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Dysphagia Assessment and Management

Works Count: 42836

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Description

This cluster of papers focuses on dysphagia, swallowing disorders, and their impact on various populations such as stroke patients, the elderly, and individuals with neurological disorders. It covers topics including aspiration pneumonia, rehabilitation, quality of life, and nutritional support for individuals with dysphagia.

Keywords

Dysphagia; Swallowing; Aspiration Pneumonia; Stroke; Elderly; Rehabilitation; Neurological Disorders; Quality of Life; Oropharyngeal Dysphagia; Nutritional Support

The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory.

2001-07-01

Anita Chen , Ralph F. Frankowski , Julie K. Bishop‐Leone +4 more

To design a reliable and validated self-administered questionnaire whose purpose is to assess dysphagia's effects on the quality of life (QOL) of patients with head and neck cancer.Cross-sectional survey study.Focus … To design a reliable and validated self-administered questionnaire whose purpose is to assess dysphagia's effects on the quality of life (QOL) of patients with head and neck cancer.Cross-sectional survey study.Focus groups were convened for questionnaire development and design. The M. D. Anderson Dysphagia Inventory (MDADI) included global, emotional, functional, and physical subscales. One hundred consecutive adult patients with a neoplasm of the upper aerodigestive tract who underwent evaluation by our Speech Pathology team completed the MDADI and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Speech pathologists completed the Performance Status Scale for each patient. Validity and reliability properties were calculated. Analysis of variance was used to assess how well the MDADI discriminated between groups of patients.The internal consistency reliability of the MDADI was calculated using the Cronbach alpha coefficient. The Cronbach alpha coefficients of the MDADI subscales ranged from 0.85 to 0.93. Test-retest reliability coefficients of the subscales ranged from 0.69 to 0.88. Spearman correlation coefficients between the MDADI subscales and the SF-36 subscales demonstrated construct validity. Patients with primary tumors of the oral cavity and oropharynx had significantly greater swallowing disability with an adverse impact on their QOL compared with patients with primary tumors of the larynx and hypopharynx (P<.001). Patients with a malignant lesion also had significantly greater disability than patients with a benign lesion (P<.001).The MDADI is the first validated and reliable self-administered questionnaire designed specifically for evaluating the impact of dysphagia on the QOL of patients with head and neck cancer. Standardized questionnaires that measure patients' QOL offer a means for demonstrating treatment impact and improving medical care. The development and validation of the MDADI and its use in prospective clinical trials allow for better understanding of the impact of treatment of head and neck cancer on swallowing and of swallowing difficulty on patients' QOL.

Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomised controlled trial

2005-02-01

Martin Dennis , Steff Lewis , C Warlow

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Oropharyngeal swallowing in normal adults of different ages

1992-09-01

JoAnne Robbins , John Hamilton , Gregory L. Lof +1 more

The cortical topography of human swallowing musculature in health and disease

1996-11-01

Shaheen Hamdy , Qasim Aziz , John C. Rothwell +5 more

AGA technical review on management of oropharyngeal dysphagia

1999-02-01

I. J. Cook , P. J. Kahrilas

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The Natural History of Dysphagia following a Stroke

1997-08-01

David Smithard , Paul O’Neill , Ruth England +4 more

Neurophysiology of swallowing

2003-09-12

Çumhur Ertekin , İbrahim Aydoğdu

Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: Which anatomic structures are affected and can they be spared by IMRT?

2004-12-01

Avraham Eisbruch , M. Schwartz , C. Rasch +6 more

Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer

2002-05-01

Avraham Eisbruch , Teresa Lyden , Carol R. Bradford +7 more

Dysphagia in acute stroke.

1987-08-15

Catherine M. Gordon , R L Hewer , Derick T Wade

A prospective study was undertaken to define the incidence, duration, and consequences of dysphagia in an unselected group of 91 consecutive patients who had suffered acute stroke. The site of … A prospective study was undertaken to define the incidence, duration, and consequences of dysphagia in an unselected group of 91 consecutive patients who had suffered acute stroke. The site of the present lesion and of any previous stroke was determined clinically and was confirmed by computed tomography of the brain or necropsy in 40 cases. Of 41 patients who had dysphagia on admission, 37 had had a stroke in one cerebral hemisphere. Only seven patients showed evidence of lesions in both hemispheres. Nineteen of 22 patients who survived a stroke in a hemisphere regained their ability to swallow within 14 days. Dysphagia in patients who had had a stroke in a cerebral hemisphere was associated in this study with a higher incidence of chest infections, dehydration, and death.

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The SWAL-QOL and SWAL-CARE Outcomes Tool for Oropharyngeal Dysphagia in Adults: III. Documentation of Reliability and Validity

2002-04-01

Colleen A. McHorney , JoAnne Robbins , Kevin Lomax +4 more

The Effects of Lingual Exercise in Stroke Patients With Dysphagia

2007-02-01

JoAnne Robbins , Stephanie Kays , Ronald E. Gangnon +4 more

Swallowing Function After Stroke

1999-04-01

Giselle Mann , Graeme J. Hankey , David Cameron

Swallowing dysfunction (dysphagia) is common and disabling after acute stroke, but its impact on long-term prognosis for potential complications and the recovery from swallowing dysfunction remain uncertain. We aimed to … Swallowing dysfunction (dysphagia) is common and disabling after acute stroke, but its impact on long-term prognosis for potential complications and the recovery from swallowing dysfunction remain uncertain. We aimed to prospectively study the prognosis of swallowing function over the first 6 months after acute stroke and to identify the important independent clinical and videofluoroscopic prognostic factors at baseline that are associated with an increased risk of swallowing dysfunction and complications.We prospectively assembled an inception cohort of 128 hospital-referred patients with acute first stroke. We assessed swallowing function clinically and videofluoroscopically, within a median of 3 and 10 days, respectively, of stroke onset, using standardized methods and diagnostic criteria. All patients were followed up prospectively for 6 months for the occurrence of death, recurrent stroke, chest infection, recovery of swallowing function, and return to normal diet.At presentation, a swallowing abnormality was detected clinically in 65 patients (51%; 95% CI, 42% to 60%) and videofluoroscopically in 82 patients (64%; 95% CI, 55% to 72%). During the subsequent 6 months, 26 patients (20%; 95% CI, 14% to 28%) suffered a chest infection. At 6 months after stroke, 97 of the 112 survivors (87%; 95% CI, 79% to 92%) had returned to their prestroke diet. Clinical evidence of a swallowing abnormality was present in 56 patients (50%; 95% CI, 40% to 60%). Videofluoroscopy was performed at 6 months in 67 patients who had a swallowing abnormality at baseline; it showed penetration of the false cords in 34 patients and aspiration in another 17. The single independent baseline predictor of chest infection during the 6-month follow-up period was a delayed or absent swallowing reflex (detected by videofluoroscopy). The single independent predictor of failure to return to normal diet was delayed oral transit (detected by videofluoroscopy). Independent predictors of the combined outcome event of swallowing impairment, chest infection, or aspiration at 6 months were videofluoroscopic evidence of delayed oral transit and penetration of contrast into the laryngeal vestibule, age >70 years, and male sex.Swallowing function should be assessed in all acute stroke patients because swallowing dysfunction is common, it persists in many patients, and complications frequently arise. The assessment of swallowing function should be both clinical and videofluoroscopic. The clinical and videofluoroscopic features at presentation that are important predictors of subsequent swallowing abnormalities and complications are videofluoroscopic evidence of delayed oral transit, a delayed or absent swallow reflex, and penetration. These findings require validation in other studies.

