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Venkat S. Improving swallowing function with thickening agents in post-stroke oropharyngeal dysphagia: a real-world experience. Curr Med Res Opin 2024:1-13. [PMID: 38864410 DOI: 10.1080/03007995.2024.2365406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Post-stroke dysphagia (PSD) is a widely prevalent and possibly life-threatening consequence that may lead to aspiration pneumonia, malnutrition, dehydration, and higher mortality risk. Recommending thickened fluids (TF) is a longstanding practice in the management of dysphagia. Augmenting liquid viscosity with a xanthan gum-based thickener benefits patients with PSD by aiding in the enhancement of bolus control, facilitating improved coordination in the swallowing mechanism, and lowering the risk of aspiration. Despite the widespread use of TF, limited high-quality evidence supports its benefits in PSD. CASE REPORT This manuscript presents the clinical experience with four varied cases of PSD. A comprehensive approach to management with TF decreased the risk of aspiration pneumonia and facilitated effective management of dietary recommendations both during hospitalization and after discharge (all Cases). In addition, TF maintained nutrition and hydration in patients with multiple hospital admissions (Case 2), maintained hydration in those unable to engage in swallow rehabilitation due to complex medical conditions (Cases 2, 3, and 4), and those who needed slow and longer recovery due to long-term risk of silent aspiration (Cases 2, 3, and 4). In one case (Case 4), the use of TF was extended for more than two years post-stroke with no reported incidence of chest infection. CONCLUSION In routine clinical practice, a comprehensive management approach with xanthan gum-based TFs reduces the risk of aspiration and aspiration pneumonia in patients with PSD while maintaining nutritional and hydration and improving swallowing function based on formal instrumental assessments. This clinical experience highlights the pivotal role of instrumental assessment, patient education, and informed decision-making to optimize outcomes with TF.
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Labeit B, Michou E, Trapl-Grundschober M, Suntrup-Krueger S, Muhle P, Bath PM, Dziewas R. Dysphagia after stroke: research advances in treatment interventions. Lancet Neurol 2024; 23:418-428. [PMID: 38508837 DOI: 10.1016/s1474-4422(24)00053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 03/22/2024]
Abstract
After a stroke, most patients have dysphagia, which can lead to aspiration pneumonia, malnutrition, and adverse functional outcomes. Protective interventions aimed at reducing these complications remain the cornerstone of treatment. Dietary adjustments and oral hygiene help mitigate the risk of aspiration pneumonia, and nutritional supplementation, including tube feeding, might be needed to prevent malnutrition. Rehabilitative interventions aim to enhance swallowing function, with different behavioural strategies showing promise in small studies. Investigations have explored the use of pharmaceutical agents such as capsaicin and other Transient-Receptor-Potential-Vanilloid-1 (TRPV-1) sensory receptor agonists, which alter sensory perception in the pharynx. Neurostimulation techniques, such as transcranial direct current stimulation, repetitive transcranial magnetic stimulation, and pharyngeal electrical stimulation, might promote neuroplasticity within the sensorimotor swallowing network. Further advancements in the understanding of central and peripheral sensorimotor mechanisms in patients with dysphagia after a stroke, and during their recovery, will contribute to optimising treatment protocols.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, North Rhine-Westphalia, Germany.
| | - Emilia Michou
- Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Achaia, Greece; Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, Greater Manchester, UK
| | - Michaela Trapl-Grundschober
- Karl Landsteiner University of Health Sciences, Krems, Lower Austria, Austria; Division of Neurology, University Hospital Tulln, Tulln, Lower Austria, Austria
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, North Rhine-Westphalia, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, North Rhine-Westphalia, Germany
| | - Philip M Bath
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic teaching hospital of the University of Muenster, Osnabrueck, Lower Saxony, Germany
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Wang K, Cheng Z, Qiao D, Xie F, Zhao S, Zhang B. Polysaccharide-dextrin thickened fluids for individuals with dysphagia: recent advances in flow behaviors and swallowing assessment methods. Crit Rev Food Sci Nutr 2024:1-25. [PMID: 38556920 DOI: 10.1080/10408398.2024.2330711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The global aging population has brought about a pressing health concern: dysphagia. To effectively address this issue, we must develop specialized diets, such as thickened fluids made with polysaccharide-dextrin (e.g., water, milk, juices, and soups), which are crucial for managing swallowing-related problems like aspiration and choking for people with dysphagia. Understanding the flow behaviors of these thickened fluids is paramount, and it enables us to establish methods for evaluating their suitability for individuals with dysphagia. This review focuses on the shear and extensional flow properties (e.g., viscosity, yield stress, and viscoelasticity) and tribology (e.g., coefficient of friction) of polysaccharide-dextrin-based thickened fluids and highlights how dextrin inclusion influences fluid flow behaviors considering molecular interactions and chain dynamics. The flow behaviors can be integrated into the development of diverse evaluation methods that assess aspects such as flow velocity, risk of aspiration, and remaining fluid volume. In this context, the key in-vivo (e.g., clinical examination and animal model), in-vitro (e.g., the Cambridge Throat), and in-silico (e.g., Hamiltonian moving particles semi-implicit) evaluation methods are summarized. In addition, we explore the potential for establishing realistic assessment methods to evaluate the swallowing performance of thickened fluids, offering promising prospects for the future.
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Affiliation(s)
- Kedu Wang
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Zihang Cheng
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Dongling Qiao
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
| | - Fengwei Xie
- Department of Chemical Engineering, University of Bath, Bath, UK
- School of Engineering, Newcastle University, Newcastle upon Tyne, UK
| | - Siming Zhao
- College of Food Science and Technology, Huazhong Agricultural University, Wuhan, China
| | - Binjia Zhang
- Chongqing Key Laboratory of Speciality Food Co-Built by Sichuan and Chongqing, College of Food Science, Southwest University, Chongqing, China
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Tomsen N, Ortega O, Clavé P. Comparing biomechanics and neurophysiology between different phenotypes of patients with oropharyngeal dysphagia. Ann N Y Acad Sci 2024; 1533:181-191. [PMID: 38345868 DOI: 10.1111/nyas.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
The pathophysiology of oropharyngeal dysphagia (OD) across patient phenotypes may differ. The aim of this study was to compare the biomechanics and neurophysiology of swallowing between healthy volunteers (HVs) and patients with dysphagia as a consequence of aging (OOD), post-stroke (PSOD), Parkinson's disease (POD), or dementia (DOD). A retrospective study including 35 HVs and 109 OOD, 195 PSOD, 78 POD, and 143 DOD patients was performed. Videofluoroscopic data of signs of impaired efficacy and safety, penetration-aspiration scale (PAS) score, and the biomechanics of laryngeal vestibule closure (LVC) and opening (LVO) and of upper esophageal sphincter opening (UESO) were collected. Neurophysiology was assessed with pharyngeal sensory evoked potentials and neurotopography maps. All OD phenotypes showed signs of impaired efficacy and safety of swallowing, increased PAS score (p < 0.001), and delayed time to LVC (p < 0.0001). OOD (p < 0.0001), PSOD (p < 0.0001), and POD (p = 0.0065) patients also had delayed time to LVO, and OOD (p = 0.0062) and DOD (p = 0.0016) patients to UESO. Regarding neurophysiology, all phenotypes presented impaired pharyngeal sensitivity, a significant reduction in cortical activation, and impaired sensory input integration. Additionally, only PSOD was associated with impaired conduction of sensory stimuli. In conclusion, we found common but also specific pathophysiological elements. These results improve our understanding of OD pathophysiology and may help pave the way for phenotype-specific treatments.
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Affiliation(s)
- Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Yang H, Chou LY, Hua CC. Effects of Calcium and pH on Rheological Thermal Resistance of Composite Xanthan Gum and High-Methoxyl Apple Pectin Matrices Featuring Dysphagia-Friendly Consistency. Foods 2023; 13:90. [PMID: 38201118 PMCID: PMC10778284 DOI: 10.3390/foods13010090] [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: 12/11/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
High-methoxyl apple pectin (AP) derived from apple was employed as the main ingredient facilitating rheological modification features in developing dysphagia-friendly fluidized alimentary matrices. Xanthan gum (XG) was also included as a composite counterpart to modify the viscoelastic properties of the thickened system under different thermal processes. The results indicate that AP is extremely sensitive to thermal processing, and the viscosity is greatly depleted under a neutral pH level. Moreover, the inclusion of calcium ions echoed the modification effect on the rheological properties of AP, and both the elastic property and viscosity value were promoted after thermal processing. The modification effect of viscoelastic properties (G' and G″) was observed whne XG was incorporated into the composite formula. Increasing the XG ratio from 7:3 to 6:4 (AP:XG) triggers the rheological transformation from a liquid-like form to a solid-like state, and the viscosity value shows that the AP-XG composite system exhibits better thermal stability after thermal processing. The ambient modifiers of pH (pH < 4) and calcium chloride concentration (7.5%) with an optimal AP-XG ratio of 7:3 led to weak-gel-like behavior (G″ < G'), helping to maintain the texture properties of dysphagia-friendly features similar to those prior to the thermal processing.
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Affiliation(s)
- Huaiwen Yang
- Department of Food Science, National Chiayi University, Chiayi City 60004, Taiwan
| | - Liang-Yu Chou
- Department of Food Science, National Chiayi University, Chiayi City 60004, Taiwan
| | - Chi-Chung Hua
- Department of Chemical Engineering, National Chung Cheng University, Chiayi City 621301, Taiwan
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Howe S, Steer K, Johnson M, Adjerid K, Edmonds C, German R, Mayerl C. Exploring the interaction of viscosity and nipple design on feeding performance in an infant pig model. J Texture Stud 2023; 54:936-946. [PMID: 37673688 PMCID: PMC10872838 DOI: 10.1111/jtxs.12797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 09/08/2023]
Abstract
Infant feeding behaviors are modulated via sensorimotor feedback, such that sensory perturbations can significantly impact performance. Properties of the nipple and milk (e.g., nipple hole size and viscosity) are critical sources of sensory information. However, the direct effects of varying milk and nipple properties on infant motor output and the subsequent changes in feeding performance are poorly understood. In this study, we use an infant pig model to explore the interaction between nipple hole size and milk viscosity. Using high-speed videofluoroscopy and electromyography, we measured key performance metrics including sucks per swallow and suck duration, then synchronized these data with the onset and offset of activity of jaw opening and closing muscles. The combination of a small nipple hole and thick milk resulted in negative effects on both suck and swallow performance, with reduced feeding efficiency compared to the other treatments. It also appears that this combination of viscosity and hole size disrupts the coordination between correlates of tongue and jaw movements. We did not see a difference in feeding efficiency between viscosities when infants fed on the large-hole nipple, which may be the result of non-Newtonian fluid mechanics. Our results emphasize the importance of considering both fluid and nipple properties when considering alterations to an infant's feeding system.
