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Dysphagia Jun 2023Over the past four decades, our understanding of swallowing neural control has expanded dramatically. However, until recently, advances in rehabilitation approaches for... (Review)
Review
Over the past four decades, our understanding of swallowing neural control has expanded dramatically. However, until recently, advances in rehabilitation approaches for dysphagia have not kept pace, with a persistent focussing on strengthening peripheral muscle. This approach is no doubt very appropriate for some if not many of our patients. But what if the dysphagia is not due to muscles weakness? The purpose of this clinical manuscript is to reflect on where we have been, where we are now and perhaps where we need to go in terms of our understanding of swallowing motor control and rehabilitation of motor control impairments. This compilation is presented to clinicians in the hope that suggesting approaches "outside the box" will inspire clinicians to focus their attention "inside the box" to ultimately improve rehabilitation and long-term outcomes for patients with dysphagia.
Topics: Humans; Deglutition Disorders; Deglutition; Muscles
PubMed: 36097215
DOI: 10.1007/s00455-022-10516-3 -
Annals of Clinical and Translational... Jun 2021Swallowing is a unique movement due to the indispensable orchestration of voluntary and involuntary movements. The transition from voluntary to involuntary swallowing is...
OBJECTIVE
Swallowing is a unique movement due to the indispensable orchestration of voluntary and involuntary movements. The transition from voluntary to involuntary swallowing is executed within milliseconds. We hypothesized that the underlying neural mechanism of swallowing would be revealed by high-frequency cortical activities.
METHODS
Eight epileptic participants fitted with intracranial electrodes over the orofacial cortex were asked to swallow a water bolus and cortical oscillatory changes, including the high γ band (75-150 Hz) and β band (13-30 Hz), were investigated at the time of mouth opening, water injection, and swallowing.
RESULTS
Increases in high γ power associated with mouth opening were observed in the ventrolateral prefrontal cortex (VLPFC) with water injection in the lateral central sulcus and with swallowing in the region along the Sylvian fissure. Mouth opening induced a decrease in β power, which continued until the completion of swallowing. The high γ burst of activity was focal and specific to swallowing; however, the β activities were extensive and not specific to swallowing. In the interim between voluntary and involuntary swallowing, swallowing-related high γ power achieved its peak, and subsequently, the power decreased.
INTERPRETATION
We demonstrated three distinct activities related to mouth opening, water injection, and swallowing induced at different timings using high γ activities. The peak of high γ power related to swallowing suggests that during voluntary swallowing phases, the cortex is the main driving force for swallowing as opposed to the brain stem.
Topics: Adolescent; Adult; Beta Rhythm; Cerebral Cortex; Deglutition; Deglutition Disorders; Electrocorticography; Epilepsy; Female; Gamma Rhythm; Humans; Male; Middle Aged; Young Adult
PubMed: 33949157
DOI: 10.1002/acn3.51344 -
Nihon Ronen Igakkai Zasshi. Japanese... 2023
Topics: Humans; Aged; Deglutition Disorders; Dementia; Deglutition
PubMed: 36889715
DOI: 10.3143/geriatrics.60.1 -
BMC Cancer Jan 2022Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of...
BACKGROUND
Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area.
METHODS
Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes.
RESULTS
Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have 'serious' to 'critical' risk of bias.
CONCLUSIONS
This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.
Topics: Aged; Deglutition; Deglutition Disorders; Esophageal Neoplasms; Exercise Therapy; Female; Humans; Male; Middle Aged; Quality of Life
PubMed: 35012495
DOI: 10.1186/s12885-021-09155-y -
Current Gastroenterology Reports Aug 2020In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the... (Review)
Review
PURPOSE OF REVIEW
In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the cause of symptoms, identify pathology and guide effective management. One of the most notable recent advances in the field of oesophageal function has been high-resolution manometry (HRM). This review explores how innovation in HRM has progressed and has far from reached a plateau.
RECENT FINDINGS
HRM technology, methodology and utility continue to evolve; simple additions to the swallow protocol (e.g. eating and drinking), shifting position, targeting symptoms and adding impedance sensors to the HRM catheter have led to improved diagnoses, therapeutic decision-making and outcomes. Progress in HRM persists and shows little sign of abating. The next iteration of the Chicago Classification of motor disorders will highlight these advances and will also identify opportunities for further research and innovation.
