongbu Republic of Korea
| | - Eun‐Seo Jung
- Department of Dental HygieneCollege of Bioecological Health, Shinhan University Uijeongbu Republic of Korea
| | - Yoon‐Young Choi
- Artificial Intelligence Big Data Medical Center, Yonsei University Wonju College of Medicine Wonju Republic of Korea
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Nativ-Zeltzer N, Belafsky PC, Bayoumi A, Kuhn MA. Volitional control of the upper esophageal sphincter with high-resolution manometry driven biofeedback. Laryngoscope Investig Otolaryngol 2019; 4:264-268. [PMID: 31024999 PMCID: PMC6476264 DOI: 10.1002/lio2.255] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/13/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Dysfunction of the upper esophageal sphincter (UES) is associated with swallow dysfunction and globus pharyngeus. Although volitional augmentation of the UES has been previously documented, the ability of individuals to control UES pressure with high‐resolution manometry (HRM) driven biofeedback has not been assessed. Purpose To evaluate the ability of patient driven HRM biofeedback to control UES basal pressure. Methods HRM data was collected from 10 patients undergoing esophageal manometry. Participants were trained on real‐time HRM‐driven biofeedback to both elevate and reduce UES pressure. Measures of baseline UES minimum, mean and maximum pressures (mmHg) were compared to biofeedback‐driven volitional increases and decreases in UES pressures. Pre‐ and post‐biofeedback data were compared with paired sample T‐tests. Results The mean age (± standard deviation) of the cohort was 68 (±12.7) years. Sixty percent (6/10) were female. The mean UES baseline pressure increased from 30.1 (±15.3) mmHg to 44.8 (±25.03) mmHg (P = .02) with biofeedback‐driven UES augmentation (P < .05). Maximum UES pressures were also increased from 63.84 (±24.1) mmHg to 152.4 (±123.7) (P = .04). Although some individuals were able to successfully decrease basal UES tone with the HRM biofeedback, no statistically significant group differences were observed (P > .05). Conclusion Volitional control of UES pressure is possible with HRM‐driven biofeedback. Patients vary in their ability to intentionally control UES pressure and some may require further training aimed at lowering UES pressure with HRM‐guided biofeedback. These data may have significant implications for the future treatment of UES disorders and warrant further investigation. Level of Evidence 4
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Affiliation(s)
- Nogah Nativ-Zeltzer
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery University of California, Davis Sacramento, California U.S.A
| | - Peter C Belafsky
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery University of California, Davis Sacramento, California U.S.A
| | - Ahmed Bayoumi
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery University of California, Davis Sacramento, California U.S.A
| | - Maggie A Kuhn
- Center for Voice and Swallowing, Department of Otolaryngology-Head & Neck Surgery University of California, Davis Sacramento, California U.S.A
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Effects of Tongue-Hold Swallows on Suprahyoid Muscle Activation According to the Relative Tongue Protrusion Length in the Elderly Individuals. Dysphagia 2018; 34:382-390. [DOI: 10.1007/s00455-018-9948-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023]
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10
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ESPEN guideline clinical nutrition in neurology. Clin Nutr 2018; 37:354-396. [DOI: 10.1016/j.clnu.2017.09.003] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 12/12/2022]
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Tongue Pressure Production and Submental Surface Electromyogram Activities During Tongue-Hold Swallow with Different Holding Positions and Tongue Length. Dysphagia 2017; 33:403-413. [DOI: 10.1007/s00455-017-9865-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
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12
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25 Years of Dysphagia Rehabilitation: What Have We Done, What are We Doing, and Where are We Going? Dysphagia 2017; 32:50-54. [DOI: 10.1007/s00455-016-9769-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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Huckabee ML, Macrae P, Lamvik K. Expanding Instrumental Options for Dysphagia Diagnosis and Research: Ultrasound and Manometry. Folia Phoniatr Logop 2016; 67:269-84. [PMID: 27160285 DOI: 10.1159/000444636] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Diagnostic assessment of swallowing in routine clinical practice relies heavily on the long-standing techniques of videofluoroscopic swallowing study (VFSS) and videoendoscopic evaluation of swallowing (VEES). These complementary and sophisticated techniques provide a real-time visualization of biomechanical movements of the structures involved in swallowing and consequent effects on bolus flow. Despite the sophistication of this instrumentation, interpretation relies heavily on subjective clinical judgement and temporal resolution is limited, limitations that may influence patient management. Adjunctive diagnostic assessments may be utilized to compensate for the limitations posed by VFSS and VEES. Ultrasound and pharyngeal manometry do not represent the latest in technological advances, with both emerging in swallowing research over 20 years ago. However, both have resisted integration into routine clinical practice, despite the fact that they offer quantitative metrics of swallowing that are not available using standard techniques. The aim of this review is to present recent research on these two less frequently used modalities in clinical swallowing assessment, discuss potential applications in clinical practice and review supportive data on test-retest reliability, rater reliability and validity. The paper will conclude with a case report that exemplifies the unique contribution of these modalities in executing and revising therapeutic approaches for a patient with neurogenic dysphagia.