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Affiliation(s)
- Stephen Howe
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Kendall Steer
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- University of Akron, Akron, Ohio, USA
| | | | | | - Chloe Edmonds
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Kent State University, Kent, Ohio, USA
| | - Rebecca German
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Kent State University, Kent, Ohio, USA
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Picó-Munyoz R, Tárrega A, Laguna L. Origins of thirstiness sensation and current food solutions. Compr Rev Food Sci Food Saf 2023; 22:4433-4450. [PMID: 37583300 DOI: 10.1111/1541-4337.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.
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Affiliation(s)
- Ruth Picó-Munyoz
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Amparo Tárrega
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
| | - Laura Laguna
- Consumer Perception and Behavior and Adapted Nutrition Laboratory, Institute of Agrochemistry and Food Technology (IATA, CSIC), Paterna, Spain
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Hsu WC, Tsai HH, Weng LC, Wang YW. The experience of eating for older nursing home residents with dysphagia: A qualitative descriptive study. Int J Older People Nurs 2023; 18:e12566. [PMID: 37583102 DOI: 10.1111/opn.12566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/17/2023] [Accepted: 07/23/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Understanding the experience of eating for nursing home residents with dysphagia is essential for developing effective and holistic compensatory intervention programmes for older adults with dysphagia. However, there is a lack of studies on the experience of eating for older adults with dysphagia, especially for individuals in Asian cultures. OBJECTIVES This study aimed to understand the experience of eating for older nursing home residents who have difficulty swallowing (dysphagia), which is often a problem for this population. METHODS This qualitative descriptive study recruited older nursing home residents with dysphagia from facilities in central Taiwan. Residents were recruited by purposive sampling. Data were collected through individual in-depth semistructured face-to-face interviews. Interviews were audio-recorded and transcribed interview data were analysed with content analysis. RESULTS A total of 20 residents participated in the study; the mean age was 78.7 years (standard deviation = 8.54 years); male and female residents were equally represented. The main core theme describing the experience of eating for nursing home residents with dysphagia was irregular coughing, which often occurred spontaneously. Three subthemes described how residents responded: making adjustments to eating and swallowing, receiving assistance from NH staff and fear of eating. CONCLUSIONS Our findings can serve as an evidence-based reference for clinical care aimed at nursing home residents with dysphagia. Support programmes that provide safe swallowing skills and emotional support for managing dysphagia are recommended. IMPLICATIONS FOR PRACTICE Nursing home residents with dysphagia should receive interventions focussed on self-supporting care, training in swallowing skills and emotional support.
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Affiliation(s)
- Wen-Ching Hsu
- Department of General Surgery, Cheng Hsin General Hospital, Taipei City, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Li-Cheng Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Wen Wang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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Tomsen N, Bolívar-Prados M, Ortega O, Clavé P. Therapeutic Effect on Swallowing Function and on Hydration Status of a New Liquid Gum-Based Thickener in Independently-Living Older Patients with Oropharyngeal Dysphagia. Nutrients 2023; 15:4621. [PMID: 37960274 PMCID: PMC10647578 DOI: 10.3390/nu15214621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
ThickenUp® Gel Express (TUGE) is a new, xanthan- and acacia-gum-based, liquid, thickening product. In independently living older adults with oropharyngeal dysphagia (OD), we assessed: (1) the rheological properties of TUGE; (2) its therapeutic effect at four viscosity levels (achieved by 5 g, 10 g, 20 g and 30 g of TUGE in water + Omnipaque X-ray contrast) versus thin liquid; and (3) the effect on hydration status and gastrointestinal tolerance after fourteen days. Shear viscosity of TUGE was measured in SI units (mPa·s at 50 s-1). The Penetration Aspiration Scale (PAS) score and the swallow response at each viscosity level was assessed with videofluoroscopy (VFS), and in the 14-day study we assessed fluid intake, hydration, and tolerance. Thickened fluids with TUGE were unaffected (-0.3%) by α-salivary amylase (α-SA). The shear viscosity values with VFS were 49.41 ± 2.38, 154.83 ± 10.22, 439.33 ± 11.72 and 672.5 ± 35.62 mPa·s. We studied 60 independently living adults (70 ± 11.4 years) with mild OD (PAS 4.1 ± 2.2, 25% aspirations). TUGE caused a shear-viscosity-dependent improvement in PAS at 150-670 mPa·s and in safety of swallow, slightly increased oral residue, did not affect pharyngeal residue and reduced time to laryngeal vestibule closure (-27%) at 670 mPa·s. Fluid intake with TUGE (1488 mL/day) was well tolerated, and hydration status improved. In conclusion, TUGE was unaffected by α-SA and strongly improved safety of swallow in a viscosity-dependent manner without affecting pharyngeal residue. Fourteen-day treatment of thickened fluids with TUGE is safe and well tolerated and improves hydration status in older adults with dysphagia.
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Affiliation(s)
- Noemí Tomsen
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mireia Bolívar-Prados
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Wang Y, Zhang J, Zhu HM, Yu CP, Bao Y, Hou XF, Huang SC. The Therapeutic Effect of Swallow Training with a Xanthan Gum-Based Thickener in Addition to Classical Dysphagia Therapy in Chinese Patients with Post-Stroke Oropharyngeal Dysphagia: A Randomized Controlled Study. Ann Indian Acad Neurol 2023; 26:742-748. [PMID: 38022444 PMCID: PMC10666846 DOI: 10.4103/aian.aian_139_23] [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: 02/15/2023] [Revised: 07/30/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Objective In patients with post-stroke oropharyngeal dysphagia (PSOD), classical dysphagia therapy (CDT) continues to provide unsatisfactory outcomes and makes it challenging for them to remove the nasal feeding tube. Increasing bolus viscosity helps prevent aspiration in PSOD. However, conventional starch thickeners enhance post-digestion residue. This study aims to evaluate the efficacy of swallow training with xanthan gum-based thickener (XGT) (Softia G, NUTRI Co., Ltd., Yokkaichi, Japan) additional to CDT in Chinese PSOD patients with a nasogastric tube when compared to CDT alone. Methods Patients with PSOD who had a nasogastric tube were randomly assigned to either the experimental group (E-group) or the control group (C-group) in this randomized controlled, single-blind, parallel-group study. Both groups received CDT for 4 weeks. The E-group cases received additional swallow training with a Softia G-prepared hydrogel training material. The Functional Oral Intake Scale (FOIS) and modified volume-viscosity swallow test (M-VVST) for swallowing safety and efficacy according to adjusted Chinese dietary habits were administered before and after treatment. Post-training, both groups' nasogastric tube removal rates were calculated. Results One hundred sixty-seven participants (E-group: 82 and C-group: 85) completed the study. The E-group's median score of FOIS improved significantly than the C-group after training (median = 5 vs. 3, P < 0.001). The incidence of coughing, voice changes, oxygen desaturation of 3% or more, pharyngeal residue and piecemeal deglutition in the E-group was significantly lower than that in the C-group (P < 0.05). The E-group had 100% nasogastric tube removal, while the C-group had 28.24% (P < 0.001). Conclusion Swallow training with XGT Softia G in addition to CDT can promote swallowing safety and efficacy in Chinese patients with PSOD more effectively than CDT alone.
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Affiliation(s)
- Yao Wang
- Department of Rehabilitation Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Jie Zhang
- Department of Rehabilitation Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Hui-Min Zhu
- Department of Rehabilitation Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Can-Ping Yu
- Department of Rehabilitation Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Yan Bao
- Department of Rehabilitation Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Xiao-Fang Hou
- Department of Rehabilitation Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China
| | - Shao-Chun Huang
- Department of Rehabilitation Medicine, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China
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11
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Labeit B, Muhle P, Dziewas R, Suntrup-Krueger S. [Diagnostics and treatment of post-stroke dysphagia]. DER NERVENARZT 2023; 94:676-683. [PMID: 37160432 DOI: 10.1007/s00115-023-01483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Post-stroke dysphagia is highly prevalent and leads to severe complications, such as aspiration pneumonia and malnutrition. Despite the high clinical relevance dysphagia management is heterogeneous and often inadequate. OBJECTIVE The aim of this review article is to provide an overview of the diagnostic and treatment strategies for post-stroke dysphagia based on recent studies. MATERIAL AND METHODS Narrative literature review. RESULTS Dysphagia screening should be performed as early as possible in every stroke patient, e.g., with a simple water swallowing test or a multiconsistency protocol. Subsequently, flexible endoscopic evaluation of swallowing (FEES) is indicated in patients with abnormal screening results or existing risk factors for dysphagia. Dietary modifications, oral hygiene measures, and nutritional therapy can help reduce complications. Behavioral swallowing therapy or experimental therapies, such as neurostimulation procedures and pharmacological approaches aim to improve swallowing function and have shown promising results in studies. CONCLUSION Timely management of dysphagia is necessary to reduce complications.