Dysphagia in the elderly: management and nutritional considerations

2012-07-01

Michael A. Crary , Livia Sura , Aarthi Madhavan +1 more

Abstract: Dysphagia is a prevalent difficulty among aging adults. Though increasing age facilitates subtle physiologic changes in swallow function, age-related diseases are significant factors in the presence and severity of … Abstract: Dysphagia is a prevalent difficulty among aging adults. Though increasing age facilitates subtle physiologic changes in swallow function, age-related diseases are significant factors in the presence and severity of dysphagia. Among elderly diseases and health complications, stroke and dementia reflect high rates of dysphagia. In both conditions, dysphagia is associated with nutritional deficits and increased risk of pneumonia. Recent efforts have suggested that elderly community dwellers are also at risk for dysphagia and associated deficits in nutritional status and increased pneumonia risk. Swallowing rehabilitation is an effective approach to increase safe oral intake in these populations and recent research has demonstrated extended benefits related to improved nutritional status and reduced pneumonia rates. In this manuscript, we review data describing age related changes in swallowing and discuss the relationship of dysphagia in patients following stroke, those with dementia, and in community dwelling elderly. Subsequently, we review basic approaches to dysphagia intervention including both compensatory and rehabilitative approaches. We conclude with a discussion on the positive impact of swallowing rehabilitation on malnutrition and pneumonia in elderly who either present with dysphagia or are at risk for dysphagia. Keywords: dysphagia, aging, malnutrition, pneumonia, rehabilitation

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Physiology and radiology of the normal oral and pharyngeal phases of swallowing.

1990-05-01

W. J. Dodds , E T Stewart , J A Logemann

Physiology and radiology of the normal oral and pharyngeal phases of swallowing.W J Dodds, E T Stewart and J A LogemannAudio Available | Share Physiology and radiology of the normal oral and pharyngeal phases of swallowing.W J Dodds, E T Stewart and J A LogemannAudio Available | Share

Dysphagia After Stroke

2005-11-04

Rosemary Martino , Norine Foley , Sanjit K. Bhogal +3 more

Objective— To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. Methods— Databases were searched (1966 through May 2005) … Objective— To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. Methods— Databases were searched (1966 through May 2005) using terms “cerebrovascular disorders,” “deglutition disorders,” and limited to “humans” for original articles addressing the frequency of dysphagia or pneumonia. Data sources included Medline, Embase, Pascal, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Selected articles were reviewed for quality, diagnostic methods, and patient characteristics. Comparisons were made of reported dysphagia and pneumonia frequencies. The relative risks (RRs) of developing pneumonia were calculated in patients with dysphagia and confirmed aspiration. Results— Of the 277 sources identified, 104 were original, peer-reviewed articles that focused on adult stroke patients with dysphagia. Of these, 24 articles met inclusion criteria and were evaluated. The reported incidence of dysphagia was lowest using cursory screening techniques (37% to 45%), higher using clinical testing (51% to 55%), and highest using instrumental testing (64% to 78%). Dysphagia tends to be lower after hemispheric stroke and remains prominent in the rehabilitation brain stem stroke. There is increased risk for pneumonia in patients with dysphagia (RR, 3.17; 95% CI, 2.07, 4.87) and an even greater risk in patients with aspiration (RR, 11.56; 95% CI, 3.36, 39.77). Conclusions— The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients. The pneumonia risk is greatest in stroke patients with aspiration. These findings will be valuable in the design of future dysphagia research.

The Dysphagia Outcome and Severity Scale

1999-05-01

Karen H. O'Neil , Mary Purdy , Janice Falk +1 more

Endoscopic and Videofluoroscopic Evaluations of Swallowing and Aspiration

1991-08-01

Kenneth Schatz , Susan E. Langmore , N. Olson

A new procedure for evaluating oropharyngeal dysphagia utilizing fiberoptic laryngoscopy was compared to the videofluoroscopy procedure. Twenty-one subjects were given both examinations within a 48-hour period. Results of the fiberoptic … A new procedure for evaluating oropharyngeal dysphagia utilizing fiberoptic laryngoscopy was compared to the videofluoroscopy procedure. Twenty-one subjects were given both examinations within a 48-hour period. Results of the fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopy examinations were compared for presence or absence of abnormal events. Good agreement was found, especially for the finding of aspiration (90% agreement). The FEES was then measured against the videofluoroscopy study for sensitivity, specificity, positive predictive value, and negative predictive value. Sensitivity was 0.88 or greater for three of the four parameters measured. Specificity was lower overall, but was still 0.92 for detection of aspiration. It was concluded that the FEES is a valid and valuable tool for evaluating oropharyngeal dysphagia. Some specific patients and conditions that lend themselves to this procedure are discussed.

