Swallowing kinematics and submental muscles activation during a newly designed maneuver called Mouth Open Swallowing Maneuver: A comparative study

The aim of this study was to design a new maneuver called the Mouth Open Swallowing Maneuver (MOSM), and to compare swallowing kinematics and submental muscles activation (SMA) between MOSM and two current approaches used in dysphagia rehabilitation. Fifty healthy volunteers were asked to perform three repetitions of dry swallowing (DS) (control task), the MOSM, the Mendelsohn Maneuver (MM), and the Tongue-Hold Maneuver (THM) during videofluoroscopic swallowing study accompanied with simultaneous SMA recording. Swallowing kinematics were measured by frame-by-frame analysis on hyolaryngeal movement using ImageJ. Swallowing with maximum hyolaryngeal movement and SMA during these tasks was used for comparative analysis. Vertical movement of the hyoid during the MOSM was significantly greater than those observed during the DS and the THM (p<0.001, p<0.001). Horizontal movement of the hyoid during DS and the THM was significantly greater than that observed during the MM (p = 0.001, p = 0.001). Vertical movement of the larynx during the MOSM was significantly greater than those observed during DS, MM, and THM (p<0.001). There was no significant difference between tasks in horizontal movement of the larynx (p = 0.785). SMA during the THM was significantly greater than that observed during MOSM (p = 0.002). No significant difference was found between other tasks in terms of SMA (p>0.05). The MOSM as a newly designed maneuver was significantly superior to other maneuvers in increasing vertical hyolaryngeal movement. The THM has as much effect on hyolaryngeal movement as the MM. In this study, the MOSM was shown to be effective in increasing hyolaryngeal movement. ClinicalTrials.gov Protocol Registration and Results System (PRS); the clinical trial registration number (NCT05579041).

Content comparison of four commonly used amputee mobility assessment scales in the literature by linking to the International Classification of Functioning, Disability, and Health

BACKGROUND

Despite the fact that there are a number of studies revealing the linkage of scales with the World Health Organization's international classification of functioning, disability, and health (ICF), there is a need for comprehensive studies examining the relationship between amputee mobility scales and ICF.

OBJECTIVE

To analyze the content of four amputee mobility scales at the item level using the ICF.

METHODS

The Locomotor Capacity Index, Rivermead Mobility Index, Amputee Mobility Predictor, and Prosthetic Limb Users Survey of Mobility were analyzed by two health professionals for content comparison according to the ICF categories. Kappa statistic was used to calculate the degree of agreement between the two investigators.

RESULTS

A total of 62 items in the scales were analyzed and linked with ICF codes. The scale questions were linked with 27 different ICF codes as follows: 1 (3.7%) "body function", 23 (85.1%) "activity and participation", 2 (7.5%) "environmental factors," and 1 (3.7%) "not definable. The estimated kappa values ranged from 0.83 to 0.90 for ICF codes.

CONCLUSION

As a result of the study, the ICF is a highly effective resource that can be used in the analysis of amputee mobility scales. Because the scale items are more concentrated on the mobility chapter, it was seen that the scales generally served their purposes. In the light of the findings obtained, it is thought that the diversity of the scales in the concept distribution will guide clinicians and researchers in choosing scales according to their target groups.

Timing of Dysphagia Screening in Alzheimer's Dementia

BACKGROUND

Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD.

METHODS

This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups.

RESULTS

Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty-six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57-23.9, P = 0.009; OR: 4.9, CI: 1.24-19.6, P = 0.023, respectively).

CONCLUSION

Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable-sarcopenia-severe sarcopenia), should be screened for dysphagia in every stage.

The pediatric version of the eating assessment tool-10 has discriminant ability to detect aspiration in children with neurological impairments

BACKGROUND

The aim of this study was to determine the ability of the Pediatric version of the Eating Assessment Tool-10 (PEDI-EAT-10) to detect aspiration in children with neurological impairments.

METHODS

Two hundred and fifty-four children were included. Swallowing function was imaged with videofluoroscopic swallowing study (VFSS). The penetration and aspiration scale (PAS) was used to determine the penetration and aspiration severity. Parents completed the PEDI-EAT-10, which is a 10 item, reliable, and valid dysphagia symptom specific outcome instrument.

KEY RESULTS

The mean age of children was 59.91 ± 55.33 months (min = 18, max = 315), of which 52.8% were male. The mean PEDI-EAT-10 of children with airway aspiration (PAS > 5) was 22.32 ± 10.73 (min = 0, max = 40) and the mean PEDI-EAT-10 of children who did not have aspiration (PAS < 6) was 12.35 ± 8.64 (min = 0, max = 40). A linear correlation was found between PEDI-EAT-10 and PAS scores of children (r = 0.41, P < 0.001). The sensitivity of a PEDI-EAT-10 score greater than 12 in predicting aspiration was 77% and the specificity was 54%. A PEDI-EAT-10 score greater than 12 has a positive predictive value of 69% and a negative predictive value of 64%.

CONCLUSIONS AND INFERENCES

The PEDI-EAT-10 could be used to detect unsafe airway issues to identify and refer children for further instrumental swallowing evaluation.