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Affiliation(s)
- Bendix Labeit
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Paul Muhle
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Rainer Dziewas
- Klinik für Neurologie und Neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - Sonja Suntrup-Krueger
- Klinik für Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Münster, Deutschland
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Yasuda T, Shimokasa K. Improved system for measuring rheological properties of thickened liquid using an inclined parallel plate and optical sensor. J Texture Stud 2023; 54:510-520. [PMID: 37144497 DOI: 10.1111/jtxs.12758] [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: 09/08/2022] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/06/2023]
Abstract
The purpose of this study was to improve the method of using an inclined parallel plate (IPP) in directly estimating the yield stressτ iy and evaluating the properties of a thickened liquid. The flow curve of the relationship between the shear rate and shear stress of a liquid thickened with a xanthan gum agent was predicted using the Herschel-Bulkley fluid model ( τ = τ y + k γ ˙ n - 1 ). We supposed that the yield stressτ y and the result of a line spread test (LST) indicate the deformation state and the flow state of shear stress ( k γ ˙ n - 1 ), respectively.τ iy , the yield stressτ ry estimated adopting a rotational viscometer and LST, was investigated for three liquids thickened with xanthan gum at four concentrations (C) at intervals of 0.5 wt% within the range 0.5-2.0 wt%. Linear plots of the relations of C versusτ iy andτ ry and the LST show that with an increase in C , the resistance force (τ ry andτ iy ) increases until flow starts, after which viscosity increases. We suggest that yield stressτ iy estimated with the IPP method effectively indicates the rheological properties of thickened liquids.
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Affiliation(s)
- Toshitaka Yasuda
- Department of Electronic Engineering, Tokyo National College of Technology, Hachioji, Japan
| | - Kenji Shimokasa
- Course of System Engineering, Division of Industrial Technology, Tsukuba University of Technology, Tsukuba, Japan
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Dumican M, Watts C, Drulia T, Zhang Y. Dysphagia Presentation, Airway Invasion, and Gender Differences in a Clinically Based Sample of People with Parkinson's Disease. Dysphagia 2023; 38:353-366. [PMID: 35809095 DOI: 10.1007/s00455-022-10472-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/28/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia in People with Parkinson's Disease (PWPD) is expected to occur in most individuals. The manifestation of dysphagia and its salient swallow dysfunction characteristics leading to decreased airway safety are not well understood. The aim of this study was to quantify dysphagia presentation and severity, examine contributors to airway invasion, and explore gender differences in dysphagia manifestation in PWPD. 60 PWPD in clinical, healthcare settings underwent a Videofluoroscopic Swallow Study (VFSS) after referral for complaints of dysphagia. VFSS records and videos were analyzed to obtain dysphagia diagnosis, Videofluoroscopic Dysphagia Scale (VDS) scores, laryngeal vestibule kinematic timings, and Penetration-Aspiration Scale scores. Frequencies of VDS component and PAS scores were examined. MANOVA and logistic regression analyses were used to identify predictors of penetration and aspiration. Pharyngeal stage dysphagia was prevalent throughout PWPD and presented more frequently than oral stage dysphagia. Pharyngeal residue was a significant predictor for aspiration events. Laryngeal vestibule closure reaction time (LVCrt) and duration time (LVCd) were significant predictors of airway invasion, as were bolus consistency and volume. LVCrt, LVCd, and pharyngeal stage VDS scores were significantly altered in men compared to women in PWPD. A broad clinical sample of PWPD displayed atypical frequencies of airway invasion and frequent atypical scores of oral and pharyngeal stage physiologies. Thicker and smaller bolus consistencies significantly reduced the odds of airway invasion. Men and women presented with significantly different swallow physiology including prolonged LVCrt, LVCd, and more frequent atypical scores of pharyngeal residue and laryngeal elevation.Journal instruction requires a country for affiliations; however, these are missing in affiliation [1, 2]. Please verify if the provided country are correct and amend if necessary.Yes, USA is correct as the provided country.
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Affiliation(s)
- Matthew Dumican
- Western Michigan University, 1903 W Michigan Ave, Kalamazoo, MI, 46008, USA.
| | - Christopher Watts
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
| | - Teresa Drulia
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
| | - Yan Zhang
- Texas Christian University, 2900 S University Dr, Fort Worth, TX, 76129, USA
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14
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Viñas P, Martín-Martínez A, Cera M, Riera SA, Escobar R, Clavé P, Ortega O. Characteristics and Therapeutic Needs of Older Patients with Oropharyngeal Dysphagia Admitted to a General Hospital. J Nutr Health Aging 2023; 27:996-1004. [PMID: 37997721 DOI: 10.1007/s12603-023-1996-8] [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: 06/28/2023] [Accepted: 09/03/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) is a prevalent geriatric syndrome causing severe nutritional and respiratory complications. OBJECTIVE We aimed to describe the characteristics and therapeutic needs of older patients with OD admitted to a general hospital. DESIGN, PARTICIPANTS AND MEASUREMENTS Prospective cohort study with patients (≥70 years) with OD consecutively admitted to a general hospital. OD was clinically assessed with the Volume-Viscosity Swallowing Test and nutritional status with the Mini Nutritional Assessment-short form. Oral health (OH) and periodontal diseases were evaluated by dentists. Functionality, frailty, sarcopenia, comorbidities, dehydration, quality of life (QoL) and mortality were also assessed. RESULTS We included 235 patients (87.3±5.5 years) with OD hospitalized for acute diseases (9.6±7.6 days). On admission, they had low functionality (Barthel: 51.3±25.1), frailty (Fried: 3.9±0.9; Edmonton: 10.3±2.7, 87.2-91.1% frail) and high comorbidities (Charlson: 3.7±2.0). Moreover, 85.1% presented signs of impaired safety and 84.7% efficacy of swallow. Up to 48% required fluid adaptation with a xanthan gum-based thickener (89.4% at 250 mPa·s; 10.6% at 800 mPa·s) and 93.2% a texture-modified diet (TMD) (74.4%, fork-mashable; 25.6%, pureed). A total of 98.7% had nutritional risk, 32.3% sarcopenia and 75.3% dehydration. OH was moderate (Oral Hygiene Index-simplified: 2.0±1.3) and 67.4% had periodontitis. QoL self-perception was 62.2% and 5.5% of patients died during hospitalization. CONCLUSION Hospitalized older OD patients have impaired safety of swallow, frailty, malnutrition, dehydration, low functional capacity and poor OH and high risk of respiratory infections. They need a multimodal intervention including fluid thickening, TMD, thickened oral nutritional supplementation and OH care to improve health status and reduce OD-associated complications.
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Affiliation(s)
- P Viñas
- Pere Clavé MD, PhD. Gastrointestinal Physiology Laboratory. CIBERehd CSdM-UAB. Hospital de Mataró. Carretera de Cirera 230, 08304. Mataró (Barcelona), Spain. Tel. +34 93 741 77 00. Fax. +34 93 741 77 33. E-mail:
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15
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Effects of thickened carbonated cola in older patients with dysphagia. Sci Rep 2022; 12:22151. [PMID: 36550151 PMCID: PMC9780357 DOI: 10.1038/s41598-022-25926-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Carbonated beverages initiate the swallowing reflex earlier than water and have a shorter pharyngeal transit time. However, the effects of carbonation in thickened beverages of the same flavor on swallowing dynamics have not been reported. Therefore, we investigated the effects of thickened carbonated beverages on swallowing in patients with dysphagia by comparing the swallowing dynamics between thickened carbonated and thickened non-carbonated beverages. We enrolled 38 patients with dysphagia and divided them into two groups. Thickened carbonated and thickened non-carbonated beverages were used. Videoendoscopic swallowing evaluations were performed. Aspiration, penetration, pharyngeal residue, and initiation position of the swallowing reflex were evaluated. The reduction in the amount of residue in both the vallecula (p = 0.007) and pyriform sinus (p = 0.004) was greater after ingestion of thickened carbonated cola than thickened non-carbonated cola. The onset of the swallowing reflex was significantly earlier after ingestion of thickened carbonated cola than thickened non-carbonated cola (p = 0.007). There were no significant differences in the extent of penetration. Thickened carbonated beverages positively affected swallowing compared with thickened non-carbonated beverages. Thus, the use of thickened carbonated beverages may be helpful for patients with dysphagia.
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Martin-Martinez A, Ortega O, Viñas P, Arreola V, Nascimento W, Costa A, Riera SA, Alarcón C, Clavé P. COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic. Clin Nutr 2022; 41:2996-3006. [PMID: 34187698 PMCID: PMC8205257 DOI: 10.1016/j.clnu.2021.06.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Prevalence and complications of oropharyngeal dysphagia (OD) and malnutrition (MN) in COVID-19 patients is unknown. Our aim was to assess the prevalence, risk factors and clinical outcomes of OD and MN in a general hospital during the first wave of the COVID-19 pandemic. METHODS This was a prospective, observational study involving clinical assessment of OD (Volume-Viscosity Swallowing Test), and nutritional screening (NRS2002) and assessment (GLIM criteria) in COVID-19 patients hospitalized in general wards at the Consorci Sanitari del Maresme, Catalonia, Spain. The clinical characteristics and outcomes of patients were assessed at pre-admission, admission and discharge, and after 3 and 6-months follow-up. RESULTS We included 205 consecutive patients (69.28 ± 17.52 years, Charlson 3.74 ± 2.62, mean hospital stay 16.8 ± 13.0 days). At admission, Barthel Index was 81.3 ± 30.3; BMI 28.5 ± 5.4 kg/m2; OD prevalence 51.7% (44.1% impaired safety of swallow); and 45.5% developed MN with a mean weight loss of 10.1 ± 5.0 kg during hospitalization. OD was an independent risk factor for MN during hospitalization (OR 3.96 [1.45-10.75]), and hospitalization was prolonged in patients with MN compared with those without (21.9 ± 14.8 vs 11.9 ± 8.9 days, respectively; p < 0.0001). OD was independently associated with comorbidities, neurological symptoms, and low functionality. At 6-month follow-up, prevalence of OD was still 23.3% and that of MN only 7.1%. Patients with OD at discharge showed reduced 6-month survival than those without OD at discharge (71.6% vs 92.9%, p < 0.001); in contrast, those with MN at discharge did not show 6-month survival differences compared to those without (85.4% vs 83.8%, p = 0.8). CONCLUSIONS Prevalence and burden of OD and MN in patients hospitalized in COVID-19 wards is very high. Our results suggest that optimizing the management of MN might shorten the hospitalization period but optimizing the management of OD will likely impact the nutritional status of COVID-19 patients and improve their clinical outcomes and survival after hospital discharge. CLINICALTRIALS gov Identifier: NCT04346212.