Fiberoptic endoscopic examination of swallowing safety: A new procedure

1988-12-01

Susan E. Langmore , Schatz M. A. Kenneth , Nels Olsen

Evaluation and Treatment of Swallowing Disorders

1994-09-01

Jeri A. Logemann

No AccessAmerican Journal of Speech-Language PathologyViewpoint1 Sep 1994Evaluation and Treatment of Swallowing Disorders Jeri A. LogemannPhD Jeri A. Logemann Department of Communication Sciences and Disorders, Otolaryngology - Head and Neck … No AccessAmerican Journal of Speech-Language PathologyViewpoint1 Sep 1994Evaluation and Treatment of Swallowing Disorders Jeri A. LogemannPhD Jeri A. Logemann Department of Communication Sciences and Disorders, Otolaryngology - Head and Neck Surgery and Neurology, Northwestern University, 2299 North Campus Drive, Evanston, IL 60208 Google Scholar https://doi.org/10.1044/1058-0360.0303.41 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In References Connelly, A., & Goldacker, F. (1992). Dysphagia management: Are training programs meeting the needs of students? Unpublished survey. Google Scholar Fujiu, M., Toleikis, J. R., Logemann, J. A., & Larson, C. R. (in press). Glossopharyngeal evoked potentials in normal subjects following mechanical stimulation of the anterior faucial pillar.Electroencephalography and Clinical Neurophysiology. Google Scholar Horner, J., Massey, E., Riski, J., Lathrop, M., & Chase, K. (1988). Aspiration following stroke: Clinical correlates and outcomes.Neurology, 38, 1359–1362. Google Scholar Johnson, E. R., McKenzie, S. W., & Sievers, A. (1993). Aspiration pneumonia in stroke.Archives of Physical Medicine and Rehabilitation, 74, 973–976. Google Scholar Kahrilas, P. J., Logemann, J. A., Krugler, C., & Flanagan, E. (1991). Volitional augmentation of upper esophageal sphincter opening during swallowing.American Journal of Physiology, 260 (Gastrointestinal Physiology, 23), G450–456. MedlineGoogle Scholar Kahrilas, P. J., Logemann, J. A., & Gibbons, P. (1992). Food intake by maneuver: An extreme compensation for impaired swallowing.Dysphagia, 7, 155–159. Google Scholar Lazarus, C., Logemann, J. A., & Gibbons, P. (1993). Effects of maneuvers on swallowing function in a dysphagic oral cancer patient.Head and Neck, 15, 419–424. Google Scholar Lazarus, C., Logemann, J. A., Rademaker, A. W., Kahrilas, P. J., Pajak, T., Lazar, R., & Halper, A. (1993). Effects of bolus volume, viscosity and repeated swallows in nonstroke subjects and stroke patients.Archives of Physical Medicine and Rehabilitation, 74, 1066–1070. Google Scholar Logemann, J. A. (1990). Dysphagia.Seminars in Speech and Language, 11(3), 157–164. Google Scholar Logemann, J. A. (1993a). The dysphagia diagnostic procedure as a treatment efficacy trial.Clinics in Communication Disorders, 3(4), 1–10. Google Scholar Logemann, J. A. (1993b). A manual for videofluoroscopic evaluation of swallowing (2nd ed.). Austin, TX: Pro-Ed. Google Scholar Logemann, J. A. (1993c). Noninvasive approaches to deglutitive aspiration.Dysphagia, 8, 331–333. Google Scholar Logemann, J. A., Rademaker, A. W., Pauloski, B. R., & Kahrilas, P. J. (1994). Effects of postural change on aspiration in head and neck surgical patients.Otolaryngology–Head and Neck Surgery, 110(2), 222–227. Google Scholar Martin, B. J. W., Logemann, J. A., Shaker, R., & Dodds, W. J. (1993). Normal laryngeal valving patterns during three breath-hold maneuvers: A pilot investigation.Dysphagia, 8, 11–20. Google Scholar Martin, B. J., Corlew, M., Wood, H., Olson, D., Golopol, L., Wingo, M., & Kirmani, N. (1994). The association of swallowing dysfunction and aspiration pneumonia.Dysphagia, 9, 1–6. Google Scholar Rademaker, A. W., Pauloski, B. R., Logemann, J. A., & Shanahan, T. K. (in press). Oropharyngeal swallow efficiency as a representative measure of swallowing function.Journal of Speech and Hearing Research. Google Scholar Rasley, A., Logemann, J. A., Kahrilas, P. J., Rademaker, A. W., Pauloski, B. R., & Dodds, W. J. (1993). Prevention of barium aspiration during videofluoroscopic swallowing studies: Value of change in posture.American Journal of Roentgenology, 160, 1005–1009. CrossrefMedlineGoogle Scholar Schmidt, J., Holas, M., Halvorson, K., & Reding, M. (1994). Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke.Dysphagia, 9, 7–11. Google Scholar Shanahan, T. K., Logemann, J. A., Rademaker, A. W., Pauloski, B. R., & Kahrilas, P. J. (1993). Chin down posture effects on aspiration in dysphagic patients.Archives of Physical Medicine and Rehabilitation, 74, 736–739. Google Scholar Welch, M. W., Logemann, J. A., Rademaker, A. W., & Kahrilas, P. J. (1993). Changes in pharyngeal dimensions effected by chin tuck.Archives of Physical Medicine and Rehabilitation, 74, 178–181. MedlineGoogle Scholar Additional Resources FiguresReferencesRelatedDetailsCited ByAmerican Journal of Speech-Language Pathology8:2 (109-117)1 May 1999Ethical Issues Involved in Patients' Rights to Refuse Artificially Administered Nutrition and Hydration and Implications for the Speech-Language PathologistTracy L. LandesAmerican Journal of Speech-Language Pathology5:1 (15-22)1 Feb 1996Ethical Decision-Making in Dysphagia ManagementHelen M. Sharp and Leigh B. Genesen Volume 3Issue 3September 1994Pages: 41-44 Get Permissions Add to your Mendeley library History Published in issue: Sep 1, 1994 Metrics Downloaded 657 times Topicsasha-topicsleader-topicsasha-article-typesKeywordsdysphagicvideofluoroscopyevaluationtreatmentswallowingCopyright & PermissionsCopyright © 1994 American Speech-Language-Hearing AssociationPDF DownloadLoading ...

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Stroke-Associated Pneumonia: Major Advances and Obstacles

2013-01-01

Yousef Hannawi , Bashar Hannawi , Chethan P. Venkatasubba Rao +2 more

To explore the risk factors for stroke-associated pneumonia (SAP).A retrospective research study was carried out to investigate the clinical data of 1435 patients admitted to the neurological intensive care unit … To explore the risk factors for stroke-associated pneumonia (SAP).A retrospective research study was carried out to investigate the clinical data of 1435 patients admitted to the neurological intensive care unit at our university hospital between 1 January 2000 and 31 December 2009.A multi-factorial analysis produced the following results: (1) SAP is 1.113 times more likely to occur for each 1-year increase in age; (2) diabetic patients are 1.612 times more likely to develop SAP than non-diabetic patients; (3) the incidence of SAP decreases by a factor of 0.890 with a one-point increase in the Glasgow coma scale score; (4) nasal feeding patients are 4.981 times more likely to develop SAP than non-nasal feeding patients; (5) patients who use H₂-receptor blocking agents are 2.837 times more likely to develop SAP than those who do not; (6) patients who preventively use antibiotics are 2.675 times more likely to develop SAP than those who do not; (7) patients whose hospitalization periods are >20 days are 0.500 times more likely to develop SAP than those who do not; (8) patients who suffer from tracheal intubation are 2.980 times more likely to develop SAP than those who do not; and (9) patients who suffer from tracheal incision are 2.190 times more likely to develop SAP than those who do not.SAP was more closely related with diabetes, age, consciousness, days of hospitalization, tracheal intubation, tracheal incision, nasal feeding treatment, and the application of H₂-receptor blocking agents and antimicrobials.

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Food oral processing—A review

2007-12-05

Jianshe Chen

The evaluation and treatment of swallowing disorders

1998-12-01

Jeri A. Logemann

The effects of laryngotracheoesophageal cleft, rheumatoid arthritis, gastroesophageal reflux disease, supracricoid partial laryngectomy with cricohyoidopexy, and postsurgical unilateral recurrent nerve paralysis on swallowing function are examined. Procedures for screening patients … The effects of laryngotracheoesophageal cleft, rheumatoid arthritis, gastroesophageal reflux disease, supracricoid partial laryngectomy with cricohyoidopexy, and postsurgical unilateral recurrent nerve paralysis on swallowing function are examined. Procedures for screening patients for symptoms of swallowing problems and diagnostic techniques that define swallowing anatomy and physiology are compared and contrasted. Surgical and behavioral treatments for swallowing disorders are described.