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Affiliation(s)
- Maggie-Lee Huckabee
- Rose Centre for Stroke Recovery and Research and Department of Communication Disorders, University of Canterbury, Christchurch, New Zealand
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Kendall KA, Ellerston J, Heller A, Houtz DR, Zhang C, Presson AP. Objective Measures of Swallowing Function Applied to the Dysphagia Population: A One Year Experience. Dysphagia 2016; 31:538-46. [PMID: 27106909 DOI: 10.1007/s00455-016-9711-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/10/2016] [Indexed: 11/25/2022]
Abstract
Quantitative, reliable measures of swallowing physiology can be made from an modified barium swallowing study. These quantitative measures have not been previously employed to study large dysphagic patient populations. The present retrospective study of 139 consecutive patients with dysphagia seen in a university tertiary voice and swallowing clinic sought to use objective measures of swallowing physiology to (1) quantify the most prevalent deficits seen in the patient population, (2) identify commonly associated diagnoses and describe the most prevalent swallowing deficits, and (3) determine any correlation between objective deficits and Eating Assessment Tool (EAT-10) scores and body mass index. Poor pharyngeal constriction (34.5 %) and airway protection deficits (65.5 %) were the most common swallowing abnormalities. Reflux-related dysphagia (36 %), nonspecific pharyngeal dysphagia (24 %), Parkinson disease (16 %), esophageal abnormality (13 %), and brain insult (10 %) were the most common diagnoses. Poor pharyngeal constriction was significantly associated with an esophageal motility abnormality (p < 0.001) and central neurologic insult. In general, dysphagia symptoms as determined by the EAT-10 did not correlate with swallowing function abnormalities. This preliminary study indicates that reflux disease is common in patients with dysphagia and that associated esophageal abnormalities are common in dysphagic populations and may be associated with specific pharyngeal swallowing abnormalities. However, symptom scores from the EAT-10 did not correspond to swallowing pathophysiology.
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Affiliation(s)
- Katherine A Kendall
- Voice Disorders Center, University of Utah, Salt Lake City, UT, USA.
- Division of Otolaryngology, Head & Neck Surgery, University of Utah, 50 Medical Drive, SOM Room 3C120, Salt Lake City, UT, 84132, USA.
| | - Julia Ellerston
- Voice Disorders Center, University of Utah, Salt Lake City, UT, USA
| | - Amanda Heller
- Voice Disorders Center, University of Utah, Salt Lake City, UT, USA
- Communication Sciences & Disorders, University of Utah, Salt Lake City, UT, USA
| | - Daniel R Houtz
- Voice Disorders Center, University of Utah, Salt Lake City, UT, USA
| | - Chong Zhang
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Crary MA. Treatment for Adults. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Langmore SE, Pisegna JM. Efficacy of exercises to rehabilitate dysphagia: A critique of the literature. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2015; 17:222-229. [PMID: 25825989 DOI: 10.3109/17549507.2015.1024171] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE This review critiques the benefit of commonly used rehabilitative exercises for dysphagia. METHOD Common goals of rehabilitation for dysphagia and principles of neuroplasticity are introduced as they apply to swallowing and non-swallowing exercises. A critique of published studies is offered regarding their evidence for showing benefit from the exercise. RESULT One of five swallow exercises had preliminary evidence for long-term benefit and two of four non-swallow exercises have strong evidence for long-term benefit. CONCLUSION Only a minority of exercises prescribed for patients with dysphagia have sufficient evidence for long-term improvement in swallowing.