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Affiliation(s)
- Alberto Martin-Martinez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Alícia Costa
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Stephanie A Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
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17
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Proposal for a Standard Protocol to Assess the Rheological Behavior of Thickening Products for Oropharyngeal Dysphagia. Nutrients 2022; 14:nu14235028. [PMID: 36501058 PMCID: PMC9738203 DOI: 10.3390/nu14235028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Increasing shear viscosity (ShV) in thickening products (TP) is a valid therapeutic strategy for oropharyngeal dysphagia (OD). However, salivary amylase in the oral phase and shear rate in the pharyngeal phase of swallowing can change the viscosity of TPs when swallowed. This study aims to design and validate a rheological protocol to reproduce the oral and pharyngeal factors that affect the therapeutic effect of TPs and report the viscosity measurements in a standardized scientific and precise manner. We measured (a) the variability of the ShV measurements across several laboratories; (b) the in vitro and ex vivo properties of TPs and (c) the impact of the X-ray contrast Omnipaque, temperature and resting time on the rheological properties of TPs. A common protocol was applied in four international laboratories to assess five ShV values (100, 200, 400, 800 and 1600 mPa·s) for the xanthan-gum TP Tsururinko Quickly (TQ). The protocol included the dose (g/100 mL water), stirring procedure and standing time before measurement. Each value was characterized at the shear rate of 50 and 300 s-1 pre- and post-oral incubation in eight volunteers. The effect of temperature, standing time and Omnipaque was assessed. The main results of the study were: (a) The mean intra-laboratory variability on the ShV at all levels was very low: 0.85%. The mean inter-laboratory variability was higher: 9.3%; (b) The shear thinning of TQ at 300 s-1 was 75-80%. Increasing the temperature or standing time did not affect the ShV, and oral amylase caused a small decrease; (c) Omnipaque slightly decreased the dose of TP and hardly affected the amylase resistance or shear thinning. This study showed that different laboratories can obtain very accurate and similar ShV measurements using this protocol which uses scientific, universal SI units (mPa·s). Our protocol accurately reproduces oral and pharyngeal factors affecting the therapeutic effect of TPs. The addition of X-ray contrast did not produce significant changes.
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18
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Effects of Food and Liquid Properties on Swallowing Physiology and Function in Adults. Dysphagia 2022; 38:785-817. [PMID: 36266521 DOI: 10.1007/s00455-022-10525-2] [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: 02/14/2022] [Accepted: 09/22/2022] [Indexed: 11/03/2022]
Abstract
Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life.
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Viñas P, Martín-Martínez A, Alarcón C, Riera SA, Miró J, Amadó C, Clavé P, Ortega O. A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19. Nutrients 2022; 14:nu14183826. [PMID: 36145215 PMCID: PMC9502091 DOI: 10.3390/nu14183826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The phenotype of patients affected by COVID-19 disease changed between the waves of the pandemic. We assessed the prevalence of oropharyngeal dysphagia (OD), malnutrition (MN), and mortality between the first three waves of COVID-19 patients in a general hospital. Methods: a prospective observational study between April 2020–May 2021. Clinical assessment for OD was made with the volume-viscosity swallowing test; nutritional assessment was performed consistent with GLIM criteria. A multimodal intervention was implemented in the second and third wave, including (a) texturized diets—fork mashable (1900 kcal + 90 g protein) or pureed (1700 kcal + 75 g protein), (b) oral nutritional supplements (500–600 kcal + 25–30 g protein), and (c) fluid thickening (250 mPa·s or 800 mPa·s). Results: We included 205 patients (69.3 ± 17.6 years) in the 1st, 200 (66.4 ± 17.5 years) in the 2nd, and 200 (72.0 ± 16.3 years;) in the 3rd wave (p = 0.004). On admission, prevalence of OD was 51.7%, 31.3% and 35.1%, and MN, 45.9%, 36.8% and 34.7%, respectively; mortality was 10.7%, 13.6% and 19.1%. OD was independently associated with age, delirium, and MN; MN, with age, OD, diarrhea and ICU admission; mortality, with age, OD and MN. (4) Conclusions: Prevalence of OD, MN and mortality was very high among COVID-19 patients. OD was independently associated with MN and mortality. An early and proactive multimodal nutritional intervention improved patients’ nutritional status.
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Affiliation(s)
- Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Alberto Martín-Martínez
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Claudia Alarcón
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Stephanie A. Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Jaume Miró
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Cristina Amadó
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-741-77-00 (ext. 1046)
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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Tomsen N, Ortega O, Alvarez-Berdugo D, Rofes L, Clavé P. A Comparative Study on the Effect of Acute Pharyngeal Stimulation with TRP Agonists on the Biomechanics and Neurophysiology of Swallow Response in Patients with Oropharyngeal Dysphagia. Int J Mol Sci 2022; 23:ijms231810773. [PMID: 36142680 PMCID: PMC9506471 DOI: 10.3390/ijms231810773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Fluid thickening is the main compensatory strategy for patients with oropharyngeal dysphagia (OD) associated with aging or neurological diseases, and there is still no pharmacological treatment. We aimed to compare the effects of increasing bolus viscosity with that of acute stimulation with TRPV1, TRPA1 or TRPM8 agonists on the biomechanics and neurophysiology of swallow response in patients with OD. We retrospectively analyzed seven studies from our laboratory on 329 patients with OD. The effect of increasing shear viscosity up to 3682 mPa·s was compared by videofluoroscopy and pharyngeal sensory evoked potentials (pSEP) with that of adding to the bolus: capsaicin (TRPV1, 150 μM/10 μM), piperine (TRPA1/V1, 1 mM/150 μM), menthol (TRPM8, 1 mM/10 mM), cinnamaldehyde-zinc (TRPA1, 100 ppm−70 mM), citral (TRPA1, 250 ppm) or citral-isopulegol (TRPA1-TRPM8, 250 ppm−200 ppm). Fluid thickening improved the safety of swallow by 80% (p < 0.0001) by delaying bolus velocity by 20.7 ± 7.0% and time to laryngeal vestibule closure (LVC) by 23.1 ± 3.7%. Capsaicin 150μM or piperine 1 mM significantly improved safety of swallow by 50% (p < 0.01) and 57.1% (p < 0.01) by speeding time to LVC by 27.6% (p < 0.001) and 19.5% (p < 0.01) and bolus velocity by 24.8% (p < 0.01) and 16.9% (p < 0.05), respectively. Cinnamaldehyde-zinc shortened the P2 latency of pSEPs by 11.0% (p < 0.01) and reduced N2-P2 amplitude by 35% (p < 0.01). In conclusion, TRPV1 and TRPV1/A1 agonists are optimal candidates to develop new pharmacological strategies to promote the recovery of brain and swallow function in patients with chronic OD.
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Affiliation(s)
- Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Correspondence: ; Tel.: +34-937417700 (ext. 2284)
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Barcelona, Spain
| | - Daniel Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Barcelona, Spain
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Calmarza-Chueca F, Sánchez-Gimeno AC, Raso-Pueyo J, Arbones-Mainar JM, Caverni-Muñoz A, Sanz-Arque A, Sanz-Paris A. Rheological Properties and Stability of Thickeners for Clinical Use. Nutrients 2022; 14:nu14173455. [PMID: 36079712 PMCID: PMC9460253 DOI: 10.3390/nu14173455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
The adaptation of liquids for patients with dysphagia requires precision and individualization in the viscosities used. We describe the variations of viscosity in water at different concentrations and evolution over time of the three compositions of commercial thickeners that are on the market (starch, starch with gums, and gum). By increasing the concentration in water, the viscosity of gum-based thickeners increases linearly, but it did not reach pudding texture, whereas the viscosity of the starch-based thickeners (alone or mixed with gums) rapidly reaches very thick textures. We modeled the viscosity at different concentrations of the four thickeners using regression analysis (R2 > 0.9). We analyzed viscosity changes after 6 h of preparation. The viscosity of gum-based thickeners increased by a maximum of 6.5% after 6 h of preparation, while starch-based thickeners increased by up to 43%. These findings are important for correct handling and prescription. Gum-based thickeners have a predictable linear behavior with the formula we present, reaching nectar and honey-like textures with less quantity of thickener, and are stable over time. In contrast, starch thickeners have an exponential behavior which is difficult to handle, they reach pudding-like viscosity, and are not stable over time.
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Affiliation(s)
| | - Ana Cristina Sánchez-Gimeno
- Food Technology, Faculty of Veterinary, AgriFood Institute of Aragon (IA2), Zaragoza University, C/Miguel Servet, 177, 50013 Zaragoza, Spain
| | - Javier Raso-Pueyo
- Food Technology, Faculty of Veterinary, AgriFood Institute of Aragon (IA2), Zaragoza University, C/Miguel Servet, 177, 50013 Zaragoza, Spain
| | - José Miguel Arbones-Mainar
- Aragón Health Research Institute, 50009 Zaragoza, Spain
- Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, Instituto Aragones de Ciencias de la Salud (IACS), University Hospital Miguel Servet, 50009 Zaragoza, Spain
- Biomedical Research Center in Physiopathology of Obesity and Nutrition (CIBERObn), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
| | | | - Alejandro Sanz-Arque
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, 50009 Zaragoza, Spain
- Aragón Health Research Institute, 50009 Zaragoza, Spain
- Correspondence:
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Dumican M, Watts C. Swallow Safety and Laryngeal Kinematics: A Comparison of Dysphagia Between Parkinson's Disease and Cerebrovascular Accident. JOURNAL OF PARKINSON'S DISEASE 2022:JPD222372. [PMID: 35964202 DOI: 10.3233/jpd-222372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cerebrovascular accident (CVA) and Parkinson's disease (PD) are well established etiologies of dysphagia. However, differing physiological mechanisms underlying dysphagia may exist between these two causes. There have been limited investigations specifically comparing dysphagia between these two groups. Comparing dysphagia presentation in two different populations may improve clinical expectations, guide treatment approaches, and inform future research. OBJECTIVE This study examined the differences in presentation of dysphagia between PD and CVA. Dysphagia presentation, swallow safety, and laryngeal kinematics were compared between two clinical cohorts. What factors best predicted airway invasion in each group were explored. METHODS 110 swallow studies of individuals with PD and CVA who were referred for swallowing evaluation were obtained. Each video was analyzed for quantitative dysphagia presentation using the Videofluoroscopic Dysphagia Scale (VDS), swallow safety using the Penetration-Aspiration scale, and kinematic timings of the laryngeal vestibule (time-to-laryngeal vestibule closure [LVC] and closure duration [LVCd]). RESULTS Frequencies of penetration or aspiration were similar between groups. The PD group displayed significantly greater pharyngeal stage swallow impairment than CVA, with more frequent reduced laryngeal elevation and increased vallecular residue. The CVA group displayed significantly greater oral stage impairment, with prolonged oral transit times. Time-to-LVC was significantly prolonged and was the strongest predictor of airway invasion in the PD group, but not for CVA. CONCLUSION Similar airway invasion rates for PD and CVA indicate the importance of screening for dysphagia in PD. Laryngeal kinematics as significant contributors to airway invasion in PD but not for CVA highlight the need for further research into these mechanisms and for targeted treatment approaches to dysphagia.