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Effect of swallowed bolus variables on oral and pharyngeal phases of swallowing

1990-05-01

Roberto Oliveira Dantas , Mark Kern , Benson T. Massey +5 more

In this investigation, we studied the effects of bolus volume and viscosity on the quantitative features of the oral and pharyngeal phases of swallowing. Concurrent videofluoroscopic and manometric studies were … In this investigation, we studied the effects of bolus volume and viscosity on the quantitative features of the oral and pharyngeal phases of swallowing. Concurrent videofluoroscopic and manometric studies were done in 10 healthy volunteers who were imaged in lateral projection. Videofluorography was done at 30 frames/s while concurrent manometry was done with 5 intraluminal transducers that straddled the pharynx and upper esophageal sphincter (UES). Submental electromyography was recorded also. Swallows of 2-20 ml were recorded for low-viscosity liquid barium and high-viscosity paste barium. Analysis indicated that the major effect of increases in bolus volume was an earlier onset of anterior tongue base movement, superior palatal movement, anterior laryngeal movement, and UES opening. These events provide receptive adaptation for receiving a swallowed bolus. Earlier UES opening was associated with an increase in the duration of sphincter opening and sphincter diameter. The major effects of high bolus viscosity, unrelated to bolus volume, were to delay oral and pharyngeal bolus transit, increase the duration of pharyngeal peristaltic waves, and prolong and increase UES opening. Thus the specific effect of bolus viscosity per se differs substantially from that of bolus volume. We conclude that 1) specific variables of swallowing are affected significantly by the variables of the swallowed bolus, such as volume and viscosity; 2) overall, bolus volume and viscosity affect swallowing in a different manner; and 3) the study findings have implications about the neural control mechanisms that govern swallowing as well as about the diagnosis and treatment of patients with abnormal oral-pharyngeal swallowing.

Social and Psychological Burden of Dysphagia: Its Impact on Diagnosis and Treatment

2002-04-01

Olle Ekberg , Shaheen Hamdy , Virginie Woisard +2 more

Validity and Reliability of the Eating Assessment Tool (EAT-10)

2008-12-01

Peter C. Belafsky , Debbie A. Mouadeb , Catherine J. Rees +4 more

Objectives: The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment … Objectives: The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10). Methods: The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses. Results: A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (±SD) EAT-10 score of the normal cohort was 0.40 ± 1.01. The mean EAT-10 score was 23.58 ± 13.18 for patients with esophageal dysphagia, 23.10 ± 12.22 for those with oropharyngeal dysphagia, 9.19 ± 12.60 for those with voice disorders, 22.42 ± 14.06 for those with head and neck cancer, and 11.71 ± 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p < 0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 ± 10.5 to 5.2 ± 7.4 after treatment (p < 0.001). Conclusions: The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.

MBS Measurement Tool for Swallow Impairment—MBSImp: Establishing a Standard

2008-10-14

Bonnie Martin‐Harris , Martin B. Brodsky , Yvonne Michel +5 more

Oral Care Reduces Pneumonia in Older Patients in Nursing Homes

2002-03-01

Takeyoshi Yoneyama , Mitsuyoshi Yoshida , Takashi Ohrui +7 more

OBJECTIVES: Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care lowers the frequency of pneumonia in institutionalized … OBJECTIVES: Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people. DESIGN: Survey. SETTING: Eleven nursing homes in Japan. PARTICIPANTS: Four hundred seventeen patients randomly assigned to an oral care group or a no oral care group. INTERVENTION: Nurses or caregivers cleaned the patients' teeth by toothbrush after each meal. Swabbing with povidone iodine was additionally used in some cases. Dentists or dental hygienists provided professional care once a week. MEASUREMENTS: Pneumonia, febrile days, death from pneumonia, activities of daily living, and cognitive functions. RESULTS: During follow‐up, pneumonia, febrile days, and death from pneumonia decreased significantly in patients with oral care. Oral care was beneficial in edentate and dentate patients. Activities of daily living and cognitive functions showed a tendency to improve with oral care. CONCLUSION: We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes. J Am Geriatr Soc 50:430–433, 2002.

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Gastrointestinal dysfunction in Parkinson's disease

2003-01-21

Ronald F. Pfeiffer

Anatomy and Physiology of Feeding and Swallowing: Normal and Abnormal

2008-10-22

Koichiro Matsuo , Jeffrey B. Palmer

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The Influence of Food Texture and Liquid Consistency Modification on Swallowing Physiology and Function: A Systematic Review

2014-10-24

Catriona M. Steele , Woroud A. Alsanei , Sona Ayanikalath +7 more

Texture modification has become one of the most common forms of intervention for dysphagia, and is widely considered important for promoting safe and efficient swallowing. However, to date, there is … Texture modification has become one of the most common forms of intervention for dysphagia, and is widely considered important for promoting safe and efficient swallowing. However, to date, there is no single convention with respect to the terminology used to describe levels of liquid thickening or food texture modification for clinical use. As a first step toward building a common taxonomy, a systematic review was undertaken to identify empirical evidence describing the impact of liquid consistency and food texture on swallowing behavior. A multi-engine search yielded 10,147 non-duplicate articles, which were screened for relevance. A team of ten international researchers collaborated to conduct full-text reviews for 488 of these articles, which met the study inclusion criteria. Of these, 36 articles were found to contain specific information comparing oral processing or swallowing behaviors for at least two liquid consistencies or food textures. Qualitative synthesis revealed two key trends with respect to the impact of thickening liquids on swallowing: thicker liquids reduce the risk of penetration-aspiration, but also increase the risk of post-swallow residue in the pharynx. The literature was insufficient to support the delineation of specific viscosity boundaries or other quantifiable material properties related to these clinical outcomes. With respect to food texture, the literature pointed to properties of hardness, cohesiveness, and slipperiness as being relevant both for physiological behaviors and bolus flow patterns. The literature suggests a need to classify food and fluid behavior in the context of the physiological processes involved in oral transport and flow initiation.