Topics: Deglutition; Electric Impedance; Esophageal Motility Disorders; Humans; Manometry; Patient Positioning
PubMed: 32767186
DOI: 10.1007/s11894-020-00787-x -
Journal of the Formosan Medical... Oct 2022The anterior-superior movement of the hyoid bone plays a significant role in securing the airway and smooth passage of food through the cricopharyngeal muscle. The hyoid... (Review)
Review
The anterior-superior movement of the hyoid bone plays a significant role in securing the airway and smooth passage of food through the cricopharyngeal muscle. The hyoid bone can be detected easily with instruments such as the videofluoroscopic swallow study (VFSS) and ultrasonography (US), which have made quantitative kinematic analysis possible. Dysphagia is a critical issue in different diseases, including stroke, Parkinson's disease (PD), head and neck cancer, and amyotrophic lateral sclerosis (ALS), and the data obtained on these diseases from swallowing kinematic analysis has been accumulating. In this review article, we aimed to present the distinct features of kinematic analysis of hyoid movement in stroke, PD, head and neck cancer, and ALS. We also present the possible relationship between altered hyoid kinematics and dysphagia.
Topics: Amyotrophic Lateral Sclerosis; Biomechanical Phenomena; Deglutition; Deglutition Disorders; Head and Neck Neoplasms; Humans; Hyoid Bone; Parkinson Disease; Stroke
PubMed: 35469721
DOI: 10.1016/j.jfma.2022.04.007 -
Journal of Neuromuscular Diseases 2023Progressive weakness can affect bulbar muscles in individuals with moderate to severe forms of spinal muscular atrophy (SMA). The paucity of standardized, valid bulbar...
BACKGROUND
Progressive weakness can affect bulbar muscles in individuals with moderate to severe forms of spinal muscular atrophy (SMA). The paucity of standardized, valid bulbar assessments capturing clinically significant deficits in SMA impedes the ability to monitor function, facilitate intervention, or detect treatment response.
OBJECTIVE
To fill this void, an international multidisciplinary team gathered to develop an agreed upon consensus-derived assessment of bulbar function in SMA for inter-professional administration to enhance our ability to monitor disease progression, support clinical management, and evaluate treatment effects.
METHODS
Fifty-six international clinicians experienced in SMA were invited and engaged using the Delphi method over multiple rounds of web-based surveys to establish consensus.
RESULTS
Serial virtual meetings occurred with 42 clinicians (21 speech and language therapists, 11 physical therapists, 5 neurologists, 4 occupational therapists, and 1 dentist). Seventy-two validated assessments of bulbar function were identified for potential relevance to individuals with SMA (32 accessible objective, 11 inaccessible objective, 29 patient-reported outcomes). Delphi survey rounds (n = 11, 15, 15) achieved consensus on individual items with relevance and wording discussed. Key aspects of bulbar function identified included: oral intake status, oral facial structure and motor strength, swallowing physiology, voice & speech, and fatigability.
CONCLUSIONS
Multidisciplinary clinicians with expertise in bulbar function and SMA used Delphi methodology to reach consensus on assessments/items considered relevant for SMA across all age groups. Future steps include piloting the new scale moving towards validation/reliability. This work supports the advancement of assessing bulbar function in children and adults with SMA by a variety of professionals.
Topics: Adult; Child; Humans; Reproducibility of Results; Muscular Atrophy, Spinal; Deglutition; Surveys and Questionnaires; Fatigue
PubMed: 37212069
DOI: 10.3233/JND-221672 -
Brazilian Journal of Otorhinolaryngology 2022Neurological alterations can generate swallowing disorders and fiberoptic endoscopic evaluation of swallowing is one of the tests performed for its diagnosis, as well as... (Review)
Review
INTRODUCTION
Neurological alterations can generate swallowing disorders and fiberoptic endoscopic evaluation of swallowing is one of the tests performed for its diagnosis, as well as assistance in dysphagia management.
OBJECTIVE
To identify and describe a fiberoptic endoscopic evaluation of swallowing standardized protocol for the neurological adult population and its stages.
METHODS
Systematic review registered on the PROSPERO platform (CRD42018069428), carried out on the websites: MEDLINE, Cochrane Library and Scielo; published between 2009 and 2020. Randomized clinical trials, cross-sectional, and longitudinal studies were included. Two independent judges evaluated the study design and extracted the data from the selected studies. Doubts regarding inclusion or not of the studies were evaluated by a third judge. Scientific articles included were those with adult neurological remained patients with outcomes: (1) diagnosis of swallowing disorder (2) change in sensitivity in laryngeal region (3) penetration of food offered (4) aspiration of food offered.