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Baixauli R, Bolivar-Prados M, Ismael-Mohammed K, Clavé P, Tárrega A, Laguna L. Characterization of Dysphagia Thickeners Using Texture Analysis-What Information Can Be Useful? Gels 2022; 8:gels8070430. [PMID: 35877515 PMCID: PMC9323126 DOI: 10.3390/gels8070430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023] Open
Abstract
Besides shear viscosity, other texture parameters (adhesiveness or cohesiveness) might be relevant for safe swallowing in people suffering from oropharyngeal dysphagia. Shear viscosity is assessed through protocols developed using a viscometer or a rheometer. In contrast, protocols and instruments (capillary break-up rheometer) to assess adhesiveness and cohesiveness are less common and much less developed. Other equipment such as texture analyzers can provide useful information on food properties. Here, we aimed to explore different texture analyzer settings (type of test, probe, and protocol) to characterize four commercial dysphagia thickeners at the shear viscosity levels recommended by manufacturers. Among the tests used (extrusion or penetration) with the different probes (disc, cone and shape holder, sphere, or cylinder), cone extrusion provided information about adhesivity, disc extrusion about sample cohesiveness, and sphere about penetration and sample elasticity. The test speeds used influenced the results, but only one speed is needed as the different speeds provided the same fluid information; for easiness, it is proposed to use 1 mm/s. Comparing the texture analyzer results with viscosity values obtained at different shears, the texture analyzer parameters reflected information that differ from shear viscosity. This information could be relevant for the therapeutic effect of thickening products and food characterization.
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Affiliation(s)
- Raquel Baixauli
- Institute of Agrochemistry and Food Technology (IATA, CSIC), 46980 Valencia, Spain; (R.B.); (A.T.)
| | - Mireia Bolivar-Prados
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain; (M.B.-P.); (K.I.-M.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
| | - Kovan Ismael-Mohammed
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain; (M.B.-P.); (K.I.-M.); (P.C.)
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Mataró, Spain; (M.B.-P.); (K.I.-M.); (P.C.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), 08304 Barcelona, Spain
| | - Amparo Tárrega
- Institute of Agrochemistry and Food Technology (IATA, CSIC), 46980 Valencia, Spain; (R.B.); (A.T.)
| | - Laura Laguna
- Institute of Agrochemistry and Food Technology (IATA, CSIC), 46980 Valencia, Spain; (R.B.); (A.T.)
- Correspondence:
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Viñas P, Bolivar-Prados M, Tomsen N, Costa A, Marin S, Riera SA, Barcons N, Clavé P. The Hydration Status of Adult Patients with Oropharyngeal Dysphagia and the Effect of Thickened Fluid Therapy on Fluid Intake and Hydration: Results of Two Parallel Systematic and Scoping Reviews. Nutrients 2022; 14:2497. [PMID: 35745228 PMCID: PMC9228104 DOI: 10.3390/nu14122497] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The effect of oropharyngeal dysphagia (OD) and thickened fluid (TF) therapy on hydration status has not been well defined in the literature. We aimed to assess the hydration status in patients with OD and the effect TF therapy has on it. METHODS Two literature reviews following PRISMA methodology (each one including a systematic and a scoping review) were performed: (R1) hydration status in adult patients with OD; (R2) effect of TF therapy on fluid intake and dehydration. Narrative and descriptive methods summarized both reviews. Quality assessment was assessed by Joanna Briggs Institute tools and GRADE. RESULTS (R1) Five out of twenty-two studies using analytical parameters or bioimpedance showed poorer hydration status among OD and 19-100% prevalence of dehydration; (R2) two high quality studies (total of 724 participants) showed positive effects of TF on hydration status. Among the articles included, nine out of ten studies that evaluated fluid intake reported a reduced TF intake below basal water requirements. CONCLUSIONS Dehydration is a highly prevalent complication in OD. There is scientific evidence on the positive effect of TF therapy on the hydration status of patients with OD. However, strict monitoring of fluid volume intake is essential due to the low consumption of TF in these patients.
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Affiliation(s)
- Paula Viñas
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Mireia Bolivar-Prados
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Noemi Tomsen
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Alicia Costa
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Sergio Marin
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Pharmacy Department, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
| | - Stephanie A. Riera
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
| | - Núria Barcons
- Medical Affairs, Nestlé Health Science, CH-1800 Vevey, Switzerland;
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, 08304 Barcelona, Spain; (P.V.); (M.B.-P.); (N.T.); (A.C.); (S.M.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
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Advances in 3D printing of food and nutritional products. ADVANCES IN FOOD AND NUTRITION RESEARCH 2022; 100:173-210. [PMID: 35659352 DOI: 10.1016/bs.afnr.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The main advantage of both 3D printing (3DP) and 3D food printing (3DFP) over other technologies is the enormous capacity of both techniques for customization. Its use makes it possible to obtain products without planning and implementing a complex and costly manufacturing process. This makes 3DFP a technology of choice for the preparation of food products that meet specific needs, such as controlled nutritional or rheological properties. However, further technological developments are still needed before 3DFP can be considered fully useful for innovative and demanding applications. If both preparation and post-processing of materials based on 3D printing are optimized, aiming to reduce production time and/or complication for non-expert users, this would open a whole new range of possibilities. It is in this sense that the development of advanced 3DFP systems becomes a must. This chapter reviews current advances in extrusion-based 3D food printing systems, with in situ gelation and mixing as key aspects to better exploit the potential of 3DFP. On one hand, 3DFP systems based on in situ gelation (G3DFP) provide greater control over the final properties of the printed products, as the selection of adequate printing parameters gives the possibility of influencing the gelation process. On the other hand, mixing is indispensable for true 3DFP automation, so that the formulations do not have to be prepared by the user. Different innovative 3DFP systems based on gelling and/or mixing are presented in this chapter. Finally, the status and future of extrusion-based 3DFP, and its application in the production of customized foods for specific needs, are also overviewed.
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Burnip E, Cichero JAY. Review of the effect of amylase-resistant dysphagia products on swallowing safety. Curr Opin Otolaryngol Head Neck Surg 2022; 30:169-176. [PMID: 35635111 DOI: 10.1097/moo.0000000000000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Thickened fluids are a widely utilised compensatory management strategy for people with impaired swallowing (dysphagia). Over recent years there has been a shift in practice to offer gum-based instead of starch-based products. A key marketing message has been that gum-based thickeners with amylase-resistant properties are superior in promoting 'safer swallowing'. This review sought evidence to evaluate the effect of amylase-resistant products on swallowing safety. RECENT FINDINGS No studies directly compared the effect of amylase-resistant products with usual care or products without amylase resistance. Five studies cited amylase-resistant properties and compared gum-based to starch-based dysphagia products or thin fluids. Swallowing safety was frequently judged subjectively with rating scales. Swallowing biomechanics were not included and clinically meaningful outcomes, such as incidence of aspiration pneumonia, were not reported. A scoping review of the grey literature found little evidence that amylase-resistant properties of dysphagia products were of significant concern to clinicians or patients. SUMMARY Despite references to the 'importance' of amylase-resistant properties of dysphagia products there is no evidence that this property improves swallowing safety. Further research is needed using objective and clinically meaningful outcome measures to allow clinicians and patients to make informed decisions for dysphagia management.
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Affiliation(s)
- E Burnip
- University of Canterbury, New Zealand
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Marin S, Serra-Prat M, Ortega O, Clavé P. Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review. Syst Rev 2022; 11:92. [PMID: 35568891 PMCID: PMC9107184 DOI: 10.1186/s13643-022-01969-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE Oropharyngeal dysphagia (OD) affects 40-81% of patients after stroke. A recent systematic review on the costs of OD and its main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could reduce clinical complications and costs. The purpose of this systematic review is to assess the available literature for healthcare interventions that are efficient or cost-effective in the management of OD. METHODS A systematic review on economic evaluations of health care interventions will be performed on post-stroke patients with OD following PRISMA recommendations. Four bibliographic databases will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetised with a narrative method and using tables. Quality evaluation will be done using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. DISCUSSION The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarise the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. TRIAL REGISTRATION PROSPERO CRD42020136245.
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Affiliation(s)
- Sergio Marin
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Catalunya, Spain. .,Pharmacy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain. .,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain.
| | - Mateu Serra-Prat
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain.,Research Unit, Consorci Sanitari del Maresme, Mataró, Catalunya, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Catalunya, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Catalunya, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Catalunya, Spain
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Yang Y, Xu J, Sang TT, Wang HY. A review and evidence based recommendations on starch- and gum-based thickeners for dysphagic patients. JOURNAL OF FOOD MEASUREMENT AND CHARACTERIZATION 2022. [DOI: 10.1007/s11694-022-01418-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dumican M, Watts C. Swallow Safety and Laryngeal Kinematics: A Comparison of Dysphagia Between Parkinson's Disease and Cerebrovascular Accident. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2147-2159. [PMID: 36120789 PMCID: PMC9661323 DOI: 10.3233/jpd-223272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cerebrovascular accident (CVA) and Parkinson's disease (PD) are well established etiologies of dysphagia. However, differing physiological mechanisms underlying dysphagia may exist between these two causes. There have been limited investigations specifically comparing dysphagia between these two groups. Comparing dysphagia presentation in two different populations may improve clinical expectations, guide treatment approaches, and inform future research. OBJECTIVE This study examined the differences in presentation of dysphagia between PD and CVA. Dysphagia presentation, swallow safety, and laryngeal kinematics were compared between two clinical cohorts. What factors best predicted airway invasion in each group were explored. METHODS 110 swallow studies of individuals with PD and CVA who were referred for swallowing evaluation were obtained. Each video was analyzed for quantitative dysphagia presentation using the Videofluoroscopic Dysphagia Scale (VDS), swallow safety using the Penetration-Aspiration scale, and kinematic timings of the laryngeal vestibule (time-to-laryngeal vestibule closure [LVC] and closure duration [LVCd]). RESULTS Frequencies of penetration or aspiration were similar between groups. The PD group displayed significantly greater pharyngeal stage swallow impairment than CVA, with more frequent reduced laryngeal elevation and increased vallecular residue. The CVA group displayed significantly greater oral stage impairment, with prolonged oral transit times. Time-to-LVC was significantly prolonged and was the strongest predictor of airway invasion in the PD group, but not for CVA. CONCLUSION Similar airway invasion rates for PD and CVA indicate the importance of screening for dysphagia in PD. Laryngeal kinematics as significant contributors to airway invasion in PD but not for CVA highlight the need for further research into these mechanisms and for targeted treatment approaches to dysphagia.