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Laryngeal Sensation: A Touchy Subject

1998-02-01

Susan E. Langmore

Initial Psychometric Assessment of a Functional Oral Intake Scale for Dysphagia in Stroke Patients

2005-08-01

Michael A. Crary , Giselle Mann , Michael E. Groher

Complications and Outcome After Acute Stroke

1996-07-01

DG Smithard , P A O'Neill , C. Park +4 more

Background and Purpose The published data on the relationship between dysphagia and both outcome and complications after acute stroke have been inconclusive. We examined the relationship between these, using bedside … Background and Purpose The published data on the relationship between dysphagia and both outcome and complications after acute stroke have been inconclusive. We examined the relationship between these, using bedside assessment and videofluoroscopic examination. Methods We prospectively studied 121 consecutive patients admitted with acute stroke. A standardized bedside assessment was performed by a physician. We performed videofluoroscopy blinded to this assessment within 3 days of stroke onset and within a median time of 24 hours of the bedside evaluations. The presence of aspiration was recorded. Mortality, functional outcome, length of stay, place of discharge, occurrence of chest infection, nutritional status, and hydration were the main outcome measures. Results Patients with an abnormal swallow (dysphagia) on bedside assessment had a higher risk of chest infection ( P =.05) and a poor nutritional state ( P <.001). The presence of dysphagia was associated with an increased risk of death ( P =.001), disability ( P =.02), length of hospital stay ( P <.001), and institutional care ( P <.05). When other factors were taken into account, dysphagia remained as an independent predictor of outcome only with regard to mortality. The use of videofluoroscopy in detecting aspiration did not add to the value of bedside assessment. Conclusions Bedside assessment of swallowing is of use in identifying patients at risk of developing complications. The value of routine screening with videofluoroscopy to detect aspiration is questioned.

Formal Dysphagia Screening Protocols Prevent Pneumonia

2005-08-19

Judith A. Hinchey , Timothy J. Shephard , Karen L. Furie +3 more

Pneumonia is an important complication of ischemic stroke and increases mortality 3-fold. Five guidelines recommend a dysphagia screen before oral intake. What constitutes an adequate dysphagia screen and which patients … Pneumonia is an important complication of ischemic stroke and increases mortality 3-fold. Five guidelines recommend a dysphagia screen before oral intake. What constitutes an adequate dysphagia screen and which patients should receive it remain unclear.Fifteen acute care institutions prospectively collected data on all admitted patients with acute ischemic stroke. Sites were required to collect data on demographics and 4 quality indicators. Optional data included stroke severity and complications. We measured adherence to a screen for dysphagia, the type of screen, and development of in-hospital pneumonia.Between December 2001 and January 2003, 2532 cases were collected. In-hospital complications were recorded on 2329 (92%) of cases. Stroke severity was captured on 1361 (54%). Adherence to a dysphagia screen was 61%. Six sites had a formal dysphagia screen, and their adherence rate was 78% compared with 57% at sites with no formal screen. The pneumonia rate at sites with a formal dysphagia screen was 2.4% versus 5.4% (P=0.0016) at sites with no formal screen. There was no difference in median stroke severity (5 versus 4; P=0.84) between the sites with and without a formal screen. A formal dysphagia screen prevented pneumonia even after adjusting for stroke severity.A formal dysphagia screen is associated with a higher adherence rate to dysphagia screens and a significantly decreased risk of pneumonia. A formal screening protocol should be offered to all stroke patients, regardless of stroke severity.

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The Effects of Lingual Exercise on Swallowing in Older Adults

2005-09-01

JoAnne Robbins , Ronald E. Gangnon , Shannon M. Theis +3 more

To determine the effects of an 8-week progressive lingual resistance exercise program on swallowing in older individuals, the most "at risk" group for dysphagia.Prospective cohort intervention study.Subjects were recruited from … To determine the effects of an 8-week progressive lingual resistance exercise program on swallowing in older individuals, the most "at risk" group for dysphagia.Prospective cohort intervention study.Subjects were recruited from the community at large.Ten healthy men and women aged 70 to 89.Each subject performed an 8-week lingual resistance exercise program consisting of compressing an air-filled bulb between the tongue and hard palate.At baseline and Week 8, each subject completed a videofluoroscopic swallowing evaluation for kinematic and bolus flow assessment of swallowing. Swallowing pressures and isometric pressures were collected at baseline and Weeks 2, 4, and 6. Four of the subjects also underwent oral magnetic resonance imaging (MRI) to measure lingual volume.All subjects significantly increased their isometric and swallowing pressures. All subjects who had the MRI demonstrated increased lingual volume of an average of 5.1%.The findings indicate that lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age-related conditions. The potential effect of lingual exercise on reducing dysphagia-related comorbidities (pneumonia, malnutrition, and dehydration) and healthcare costs while improving quality of life is encouraging.

Aspiration Pneumonia and Dysphagia in the Elderly

2003-07-01

Paul E. Marik , Danielle A. Kaplan

The natural history and functional consequences of dysphagia after hemispheric stroke.

1989-02-01

D H Barer

Data from 357 conscious stroke patients taking part in an acute intervention trial and assessed within 48 hours of the onset of symptoms, were used to investigate the prevalence and … Data from 357 conscious stroke patients taking part in an acute intervention trial and assessed within 48 hours of the onset of symptoms, were used to investigate the prevalence and natural history of swallowing problems. Nearly 30% of patients with single-hemisphere strokes were initially found to have difficulty swallowing a mouthful of water, but in most of those who survived, the deficit had resolved by the end of the first week. Strong correlations were found between dysphagia and speech impairment (comprehension and expression) and with facial weakness, but there was no association with the side of the stroke. After controlling for other markers of overall stroke severity such as conscious level, urinary continence, white blood cell count and strength in the affected limbs, swallowing impairment still showed a significant inverse correlation with functional ability at 1 and 6 months. These results indicate that, even if dysphagia itself is not responsible for much excess mortality in acute stroke, it might still lead to complications which hamper functional recovery.

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Validation of the 3-oz Water Swallow Test for Aspiration Following Stroke

1992-12-01

Kathleen L. DePippo , M. Holas , Michael Reding

A 3-oz water swallow test identified 80% (16/20) of patients aspirating during a subsequent videofluoroscopic modified barium swallow examination (sensitivity, 76%; specificity, 59%). It also identified patients with more severe … A 3-oz water swallow test identified 80% (16/20) of patients aspirating during a subsequent videofluoroscopic modified barium swallow examination (sensitivity, 76%; specificity, 59%). It also identified patients with more severe dysphagia aspirating larger amounts (sensitivity, 94%; specificity, 26%) or thicker consistencies (sensitivity, 94%; specificity, 30%) of test material. The 3-oz water swallow test is a sensitive screening tool for identifying patients at risk for clinically significant aspiration who need referral for more definitive modified barium swallow evaluation.

Dysphagia Bedside Screening for Acute-Stroke Patients

2007-09-21

Michaela Trapl‐Grundschober , Paul Enderle , Monika Nowotny +4 more

Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed … Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly. Methods— Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallowing was compared with the semisolid score. Results— Interrater reliability yielded excellent agreement between both raters (κ=0.835, P <0.001). In both groups, GUSS predicted aspiration risk well (area under the curve=0.77; 95% CI, 0.53 to 1.02 in the 20-patient sample; area under the curve=0.933; 95% CI, 0.833 to 1.033 in the 30-patient sample). The cutoff value of 14 points resulted in 100% sensitivity, 50% specificity, and a negative predictive value of 100% in the 20-patient sample and of 100%, 69%, and 100%, respectively, in the 30-patient sample. Content validity showed a significantly higher aspiration risk with liquids compared with semisolid textures ( P =0.001), therefore confirming the subtest sequence of GUSS. Conclusions— The GUSS offers a quick and reliable method to identify stroke patients with dysphagia and aspiration risk. Such a graded assessment considers the pathophysiology of voluntary swallowing in a more differentiated fashion and provides less discomfort for those patients who can continue with their oral feeding routine for semisolid food while refraining from drinking fluids.