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Affiliation(s)
- Susan E Langmore
- Department of Otolaryngology, Boston University School of Medicine , Boston, MA , USA
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Dysphagia--a common, transient symptom in critical illness polyneuropathy: a fiberoptic endoscopic evaluation of swallowing study*. Crit Care Med 2015; 43:365-72. [PMID: 25377021 DOI: 10.1097/ccm.0000000000000705] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Critical illness polyneuropathy is a common disorder in the neurological ICU. Dysphagia is well known to deteriorate outcome in the ICU. The prevalence of dysphagia in critical illness polyneuropathy is not known. The aim of this study was to evaluate the prevalence of dysphagia in critical illness polyneuropathy using fiberoptic endoscopic evaluation of swallowing. DESIGN Prospective, cohort study. SETTING Neurological rehabilitation ICU. PATIENTS Twenty-two patients with critical illness polyneuropathy. INTERVENTIONS Clinical swallowing examination and serial fiberoptic endoscopic evaluation of swallowing (days 3, 14, and 28 after admission). MEASUREMENTS AND MAIN RESULTS Swallowing of saliva, pureed consistencies, and liquids was tested using fiberoptic endoscopic evaluation of swallowing at three different time points. The penetration-aspiration scale by Rosenbek et al and the secretion severity rating scale by Murray et al were used for grading. Functional outcome after rehabilitation was assessed using the functional independence measure.: Pathologic swallowing was found in 20 of 22 patients (91%). Hypesthesia of laryngeal structures was found in 17 of 22 patients (77%) during the first fiberoptic endoscopic evaluation of swallowing. Over the 4-week follow-up period, laryngeal hypesthesia resolved in 75% of affected cases. Pureed consistencies were swallowed safely in 18 of 22 cases (82%), whereas liquids and saliva showed high aspiration rates (13 of 17 [78%] and 10 of 22 [45%], respectively). Swallowing function recovered completely in 21 of 22 (95%) within 4 weeks. CONCLUSIONS Dysphagia is frequent among patients with critical illness polyneuropathy treated in the ICU. Old age, chronic obstructive pulmonary disease, the mode of mechanical ventilation, the prevalence of tracheal tubes, and behavioral "learned nonuse" may all be contributing factors for the development of dysphagia in critical illness polyneuropathy. Complete recovery occurs in a high percentage of affected individuals within 4 weeks.
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Johnson DN, Herring HJ, Daniels SK. Dysphagia Management in Stroke Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0059-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hammer MJ, Jones CA, Mielens JD, Kim CH, McCulloch TM. Evaluating the tongue-hold maneuver using high-resolution manometry and electromyography. Dysphagia 2014; 29:564-70. [PMID: 24969727 DOI: 10.1007/s00455-014-9545-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 05/24/2014] [Indexed: 11/26/2022]
Abstract
The tongue-hold maneuver is a widely used clinical technique designed to increase posterior pharyngeal wall movement in individuals with dysphagia. It is hypothesized that the tongue-hold maneuver results in increased contraction of the superior pharyngeal constrictor. However, an electromyographic study of the pharynx and tongue during the tongue-hold is still needed to understand whether and how swallow muscle activity and pressure may change with this maneuver. We tested eight healthy young participants using simultaneous intramuscular electromyography with high-resolution manometry during three task conditions including (a) saliva swallow without maneuver, (b) saliva swallow with the tongue tip at the lip, and (c) saliva swallow during the tongue-hold maneuver. We tested the hypothesis that tongue and pharyngeal muscle activity would increase during the experimental tasks, but that pharyngeal pressure would remain relatively unchanged. We found that the pre-swallow magnitude of tongue, pharyngeal constrictor, and cricopharyngeus muscle activity increased. During the swallow, the magnitude and duration of tongue and pharyngeal constrictor muscle activity each increased. However, manometric pressures and durations remained unchanged. These results suggest that increased superior pharyngeal constrictor activity may serve to maintain relatively stable pharyngeal pressures in the absence of posterior tongue movement. Thus, the tongue-hold maneuver may be a relatively simple but robust example of how the medullary swallow center is equipped to dynamically coordinate actions between tongue and pharynx. Our findings emphasize the need for combined modality swallow assessment to include high-resolution manometry and intramuscular electromyography to evaluate the potential benefit of the tongue-hold maneuver for clinical populations.
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Affiliation(s)
- Michael J Hammer
- Division of Otolaryngology, Department of Surgery, Room K4/769 Clinical Sciences Center, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA,
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Lamvik K, Macrae P, Doeltgen S, Collings A, Huckabee ML. Normative data for pharyngeal pressure generation during saliva, bolus, and effortful saliva swallowing across age and gender. SPEECH LANGUAGE AND HEARING 2014. [DOI: 10.1179/2050572814y.0000000042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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The Effects of Eight-week Tongue-holding Maneuver Program on Activation of Swallowing-related Muscles. ACTA ACUST UNITED AC 2014. [DOI: 10.14519/jksot.2014.22.1.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Macrae P, Humbert I. Exploiting Experience-Dependent Plasticity in Dysphagia Rehabilitation: Current Evidence and Future Directions. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-013-0025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Heck FM, Doeltgen SH, Huckabee ML. Effects of submental neuromuscular electrical stimulation on pharyngeal pressure generation. Arch Phys Med Rehabil 2012; 93:2000-7. [PMID: 22497988 DOI: 10.1016/j.apmr.2012.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/30/2012] [Accepted: 02/16/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the immediate and late effects of submental event-related neuromuscular electrical stimulation (NMES) on pharyngeal pressure generation during noneffortful and effortful saliva swallows. DESIGN Before-after trial. SETTING Swallowing rehabilitation research laboratory. PARTICIPANTS Sex-matched (N=20) healthy research volunteers. INTERVENTIONS Participants received 80Hz NMES of 4-second duration to floor of mouth muscles that was time-locked to 60 volitional saliva swallows. MAIN OUTCOME MEASURES Manometry measures of peak pressures and duration of pressure events in the oropharynx, hypopharynx, and the upper esophageal sphincter (UES) were derived during execution of noneffortful and effortful saliva swallows. Measures were taken at baseline, during stimulation, and at 5-, 30-, and 60-minutes poststimulation. RESULTS Baseline pharyngeal and UES pressures did not differ between stimulated and nonstimulated swallows. At 5- and 30-minutes poststimulation, peak pressure decreased at the hypopharyngeal and at the UES sensor during noneffortful swallows. The effect lasted up to an hour only in the hypopharynx. No changes in duration of pressure events were observed. CONCLUSIONS Using this treatment paradigm, decreased peak amplitude in the hypopharynx up to an hour after treatment indicates a potential risk of decreased bolus flow associated with NMES. On the other hand, decreased UES relaxation pressure may facilitate bolus transit into the esophagus.