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Calmarza-Chueca F, Cristina-Sánchez-Gimeno A, Perez-Nogueras J, Caverni-Muñoz A, Sanz-Arque A, Arbones-Mainar JM, Sanz-Paris A. Institutionalized elderly are able to detect small viscosity variations in thickened water with gum-based thickeners: should texture classifications be reviewed? BMC Geriatr 2021; 21:647. [PMID: 34798812 PMCID: PMC8603478 DOI: 10.1186/s12877-021-02599-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of dysphagia is very high in institutionalized elderly. Knowledge of the rheological and sensory characteristics of the various thickeners in elderly is limited, although it has been seen that there are differences between the rheological behaviors of gum-based thickeners with different composition. Moreover, we have not found sensory studies of viscosity in institutionalized elderly. Our hypothesis was that viscosity ranges established by the scientific societies, such as the National Dysphagia Diet Task Force (NDD), seem to be very wide and individuals might be able to detect small differences within the same texture range. The objectives of our study were 1) comparing the rheological characteristics of two commercial gum-based thickeners with different composition, dissolved in water under standard conditions, and 2) perform a sensory analysis (with both adults and institutionalized elderly) to detect different viscosities within the same texture (nectar and honey). METHODS Two commercial thickeners based on gums (NC and RC) were studied analyzing their viscosity in water with different concentrations (shear rate: 50 s- 1; temperature: 22-25 °C). A sensory analysis involving 26 elderly and 29 adult controls was carried out to evaluate whether differences within nectar and honey textures among gum-based thickeners could be distinguished. RESULTS As the shear rate increases, viscosity decreases (non-Newtonian and pseudoplastic behavior). At the same concentration, each thickener produces a different viscosity (p < 0.05). Institutionalized elderly detected viscosity differences in nectar range of 49.9 (2.5) mPa·s (p < 0.05) and 102.2 (4.7) mPa·s (p < 0.0001). They also detected viscosity differences in honey texture range of 134.6 (9.7) mPa·s (p < 0.05) y 199.3 (9.2) mPa·s (p < 0.0001). Their caregivers also detected viscosity differences in both viscosity ranges (p < 0.0001) and with greater intensity than the elderly in honey texture (p: 0.016). CONCLUSIONS Our results suggest that the accepted viscosity ranges by NDD for the different textures might be too wide because institutionalized elderly and their caregivers are able to discern small differences in viscosity in nectar and honey textures. Gum-based thickeners with different composition showed differences in viscosity capacity, so they are not interchangeable.
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Affiliation(s)
| | - Ana Cristina-Sánchez-Gimeno
- Food Technology, Faculty of Veterinary, Zaragoza University, AgriFood Institute of Aragon (IA2), C/ Miguel Servet, 177, 50013, Zaragoza, Spain
| | | | | | - Alejandro Sanz-Arque
- Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain
| | - José Miguel Arbones-Mainar
- Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain.,Adipocyte and Fat Biology Laboratory (AdipoFat), Translational Research Unit, University Hospital Miguel Servet, Instituto Aragones de Ciencias de la Salud (IACS), 50009, Zaragoza, Spain.,Center for Biomedical Research in Network Physiopathology Obesity and Nutrition (CIBERObn), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Alejandro Sanz-Paris
- Department of Endocrinology and Nutrition, Miguel Servet Hospital, Zaragoza, Spain. .,Aragón Health Research Institute/ Instituto de Investigación Sanitaria (IIS) Aragón, Zaragoza, Spain.
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Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
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Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
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Duncan DR, Larson K, Davidson K, Williams N, Liu E, Watters K, Rahbar R, Rosen RL. Acid Suppression Does Not Improve Laryngomalacia Outcomes but Treatment for Oropharyngeal Dysphagia Might Be Protective. J Pediatr 2021; 238:42-49.e2. [PMID: 34186104 PMCID: PMC9756139 DOI: 10.1016/j.jpeds.2021.06.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether the use of acid suppression and thickened feeds impact laryngomalacia outcomes in infants, including supraglottoplasty risk, time to supraglottoplasty, and hospitalization risk. STUDY DESIGN We performed a retrospective cohort study to compare risk and time with supraglottoplasty and frequency and duration of hospitalizations for infants diagnosed with laryngomalacia at Boston Children's Hospital between January 1 and December 31, 2017. The primary outcomes were supraglottoplasty requirement, time to supraglottoplasty, and hospitalization risk. Multivariate analyses were performed to determine predictors of supraglottoplasty and hospitalization risk after adjusting for laryngomalacia severity and comorbidities in addition to propensity score adjustment. Kaplan-Meier curves were created to determine the impact of acid suppression use on time to supraglottoplasty. RESULTS In total, 236 subjects with mean age 62.6 ± 4 days were included in the analysis; 55% were treated with acid suppression. Subjects treated with acid suppression had a greater risk of supraglottoplasty (hazard ratio 3.36, 95% CI 1.36-8.29, P = .009), shorter time to supraglottoplasty (5.64 ± 0.92 vs 7.98 ± 1.92 months, P = .006), and increased respiratory hospitalization risk (relative risk 1.97, 95% CI 1.01-3.85, 0.047), even after adjustment for covariates. Subjects receiving thickening had fewer respiratory hospitalization nights and longer time to supraglottoplasty (9.3 ± 1.7 vs 4.56 ± 0.73 months, P = .004), even after adjustment. CONCLUSIONS Acid suppression use does not reduce the frequency of supraglottoplasty and related hospitalizations compared with untreated subjects. However, patients treated with thickening have decreased hospitalization and longer time to supraglottoplasty, suggesting that thickening of feeds may be a preferred intervention over acid suppression.
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Affiliation(s)
- Daniel R. Duncan
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Kara Larson
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Kathryn Davidson
- Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Nina Williams
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | - Karen Watters
- Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Reza Rahbar
- Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, MA
| | - Rachel L. Rosen
- Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, Massachusetts
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Riera SA, Marin S, Serra-Prat M, Tomsen N, Arreola V, Ortega O, Walshe M, Clavé P. A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia. Foods 2021; 10:1900. [PMID: 34441677 PMCID: PMC8391460 DOI: 10.3390/foods10081900] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023] Open
Abstract
(1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR-) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD's prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.
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Affiliation(s)
- Stephanie A. Riera
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Department of Surgery and Morphological Sciences, University Autonomous of Barcelona, 08193 Cerdanyola del Vallès, Catalunya, Spain
| | - Sergio Marin
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Department of Pharmacy, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Catalunya, Spain
| | - Mateu Serra-Prat
- Research Unit, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain;
| | - Noemí Tomsen
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08304 Mataró, Catalunya, Spain
| | - Viridiana Arreola
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
| | - Omar Ortega
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08304 Mataró, Catalunya, Spain
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, 8PVW G5 Dublin, Ireland;
| | - Pere Clavé
- Gastrointestinal Motility Laboratory, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Catalunya, Spain; (S.A.R.); (S.M.); (N.T.); (V.A.); (O.O.)
- Department of Surgery and Morphological Sciences, University Autonomous of Barcelona, 08193 Cerdanyola del Vallès, Catalunya, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 08304 Mataró, Catalunya, Spain
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Costa A, Martin A, Arreola V, Riera SA, Pizarro A, Carol C, Serras L, Clavé P. Assessment of Swallowing Disorders, Nutritional and Hydration Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including Cerebral Palsy. Nutrients 2021; 13:2413. [PMID: 34371923 PMCID: PMC8308512 DOI: 10.3390/nu13072413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Special needs schools (SNS) educate children and young people with major neurological disabilities who are at high risk of oropharyngeal dysphagia (OD) and malnutrition (MN). We aimed to assess the prevalence of OD, MN, dehydration (DH), and oral health (OH) in students at an SNS. METHODS A cross-sectional observational study was conducted at SNS L'Arboç, Catalonia, Spain. We assessed (a) demographics, health status, comorbidities, and gross motor function classification system (GMFCS), (b) swallowing function, oral-motor evaluation, masticatory capacity, and EDACS classification for eating and drinking abilities, (c) nutritional and DH status (anthropometry, bioimpedance and dietary records), and (d) OH (Oral Hygiene Index Simplified). RESULTS A total of 33 students (mean age 13.3 years; 39.4% level V of GMFCS) were included. Main diagnosis was cerebral palsy at 57.6%. All students presented OD, 90.6% had impaired safety, 68.7% were at levels II-III of EDACS, and 31.3% required PEG; furthermore, 89.3% had chronic MN, 21.4% had acute MN, 70% presented intracellular DH, and 83.9% presented impaired OH. CONCLUSION MN, DH, OD, and poor OH are highly prevalent conditions in students with cerebral palsy and other neurological disabilities and must be specifically managed through nutritional and educational strategies. The multidisciplinary team at SNS should include healthcare professionals specifically trained in these conditions.