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Consequence of Dysphagia in the Hospitalized Patient

2010-08-16

Kenneth W. Altman , Gou‐Pei Yu , Steven D. Schaefer

To determine if comorbid dysphagia in all hospitalized patients has the potential to prolong hospital stay and increase morbidity. Dysphagia is increasingly prevalent with age and comorbid medical conditions. Our … To determine if comorbid dysphagia in all hospitalized patients has the potential to prolong hospital stay and increase morbidity. Dysphagia is increasingly prevalent with age and comorbid medical conditions. Our research group has previously shown that dysphagia is a bad prognostic indicator in patients with stroke.Analysis of national database.The National Hospital Discharge Survey (NHDS), 2005-2006, was evaluated for presence of dysphagia and the most common comorbid medical conditions. Patient demographics, associated disease, length of hospital stay, morbidity and mortality were also evaluated.There were over 77 million estimated hospital admissions in the period evaluated, of which 271,983 were associated with dysphagia. Dysphagia was most commonly associated with fluid or electrolyte disorder, esophageal disease, stroke, aspiration pneumonia, urinary tract infection, and congestive heart failure. The median number of hospitalization days for all patients with dysphagia was 4.04 compared with 2.40 days for those patients without dysphagia. Mortality increased substantially in patients with dysphagia associated with rehabilitation, intervertebral disk disorders, and heart diseases.Dysphagia has a significant impact on hospital length of stay and is a bad prognostic indicator. Early recognition of dysphagia and intervention in the hospitalized patient is advised to reduce morbidity and length of hospital stay.

Aspiration Pneumonitis and Aspiration Pneumonia

2001-03-01

Paul E. Marik

Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract.1,2 Several pulmonary syndromes may occur after aspiration, depending on the amount and … Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract.1,2 Several pulmonary syndromes may occur after aspiration, depending on the amount and nature of the aspirated material, the frequency of aspiration, and the host's response to the aspirated material.2 Aspiration pneumonitis (Mendelson's syndrome) is a chemical injury caused by the inhalation of sterile gastric contents, whereas aspiration pneumonia is an infectious process caused by the inhalation of oropharyngeal secretions that are colonized by pathogenic bacteria. Although there is some overlap between these syndromes, they are distinct clinical entities (Table 1). Other . . .

AN ELECTROMYOGRAPHIC ANALYSIS OF REFLEX DEGLUTITION

1956-01-01

Robert W. Doty , James F. Bosma

Short chain fatty acids and gut microbiota differ between patients with Parkinson's disease and age-matched controls

2016-09-02

Marcus M. Unger , Jörg Spiegel , Klaus-Ulrich Dillmann +6 more

European Society for Swallowing Disorders &ndash; European Union Geriatric Medicine Society white paper: oropharyngeal dysphagia as a geriatric syndrome

2016-10-01

Laura W. J. Baijens , Père Clavé , Patrick Cras +7 more

Abstract: This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, … Abstract: This position document has been developed by the Dysphagia Working Group, a committee of members from the European Society for Swallowing Disorders and the European Union Geriatric Medicine Society, and invited experts. It consists of 12 sections that cover all aspects of clinical management of oropharyngeal dysphagia (OD) related to geriatric medicine and discusses prevalence, quality of life, and legal and ethical issues, as well as health economics and social burden. OD constitutes impaired or uncomfortable transit of food or liquids from the oral cavity to the esophagus, and it is included in the World Health Organization’s classification of diseases. It can cause severe complications such as malnutrition, dehydration, respiratory infections, aspiration pneumonia, and increased readmissions, institutionalization, and morbimortality. OD is a prevalent and serious problem among all phenotypes of older patients as oropharyngeal swallow response is impaired in older people and can cause aspiration. Despite its prevalence and severity, OD is still underdiagnosed and untreated in many medical centers. There are several validated clinical and instrumental methods (videofluoroscopy and fiberoptic endoscopic evaluation of swallowing) to diagnose OD, and treatment is mainly based on compensatory measures, although new treatments to stimulate the oropharyngeal swallow response are under research. OD matches the definition of a geriatric syndrome as it is highly prevalent among older people, is caused by multiple factors, is associated with several comorbidities and poor prognosis, and needs a multidimensional approach to be treated. OD should be given more importance and attention and thus be included in all standard screening protocols, treated, and regularly monitored to prevent its main complications. More research is needed to develop and standardize new treatments and management protocols for older patients with OD, which is a challenging mission for our societies. Keywords: Swallowing disorders, malnutrition, aged, frail elderly, quality of life, healthy aging, sarcopenia

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Development of International Terminology and Definitions for Texture-Modified Foods and Thickened Fluids Used in Dysphagia Management: The IDDSI Framework

2016-12-02

Julie A. Y. Cichero , Peter Lam , Catriona M. Steele +7 more

Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The … Dysphagia is estimated to affect ~8% of the world's population (~590 million people). Texture-modified foods and thickened drinks are commonly used to reduce the risks of choking and aspiration. The International Dysphagia Diet Standardisation Initiative (IDDSI) was founded with the goal of developing globally standardized terminology and definitions for texture-modified foods and liquids applicable to individuals with dysphagia of all ages, in all care settings, and all cultures. A multi-professional volunteer committee developed a dysphagia diet framework through systematic review and stakeholder consultation. First, a survey of existing national terminologies and current practice was conducted, receiving 2050 responses from 33 countries. Respondents included individuals with dysphagia; their caregivers; organizations supporting individuals with dysphagia; healthcare professionals; food service providers; researchers; and industry. The results revealed common use of 3–4 levels of food texture (54 different names) and ≥3 levels of liquid thickness (27 different names). Substantial support was expressed for international standardization. Next, a systematic review regarding the impact of food texture and liquid consistency on swallowing was completed. A meeting was then convened to review data from previous phases, and develop a draft framework. A further international stakeholder survey sought feedback to guide framework refinement; 3190 responses were received from 57 countries. The IDDSI Framework (released in November, 2015) involves a continuum of 8 levels (0–7) identified by numbers, text labels, color codes, definitions, and measurement methods. The IDDSI Framework is recommended for implementation throughout the world.