RESULTS
3724 articles were initially selected, after personalized search for patients with neurological alterations 101 studies remained. In the end, 21 qualitative studies from 2009 to 2020 remained in the systematic review and they were described in detail and compared. Seven articles used protocols of the institutions in which the research took place and four mentioned using the same protocol. The reliable reproducibility of the protocols is feasible only in three of the articles, even presenting different protocols.
CONCLUSION
There is no standard or validated protocol to assess the swallowing function of adults with neurological diseases.
Topics: Adult; Cross-Sectional Studies; Deglutition; Deglutition Disorders; Endoscopy; Humans; Reproducibility of Results
PubMed: 33895102
DOI: 10.1016/j.bjorl.2021.03.002 -
Dysphagia Feb 2023Owing to differences in clinical approaches toward videofluoroscopic swallowing studies (VFSS), professional and governing bodies in some countries have implemented...
Owing to differences in clinical approaches toward videofluoroscopic swallowing studies (VFSS), professional and governing bodies in some countries have implemented guidelines for performing VFSS. However, in India, the establishment of such practice guidelines is in initial stages of acceptance and there are no uniform guidelines. The aim of the current study was to investigate and describe the clinical practice patterns related to VFSS assessments among Speech-Language Pathologists (SLPs) in India. An electronic survey consisting of 34 questions categorized into four main sections (demographic details and education; current practice; instrumental and technical considerations; protocol and assessment methods) was sent to SLPs registered with the Indian Speech and Hearing Association (ISHA) through email and social media from August 2020 to January 2021. A total of 129 eligible responses were received. More than 50% of the participants used a standard assessment and analysis protocol. Barium and water-soluble contrasts were mostly used, and 97% of participants did not know what percent weight to volume (w/v) or volume to volume (v/v) contrast to fluid were used. Considerable amount of variability was observed in the responses of our participants, which was consistent with international surveys of VFSS practice patterns. Lack of adequate radiation safety measures was also observed. Our findings suggest a need to increase awareness and training among Indian SLPs in technical and procedural aspects of VFSS, and more sensitization toward radiation safety. ISHA should consider forming a committee to develop and adopt uniform nationwide practices in VFSS. Future studies exclusively investigating barriers and facilitators to VFSS practice in the Indian scenario are necessary.
Topics: Humans; Deglutition Disorders; Deglutition; Pathologists; Speech; India; Speech-Language Pathology
PubMed: 35802175
DOI: 10.1007/s00455-022-10487-5 -
Nutrients Aug 2022Recently, a therapeutic method to stimulate the suprahyoid muscle using peripheral magnetic stimulation for dysphagia rehabilitation has been reported. However, clinical... (Review)
Review
Recently, a therapeutic method to stimulate the suprahyoid muscle using peripheral magnetic stimulation for dysphagia rehabilitation has been reported. However, clinical evidence, application protocol, and intervention method remain unclear. Therefore, a systematic review of the published literature is needed. The objective of this study was to systematically review clinical studies of peripheral magnetic stimulation applied for rehabilitation of dysphagia. Issues to be considered in future studies are also suggested. This systematic review performed a literature search of four databases (Medline, Embase, CINAHL, and Web of Science) to identify relevant studies published on the application of repetitive peripheral magnetic stimulation (rPMS) for swallowing-related muscles between 2010 and 2022. Seven studies were reviewed. Randomized controlled trials and one-group pre-post, case study designs were included. In the included studies, rPMS was applied to strengthen the submental suprahyoid muscles. The intervention regime varied. The rPMS was applied at a frequency of 30 Hz for 2 s. Rest time ranged from 8 s to 27-28 s. The number of intervention sessions ranged from 2-3 to 30. The intensity ranged from pain-inducing minimum intensity (90% of maximum stimulus output) to non-painful intensity (70-80% of maximum intensity). The rPMS on the suprahyoid muscles had positive effects on physiological changes in the swallowing function, such as displacement of the hyoid bone, muscle strength (cervical flexor, jaw-opening force), swallowing safety, swallowing performance, and swallowing-related quality of life. Participants also reported little pain and adverse reactions during rPMS. Although rPMS is a therapeutic option that can help improve the swallowing function as a non-invasive stimulation method in the rehabilitation of dysphagia, clinical evidence is needed for the development of clear stimulation protocols and guidelines.
Topics: Humans; Deglutition; Deglutition Disorders; Magnetic Phenomena; Quality of Life
PubMed: 36079772
DOI: 10.3390/nu14173514