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Affiliation(s)
- Frauke M Heck
- Department of Communication Disorders, University of Canterbury, Van der Veer Institute for Parkinson's and Brain Research, Christchurch, New Zealand.
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Doeltgen SH, Huckabee ML. Swallowing Neurorehabilitation: From the Research Laboratory to Routine Clinical Application. Arch Phys Med Rehabil 2012; 93:207-13. [DOI: 10.1016/j.apmr.2011.08.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/18/2011] [Accepted: 08/25/2011] [Indexed: 10/14/2022]
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Oh JC, Park JW, Cha TH, Woo HS, Kim DK. Exercise using tongue-holding swallow does not improve swallowing function in normal subjects. J Oral Rehabil 2011; 39:364-9. [PMID: 22191994 DOI: 10.1111/j.1365-2842.2011.02274.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We evaluated the effects of repetitive tongue-holding swallow (THS) as an exercise for improving swallowing function. Twenty healthy subjects were randomly divided into two groups. One group [THS group (THSG)] performed the tongue-holding manoeuvre every 5s for 20min. The other group (normal swallow group) swallowed without tongue-holding for the same length of time as a control. Twenty sessions of training were performed for 4weeks. All participants also had a videofluoroscopic swallowing study for analysing the biomechanical parameters of swallowing (hyolaryngeal movement, posterior pharyngeal wall movement and the pharyngeal constriction ratio). After 4weeks of training, none of the biomechanical parameters changed in either group. Exercise using THS did not affect swallowing function in normal subjects.
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Affiliation(s)
- J-C Oh
- Department of Physical Medicine and Rehabilitation, Dongguk University Ilsan Hospital, Gyeonggi-do, Korea
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Doeltgen SH, Macrae P, Huckabee ML. Pharyngeal pressure generation during tongue-hold swallows across age groups. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2011; 20:124-130. [PMID: 21386045 DOI: 10.1044/1058-0360(2011/10-0067)] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE To compare the effects of the tongue-hold swallowing maneuver on pharyngeal pressure generation in healthy young and elderly research volunteers. METHOD Sixty-eight healthy research volunteers (young, n = 34, mean age = 26.8 years, SD = 5.5; elderly, n = 34, mean age = 72.6 years, SD = 4.8; sex equally represented) performed 5 noneffortful saliva swallows and 5 tongue-hold swallows each. Amplitude and duration of pharyngeal pressure were investigated during both swallowing conditions with solid-state pharyngeal manometry at the level of the oropharynx, hypopharynx, and upper esophageal sphincter (UES). RESULTS At both pharyngeal levels, tongue-hold swallows produced lower peak pressure compared with saliva swallows. During tongue-hold swallows, UES relaxation pressure was increased in the elders, whereas the younger group displayed a trend toward reduced relaxation pressure. Elderly individuals produced pressure longer during control swallows in the oropharynx and hypopharynx than young individuals. CONCLUSIONS The tongue-hold maneuver affects oropharyngeal and hypopharyngeal pressure in the young and elders in similar ways, whereas effects on UES peak relaxation pressure differ between age groups. Reduced pharyngeal peak pressure and increased UES relaxation pressure underscore the notion that tongue-hold swallows should not be performed when bolus is present. Long-term training effects remain to be investigated.
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Pharyngeal Pressures During Swallowing Within and Across Three Sessions: Within-Subject Variance and Order Effects. Dysphagia 2011; 26:385-91. [DOI: 10.1007/s00455-010-9324-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 12/21/2010] [Indexed: 10/18/2022]
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Effects of Repeated Volitional Swallowing on the Excitability of Submental Corticobulbar Motor Pathways. Dysphagia 2010; 26:311-7. [DOI: 10.1007/s00455-010-9313-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 10/22/2010] [Indexed: 10/18/2022]
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