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Meta-analysis of the Parkinson’s disease gut microbiome suggests alterations linked to intestinal inflammation

2021-03-10

Stefano Romano , George M. Savva , Janis R. Bedarf +3 more

The gut microbiota is emerging as an important modulator of neurodegenerative diseases, and accumulating evidence has linked gut microbes to Parkinson's disease (PD) symptomatology and pathophysiology. PD is often preceded … The gut microbiota is emerging as an important modulator of neurodegenerative diseases, and accumulating evidence has linked gut microbes to Parkinson's disease (PD) symptomatology and pathophysiology. PD is often preceded by gastrointestinal symptoms and alterations of the enteric nervous system accompany the disease. Several studies have analyzed the gut microbiome in PD, but a consensus on the features of the PD-specific microbiota is missing. Here, we conduct a meta-analysis re-analyzing the ten currently available 16S microbiome datasets to investigate whether common alterations in the gut microbiota of PD patients exist across cohorts. We found significant alterations in the PD-associated microbiome, which are robust to study-specific technical heterogeneities, although differences in microbiome structure between PD and controls are small. Enrichment of the genera Lactobacillus, Akkermansia, and Bifidobacterium and depletion of bacteria belonging to the Lachnospiraceae family and the Faecalibacterium genus, both important short-chain fatty acids producers, emerged as the most consistent PD gut microbiome alterations. This dysbiosis might result in a pro-inflammatory status which could be linked to the recurrent gastrointestinal symptoms affecting PD patients.

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Deglutition.

1982-01-01

Arthur J. Miller

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

1998-02-01

Susan E. Langmore , Margaret S. Terpenning , Anthony Schork +4 more

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Dysphagia and Oral Health in Older Adults with Motoric Cognitive Risk Syndrome

2025-06-25

Özgü İnal , Senem Demirdel , Necmiye Ün Yıldırım +1 more | Dysphagia

Abstract Slow gait speed and subjective cognitive decline in older adults are characteristics of motoric cognitive risk syndrome (MCRS). Dysphagia and oral health may be connected to MCRS because they … Abstract Slow gait speed and subjective cognitive decline in older adults are characteristics of motoric cognitive risk syndrome (MCRS). Dysphagia and oral health may be connected to MCRS because they are linked to both motor function and cognitive performance. This study aimed to investigate dysphagia and oral health among older adults with MCRS. Community-dwelling adults over 65 years of age who visited the geriatric outpatient clinic for regular check-ups were included (N = 152). Socio-demographic and clinical data were collected, and the Eating Assessment Tool (EAT-10) and Geriatric Oral Health Assessment Index (GOHAI) were implemented. Participants were divided into two groups as MCRS (N = 36) and non-MCRS (N = 116). Poorer GOHAI and EAT-10 scores were observed in the MCRS group (all p < 0.05 for all). After adjusting for potential confounding factors, higher EAT-10 scores were found to be independently associated with MCRS (OR = 1.13, 95% CI: 1.04–1.23, p = 0.005), but not GOHAI scores. Our findings indicated an association between dysphagia and MCRS in older adults. This is the first study in the literature to examine the association between dysphagia and oral health among older adults with MCRS. MCRS is a very recent topic in the literature and the parameters associated with MCRS are not clear. This study will contribute to the literature filling an important gap because a better understanding of the mechanisms linking these two comorbidities is vital for the development of targeted interventions aimed at reducing swallowing difficulties in patients with MCRS.

Voice symptoms, dysphagia risk, quality of life, and mental health in total laryngectomized patients: a self-perception study

2025-06-25

J Pereira , Vaneli Colombo Rossi , Carlos Takahiro Chone +1 more | Brazilian Journal of Otorhinolaryngology

Effect of deterioration of swallowing functions on the frailty status in older adults: a longitudinal cohort study

2025-06-24

En-Chih Weng , Yoko Hasegawa , Tasuku Yoshimoto +7 more | BMC Geriatrics

Deterioration of swallowing function (DSF) is common among aging adults and can lead to negative health outcomes such as increased risk of malnutrition. However, the longitudinal relationship between the DSF … Deterioration of swallowing function (DSF) is common among aging adults and can lead to negative health outcomes such as increased risk of malnutrition. However, the longitudinal relationship between the DSF and frailty status remains unclear. This study aimed to investigate whether declining swallowing function is linked to frailty progression in independent older adults. This study included 795 community-dwelling Japanese individuals aged ≥ 65 years who participated in two surveys: one at baseline and one after two years. Swallowing function was evaluated using the repetitive saliva swallowing test, tongue pressure test, and questionnaire. DSF was identified by meeting more than one of three criteria: Repeated Saliva Swallow Test below 3, tongue pressure under 27.4 kPa for men and 26.5 kPa for women, and a "yes" response to the questionnaire. Frailty status was assessed using the Kihon Checklist, with participants showing a decline categorized into the "aggravation group." Oral function (number of teeth, occlusal force, masticatory performance, and oral dryness) and physical function (body mass index, gait speed, grip strength, and skeletal muscle mass index) were evaluated. Comparisons between the two groups were made using the Student's t-test or the χ2 test. Differences among the three groups were assessed using the one-way analysis of variance or the χ2 test. Significant differences in continuous variables were analyzed using the Least Significant Difference method, with P-values adjusted using the Bonferroni correction. Initially, 87 (10.9%) participants were frail. By follow-up, 149 participants (37.9%) had progressed to frailty, 83 of whom (55.7%) exhibited impaired swallowing function at baseline. At baseline, frailty was significantly associated with age, gait speed, decreased swallowing function, number of functional teeth, occlusal force, and masticatory performance. None of the three swallowing function assessment methods were significantly associated with the progression of frailty. In contrast, logistic regression analysis of frailty progression showed that impaired swallowing function was a significant explanatory variable (OR, 1.53; 95% CI: 1.04-2.21). This study found a significant association between frailty and multiple factors, particularly oral function. Specifically, diminished swallowing function has emerged as a notable independent predictor of frailty progression.

Post-resuscitation Critical Illness Dysphagia: A Case Report

2025-06-24

Ansar Hassan , Shikha Shah , Nikki Bustamante +1 more | Cureus

Goal setting for patients with dysphagia - Clinical examination over 85 patients

2025-06-24

Eiro Kubota , Atsushi Abe | International Journal of Oral and Maxillofacial Surgery

Relationship Between Oral Thickness Perception and Food Dynamics During Liquid Swallowing in Healthy Young Adults

2025-06-23

Masahiro Kuroda , Yoshihiko Ito , Yuki Ito +2 more | Journal of Oral Rehabilitation

The swallowing reflex is a coordinated movement controlled by motor and sensory functions of the oral cavity and pharynx. Swallowing patterns are adjusted through peripheral nerve stimulation and central afferent … The swallowing reflex is a coordinated movement controlled by motor and sensory functions of the oral cavity and pharynx. Swallowing patterns are adjusted through peripheral nerve stimulation and central afferent input, which are associated with food properties. Notably, in older adult care, thickeners are included in liquids to slow pharyngeal transit and improve swallowing safety. Therefore, perceiving liquid viscosity may affect swallowing control and safety. However, it remains unclear whether changes in food dynamics owing to varying viscosity are passive or adaptive. To investigate the relationship between oral thickness perception and food dynamics during liquid swallowing in healthy young adults. Participants were classified into high- and low-sensitivity groups based on their thickness discrimination ability score recorded through a sensory test using eight thickened water concentrations. The flow velocity spectrum was recorded while water and three thickened water concentrations were ingested using the pulsed Doppler mode of ultrasound imaging. The maximum pharyngeal transit velocity, mean pharyngeal transit velocity, pharyngeal transit time (PTT) and flow velocity spectrum area were calculated using the flow velocity spectrum. The Wilcoxon rank-sum test was used to compare the parameters between groups. The high-sensitivity group showed a significantly lower standard deviation of PTT when swallowing 2.0 wt% thickened water compared with the low-sensitivity group (p < 0.05). Individuals with high thickness sensitivity can perceive food properties accurately, adjust their swallowing movements accordingly, and perform stable swallowing consistently.