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Affiliation(s)
- Alicia Costa
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Unitat de Dietètica i Nutrició, Hospital de Mataró, 08304 Mataró, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, 08035 Cerdanyola del Vallès, Spain
| | - Alberto Martin
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salut Carlos III, 28029 Madrid, Spain
| | - Viridiana Arreola
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salut Carlos III, 28029 Madrid, Spain
| | - Stephanie A. Riera
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
| | - Ana Pizarro
- Departament de Periodòncia, Facultat d’Odontologia de Barcelona UIC, 08195 Sant Cugat del Vallès, Spain;
| | - Cristina Carol
- Escola l’Arboç, Fundació El Maresme, 08301 Mataró, Spain;
| | - Laia Serras
- Unitat de Suport Tècnic, Fundació El Maresme, 08301 Mataró, Spain;
| | - Pere Clavé
- Unitat d’Exploracions Funcionals Digestives CSdM-UAB, Hospital de Mataró, 08304 Mataró, Spain; (A.M.); (V.A.); (S.A.R.)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salut Carlos III, 28029 Madrid, Spain
- Fundació de Recerca en Gastroenterologia (Furega), 08008 Barcelona, Spain
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Lin SC, Lin KH, Tsai YC, Chiu EC. Effects of a food preparation program on dietary well-being for stroke patients with dysphagia: A pilot study. Medicine (Baltimore) 2021; 100:e26479. [PMID: 34160459 PMCID: PMC8238296 DOI: 10.1097/md.0000000000026479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 06/07/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Dysphagia is one of the common issues observed in patients with stroke. Stroke patients with dysphagia have to eat blended food or similar types of food for each meal, resulting in dietary dissatisfaction. The purpose of this study was to investigate the effects of a food preparation program on dietary well-being for stroke patients with dysphagia. METHODS This study was a pilot randomized clinical trial. Twenty-two patients were assigned randomly into the food preparation group (n = 11) and control group (n = 11). The food preparation group received oral motor exercises, recognition of food texture and thickener, and hands-on food preparation for 6 weeks. Outcome measures included the Dietary Well-Being Scale, brief version of the World Health Organization Quality of life, Swallowing Quality of Life Questionnaire, and Mini Nutritional Assessment. RESULTS Patients in the food preparation group showed significant improvements in the Dietary Well-Being Scale, psychological and environmental domains of the brief version of the World Health Organization Quality of life (P = .001-.024) with small to large effect sizes (success rate difference = 0.23-0.46). The Swallowing Quality of Life Questionnaire and Mini Nutritional Assessment displayed non-significant differences (P = .053-.092) and revealed small to moderate effect sizes (success rate difference = 0.23-0.32). CONCLUSIONS The food preparation program showed a positive impact on dietary well-being and a potential improvement in the health-related quality of life, quality of life related to the process of swallowing, and nutritional status for stroke patients with dysphagia. We recommend that stroke patients with dysphagia receive adequate knowledge and hands-on food preparation training to increase their dietary intake and well-being.
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Affiliation(s)
| | | | - Yi-Chi Tsai
- Taipei Private YoHsiang Long Term Care Institution
| | - En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Acceptance of different types of thickeners, with and without flavoring, in hospitalized patients with dysphagia - A pilot study. NUTR HOSP 2021; 38:1082-1088. [PMID: 34139853 DOI: 10.20960/nh.03639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION the goal of this work was to evaluate the acceptance of various types of thickeners, specifically modified starch thickener and gum thickener, both with and without flavoring. PATIENTS AND METHODS a randomized sample of 40 hospitalized patients with oropharyngeal dysphagia was recruited. The taste, smell, and appearance of each type of thickener were evaluated, as well as the volume of liquid ingested by the patients taking each type of thickener (modified starch thickener vs. gum thickener, both with and without flavoring). RESULTS the overall acceptance of gum thickener was significantly higher than that of modified starch thickener (7.45 (1.57) vs. 5.10 (2.43), respectively; p = 0.001). When a food flavor was added to the thickened water, the overall rating of the product was higher than when no flavor was added (7.70 (1.53) vs. 4.85 (2.16); p < 0.001). The difference between the daily volume of water consumed by the patients who received gum thickeners (928.33 (331.27) mL) and those who received starch thickeners (670.00 (288.35) mL) was statistically significant (p = 0.012). Patient consumption was also higher when flavoring was added as compared to when it was not (943.33 (302.45) mL) vs. (655.00 (304.60) mL; p = 0.005). CONCLUSION the acceptances of the thickener and of water intake by patients with dysphagia were both significantly higher when using gum thickeners compared to starch thickeners, and when adding flavoring.
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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: 0.7] [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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Raheem D, Carrascosa C, Ramos F, Saraiva A, Raposo A. Texture-Modified Food for Dysphagic Patients: A Comprehensive Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5125. [PMID: 34066024 PMCID: PMC8150365 DOI: 10.3390/ijerph18105125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 12/16/2022]
Abstract
Food texture is a major food quality parameter. The physicochemical properties of food changes when processed in households or industries, resulting in modified textures. A better understanding of these properties is important for the sensory and textural characteristics of foods that target consumers of all ages, from children to the elderly, especially when food product development is considered for dysphagia. Texture modifications in foods suitable for dysphagic patients will grow as the numbers of elderly citizens increase. Dysphagia management should ensure that texture-modified (TM) food is nutritious and easy to swallow. This review addresses how texture and rheology can be assessed in the food industry by placing particular emphasis on dysphagia. It also discusses how the structure of TM food depends not only on food ingredients, such as hydrocolloids, emulsifiers, and thickening and gelling agents, but also on the applied processing methods, including microencapsulation, microgels as delivery systems, and 3D printing. In addition, we address how to modify texture for individuals with dysphagia in all age groups, and highlight different strategies to develop appropriate food products for dysphagic patients.
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Affiliation(s)
- Dele Raheem
- Northern Institute for Environmental and Minority Law (NIEM), Arctic Centre, University of Lapland, 96101 Rovaniemi, Finland;
| | - Conrado Carrascosa
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - Fernando Ramos
- Pharmacy Faculty, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - Ariana Saraiva
- Department of Animal Pathology and Production, Bromatology and Food Technology, Faculty of Veterinary, Universidad de Las Palmas de Gran Canaria, Trasmontaña s/n, 35413 Arucas, Spain;
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
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Matsuo T, Matsuyama M. Detection of poststroke oropharyngeal dysphagia with swallowing screening by ultrasonography. PLoS One 2021; 16:e0248770. [PMID: 33730038 PMCID: PMC7968693 DOI: 10.1371/journal.pone.0248770] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/26/2021] [Indexed: 12/19/2022] Open
Abstract
There are currently no standard evaluation tools for poststroke neurogenic oropharyngeal dysphagia. We previously suggested calculating the relative movements of the hyoid bone and larynx by ultrasonography to evaluate swallowing movement. Swallowing movement is altered in neurogenic oropharyngeal dysphagia. Therefore, the present study aimed to verify whether an ultrasonographic evaluation of swallowing movement facilitates the detection of neurogenic oropharyngeal dysphagia. Eighteen healthy male elderly participants (the healthy group) and 18 male stroke patients diagnosed with neurogenic oropharyngeal dysphagia (the dysphagia group) were enrolled. Participants swallowed 5 mL of liquid and water with an adjusted viscosity and the movements of the hyoid bone and larynx were visualized by ultrasonography. The results obtained revealed significant differences in laryngeal duration (static phase), laryngeal displacement (elevation phase), and the hyoid bone–laryngeal motion ratio (HL motion ratio) between the two groups. A multiple regression analysis was performed to adjust for confounding factors, and laryngeal duration (static phase) and the HL motion ratios were identified as factors affecting dysphagia. In the receiver operation characteristic curve of the two variations, the area under the curve for laryngeal duration (static phase) was 0.744 and the cut-off was 0.26 sec with 72.2% sensitivity and 88.9% specificity; the area under the curve for the HL motion ratio was 0.951 and the cut-off was 0.56 with 88.9% sensitivity and 88.9% specificity. Therefore, the objective evaluation of hyoid bone and larynx movements during swallowing by ultrasonography facilitated the detection of neurogenic oropharyngeal dysphagia.
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Affiliation(s)
- Takao Matsuo
- Faculty of Allied Health Sciences, Division of Speech-Language-Hearing Therapy, Department of Rehabilitation Sciences, Kansai University of Welfare Sciences, Asahigaoka, Kashiwara city, Osaka, Japan
- * E-mail:
| | - Miwa Matsuyama
- Department of Oral Health Care and Rehabilitation, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuramoto-cho, Tokushima city, Tokushima, Japan
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Thickened liquids: do they still have a place in the dysphagia toolkit? Curr Opin Otolaryngol Head Neck Surg 2021; 28:145-154. [PMID: 32332203 DOI: 10.1097/moo.0000000000000622] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The use of commercially or naturally thickened liquids is a well-established treatment for patients with dysphagia to fluids, the aim of which is to improve swallow safety by minimizing risk of aspiration. Although the most recent systematic reviews conclude that this treatment lacks evidential support and leads to patient-reported worsening health and quality of life, thickened liquids continue to be used with patients with dysphagia across clinical settings. This review briefly summarizes the evidence and considers potential reasons for the apparent mismatch between the evidence and clinical practice. RECENT FINDINGS Continuing practice with thickened liquids is influenced by a range of factors, including gaps in clinical knowledge, inadequate patient involvement, a culture of common practice and a reliance on invalid surrogate studies or research lacking a credible association between thickened liquids and clinically meaningful endpoints. SUMMARY While awaiting further research, clinical decision-making about thickened liquids can be improved by considering the evidence of clinically meaningful endpoints, promoting shared decision-making with patients and underpinning practice with knowledge about the complex relationship between dysphagia, aspiration and pneumonia.
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Best Practice Recommendations for Stroke Patients with Dysphagia: A Delphi-Based Consensus Study of Experts in Turkey-Part II: Rehabilitation. Dysphagia 2021; 36:800-820. [PMID: 33399995 DOI: 10.1007/s00455-020-10218-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 11/17/2020] [Indexed: 01/01/2023]
Abstract
Dysphagia is one of the most common and important complications of stroke. It is an independent marker of poor outcome following acute stroke and it continues to be effective for many years. This consensus-based guideline is not only a good address to clinical questions in practice for the clinical management of dysphagia including management, diagnosis, follow-up, and rehabilitation methods, but also includes detailed algorithms for these topics. The recommendation paper has been written by a multidisciplinary team and offers 117 recommendations for stroke patients with dysphagia. While focusing on management principles, diagnosis, and follow-up in the 1st part (45 items), rehabilitation details were evaluated in the 2nd part (72 items).
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Fernández-Ruiz VE, Paredes-Ibáñez R, Armero-Barranco D, Sánchez-Romera JF, Ferrer M. Analysis of Quality of Life and Nutritional Status in Elderly Patients with Dysphagia in Order to Prevent Hospital Admissions in a COVID-19 Pandemic. Life (Basel) 2020; 11:22. [PMID: 33396486 PMCID: PMC7824070 DOI: 10.3390/life11010022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 12/28/2022] Open
Abstract
(1) Background: Oropharyngeal dysphagia (OD) is currently recognized as one of the geriatric syndromes due to its high frequency in older people and its associated complications, which have a direct impact on quality of life. The main objective is to determine the effectiveness of telehealth consultation for the re-evaluation of nutritional status and quality of life assessment in older people diagnosed with OD associated with active use of thickeners to prevent hospital admissions in a COVID-19 pandemic. (2) Methods: an observational, descriptive, and longitudinal study that included a sample of 33 subjects with age equal or superior to 65 years diagnosed with OD with conserved cognitive capacity. The nutritional status was evaluated through the Mini-Nutritional Assessment (MNA) questionnaire and biochemical parameters and, the quality of life was determined through the Swallowing Quality of Life (SWAL-QOL) questionnaire. (3) Results: Thirty-three older patients with OD were recruited (54.5% women), with a mean age of 83.5 ± 7.6 years. The main cause of OD in the study population was neurodegenerative disease (51.5%), followed by cerebrovascular disease (33.3%), and other causes (15.2%). Sixty point six percent of patients were found to be at risk of malnutrition. The MNA score was significantly correlated to albumin (r: 0.600, p < 0.001) and total proteins (r: 0.435, p = 0.015), but not to total cholesterol (r: -0.116, p = 0.534) or lymphocytes (r: -0.056, p = 0.758). The mean total score of the SWAL-QOL was 75.1 ± 16.4 points. (4) Conclusions: the quality of life of the subjects related to the use of a thickener is good. Although the body mass index (BMI) and average biochemical, nutritional parameters of the subjects are within the range of normality, the MNA has detected a high percentage of subjects with the risk of malnutrition, which suggests the need for continuous re-evaluation in these patients, demonstrating the viability of the telematic route in this research.
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Affiliation(s)
- Virginia E. Fernández-Ruiz
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Clinic Hospital, 30120 Murcia, Spain; (V.E.F.-R.); (M.F.)
- Faculty of Nursing, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain;
| | - Rocío Paredes-Ibáñez
- Community and Family Nursing Specialist, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain
| | - David Armero-Barranco
- Faculty of Nursing, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain;
| | - Juan Francisco Sánchez-Romera
- Department of Human Anatomy and Psychobiology, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain;
| | - Mercedes Ferrer
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Clinic Hospital, 30120 Murcia, Spain; (V.E.F.-R.); (M.F.)
- Endocrinology and Nutrition Department, Calle Campus Universitario, University of Murcia, 11, 30100 Murcia, Spain
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2020; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. .,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany.,Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy.,Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.,Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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Merino G, Gómez I, Marín-Arroyo MR, Beriain MJ, Ibañez FC. Methodology for design of suitable dishes for dysphagic people. INNOV FOOD SCI EMERG 2020. [DOI: 10.1016/j.ifset.2020.102383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ortega O, Bolívar-Prados M, Arreola V, Nascimento WV, Tomsen N, Gallegos C, Brito-de La Fuente E, Clavé P. Therapeutic Effect, Rheological Properties and α-Amylase Resistance of a New Mixed Starch and Xanthan Gum Thickener on Four Different Phenotypes of Patients with Oropharyngeal Dysphagia. Nutrients 2020; 12:nu12061873. [PMID: 32585942 PMCID: PMC7353421 DOI: 10.3390/nu12061873] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 11/16/2022] Open
Abstract
Thickened fluids are a therapeutic strategy for oropharyngeal dysphagia (OD). However, its therapeutic effect among different phenotypes of OD patients has not yet been compared. We aimed to assess the therapeutic effect and α-amylase resistance of a mixed gum/starch thickener [Fresubin Clear Thickener® (FCT)] on four phenotypes of OD patients: G1) 36 older; G2) 31 head/neck cancer (HNC); G3) 30 Parkinson’s disease; and G4) 31 chronic post-stroke. Therapeutic effect of FCT was assessed during videofluoroscopy using the Penetration-Aspiration Scale (PAS), for 5/20 mL boluses, at four levels of shear-viscosity (<50, 250, 1000 and 2000 mPa·s). The effect of α-amylase was assessed after 30 s of oral incubation. Patients had high prevalence of VFS signs of impaired efficacy (98.44%) and safety (70.31%) of swallow with a severe PAS score (4.44 ± 0.20). Most severe OD was in HNC (80.6% unsafe swallows). FCT showed a strong therapeutic effect on the safety of swallow at a range between 250–1000 mPa·s (74.19–96.67%, safe swallows in G1, G3, G4, and 58.06% in G2), without increasing pharyngeal residue. Viscosity was unaffected by α-amylase. Increasing shear-viscosity with FCT causes a strong viscosity-dependent therapeutic effect on the safety of swallow. This effect depends on the phenotype and is similar among older, Parkinson’s and post-stroke patients.
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Affiliation(s)
- Omar Ortega
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (O.O.); (M.B.-P.); (V.A.); (W.V.N.); (N.T.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mireia Bolívar-Prados
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (O.O.); (M.B.-P.); (V.A.); (W.V.N.); (N.T.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (O.O.); (M.B.-P.); (V.A.); (W.V.N.); (N.T.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Weslania Viviane Nascimento
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (O.O.); (M.B.-P.); (V.A.); (W.V.N.); (N.T.)
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (O.O.); (M.B.-P.); (V.A.); (W.V.N.); (N.T.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Crispulo Gallegos
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, 61352 Bad Homburg, Germany; (C.G.); (E.B.-d.L.F.)
| | - Edmundo Brito-de La Fuente
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, 61352 Bad Homburg, Germany; (C.G.); (E.B.-d.L.F.)
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, CIBERehd CSdM-UAB, Hospital de Mataró, 08404 Mataró, Spain; (O.O.); (M.B.-P.); (V.A.); (W.V.N.); (N.T.)
- Centro de Investigación Biomédica en Red, Enfermedades Hepato-Digestivas (CIBERehd) Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-937-417-700 (ext. 2746)
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Bolivar‐Prados M, Rofes L, Arreola V, Guida S, Nascimento WV, Martin A, Vilardell N, Ortega Fernández O, Ripken D, Lansink M, Clavé P. Effect of a gum-based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia. Neurogastroenterol Motil 2019; 31:e13695. [PMID: 31402571 PMCID: PMC6852432 DOI: 10.1111/nmo.13695] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/16/2019] [Accepted: 07/23/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Increasing viscosity with thickening agents is a valid therapeutic strategy for oropharyngeal dysphagia (OD). To assess the therapeutic effect of a xanthan gum-based thickener (Nutilis Clear® ) at six viscosities compared with thin liquid in poststroke OD (PSOD) patients. METHODS A total of 120 patients with PSOD were studied in this controlled, multiple-dose, fixed-order, and single-blind study using videofluoroscopy (VFSS). A series of boluses of 10 mL thin liquid and 2000, 1400, 800, 450, 250, and 150 mPa s viscosities were given in duplicate, interrupted in case of aspiration. We assessed the safety and efficacy of swallow and the kinematics of the swallow response. KEY RESULTS A total of 41.2% patients had safe swallow at thin liquid which significantly increased for all viscosities from 71.9% at 150 mPa s to 95.6% at 1400 mPa s (P < .001). PAS score (3.7 ± 2.3) at thin liquid was also reduced by increasing bolus viscosity (P < .001). The prevalence of patients with aspiration at thin liquid was 17.5% and decreased at all viscosities (P < .01), except at 150 mPa s. Increasing viscosity shortened time to laryngeal vestibule closure (LVC) at all viscosities (P < .01) and reduced bolus velocity at ≥450 mPa s (P < .05). The prevalence of patients with pharyngeal residue at each viscosity 37.7%-44.7% was similar to that at thin liquid (41.2%). CONCLUSIONS AND INFERENCES The prevalence of unsafe swallow with thin liquids is very high in PSOD. Increasing shear bolus viscosity with this xanthan gum-based thickener significantly increased the safety of swallow in patients with PSOD in a viscosity-dependent manner without increasing the prevalence of pharyngeal residue.
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Affiliation(s)
- Mireia Bolivar‐Prados
- Gastrointestinal Physiology LaboratoryHospital de Mataró, Universitat Autònoma de BarcelonaMataróSpain
| | - Laia Rofes
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)BarcelonaSpain
| | - Viridiana Arreola
- Gastrointestinal Physiology LaboratoryHospital de Mataró, Universitat Autònoma de BarcelonaMataróSpain
| | - Sonia Guida
- Danone Nutricia ResearchNutricia Advanced Medical NutritionUtrechtThe Netherlands
| | - Weslania V. Nascimento
- Gastrointestinal Physiology LaboratoryHospital de Mataró, Universitat Autònoma de BarcelonaMataróSpain
| | - Alberto Martin
- Gastrointestinal Physiology LaboratoryHospital de Mataró, Universitat Autònoma de BarcelonaMataróSpain
| | - Natàlia Vilardell
- Gastrointestinal Physiology LaboratoryHospital de Mataró, Universitat Autònoma de BarcelonaMataróSpain
| | - Omar Ortega Fernández
- Gastrointestinal Physiology LaboratoryHospital de Mataró, Universitat Autònoma de BarcelonaMataróSpain
| | - Dina Ripken
- Danone Nutricia ResearchNutricia Advanced Medical NutritionUtrechtThe Netherlands
| | - Mirian Lansink
- Danone Nutricia ResearchNutricia Advanced Medical NutritionUtrechtThe Netherlands
| | - Pere Clavé
- Gastrointestinal Physiology LaboratoryHospital de Mataró, Universitat Autònoma de BarcelonaMataróSpain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd)BarcelonaSpain
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