Muscle Function and Electromyography: (almost) 70 years since Doty and Bosma (1956)

2025-06-23

Rebecca Z. German , Christopher J. Mayerl | Journal of Neurophysiology

Swallowing, and dysphagia, the pathophysiology of swallowing, differ from most motor activities in that they are not readily observable without invasive imaging or measurement. Successful swallowing depends more on precision … Swallowing, and dysphagia, the pathophysiology of swallowing, differ from most motor activities in that they are not readily observable without invasive imaging or measurement. Successful swallowing depends more on precision of control and coordination with respiration than it does on force or work generation, which differs from many other motor tasks. Electromyography (EMG), an essential method for investigating motor function in general, has become critical to understanding the physiology of swallowing. In 1956, Doty and Bosma published a landmark paper using EMG to describe the motor pattern of a swallow. Since then, the specific methods of bi-polar indwelling electrodes have not significantly changed, but our understanding of muscle and ability to analyze EMG data has grown remarkably. Advances in imaging and quantitative analysis, largely derived from studies of fine motor control of the limbs and locomotion, are a boon to studies of swallowing, and have advanced our understanding of neural control. EMG patterns are a direct readout of central motor control, and valuable for determining the evolution of swallowing, the normal physiology of swallowing, and the pathophysiology of dysphagia. The potential for increasing our knowledge of these aspects of swallowing is high, given current advances in EMG technique and analysis. Here, we briefly discuss the current state of our knowledge of the motor control of the swallow, review what we have learned in the past seventy years about the swallow, and end by highlighting how embracing novel technologies and techniques will enable us to further understand the neural control of this critical behavior.

Compliance With Swallowing Instruction and Quality of Life in Patients With Parkinson's Disease: A Retrospective Assessment of Instructional Methods to Maintain and Improve Quality of Life

2025-06-23

Keigo Nakayama , Toshiyuki Yamamoto , Takatoshi Hara +4 more | World Journal of Otorhinolaryngology - Head and Neck Surgery

ABSTRACT Objectives To investigate the effects of swallowing instructional methods and content on instructional compliance among patients with Parkinson's disease (PD). Methods Overall, 59 of the 317 patients with PD … ABSTRACT Objectives To investigate the effects of swallowing instructional methods and content on instructional compliance among patients with Parkinson's disease (PD). Methods Overall, 59 of the 317 patients with PD who underwent a videofluoroscopic examination of swallowing (VF) and completed the Japanese version of the Dysphagia Handicap Index (DHI‐J) within 45 days before and after VF were analyzed. Based on records of compliance with alternative strategies from the time of instruction to 6 months, patients were classified into the compliance (CP) and noncompliance (NCP) groups. Results The NCP and CP groups included 31 (52.5%) and 28 (47.5%) patients, respectively. No significant differences in self‐reported severity or DHI score were identified, and quality of life (QOL) and awareness did not influence compliance. The CP group had more patients who received instruction using swallowing charts or handouts than the NCP group. More patients lived with family members. The NCP group had significantly higher DHI‐Physical (P) and DHI‐Total scores and lower QOL post‐instruction reassessment (Post) than pre‐instruction reassessment (Pre). Conversely, the CP group had significantly lower DHI‐P, DHI‐Emotional, and DHI‐Total scores and higher QOL in Post than in Pre. Conclusions When teaching swallowing with alternative strategies for dysphagia, using visual elements rather than verbal instructional elements alone is beneficial for improving compliance with instructional content. Compliance with swallowing instructions can maintain and improve QOL after the intervention. Patients living with family members demonstrated better compliance, likely due to meals provided by family members, along with advice and cooperation influencing compliance with the guidelines.

Unilateral contralesional versus bilateral repetitive transcranial magnetic stimulation for patients with post stroke dysphagia: a randomized controlled study

2025-06-23

Basem Hamdy Fouda , Ahmed Mustafa Kishk | Neurological Sciences

Dysphagia is a frequent and challenging complication after stroke, severely impacting both recovery and quality of life. Conventional rehabilitation approaches often yield limited results, underscoring the need for novel treatments. … Dysphagia is a frequent and challenging complication after stroke, severely impacting both recovery and quality of life. Conventional rehabilitation approaches often yield limited results, underscoring the need for novel treatments. This work compared the effectiveness of two different repetitive transcranial magnetic stimulation (rTMS) approaches in enhancing swallowing function in post-stroke dysphagia (PSD). This prospective, randomized, controlled trial was conducted with 60 patients, 18-80 years old, diagnosed with acute ischemic stroke and suffered from PSD. Participants were randomized equally to three groups: Group 1 received bilateral facilitatory rTMS targeting both hemispheres, Group 2 received unilateral facilitatory rTMS on the contralesional hemisphere, and Group 3 received sham rTMS. Motor threshold (MT) scores were similar across the three groups at baseline (date 0). At follow-up, Group 1 showed significantly lower MT scores than Group 3 at dates 1 and 3 (P < 0.05), with no significant difference between Group 2 and Groups 1 and 3. At date 2, Group 1 had significantly lower MT scores than both Groups 2 and 3 (P < 0.05), while scores between Group 2 and Group 3 were comparable. MT was comparable among the groups at date 0, 1, 2, and 3. For the Modified Rankin Scale, at date 3, Groups 1 and 2 had significantly lower scores than Group 3, with no significant difference between Groups 1 and 2. Bilateral facilitatory rTMS is an effective and safe intervention for improving swallowing function in PSD.

Application of an <scp>artificial intelligence</scp>–assisted electronic stethoscope for evaluating swallowing function decline across age groups and sex in Japan

2025-06-22

Koichiro Matsuo , Kenji Suzuki , Risako Mikami +4 more | Geriatrics and gerontology international/Geriatrics & gerontology international

Aim This preliminary investigation examined whether pharyngeal clearance time (PCT) measured by a neck‐worn electronic stethoscope (NWES) differed by age and sex. Methods A total of 155 healthy adults consented … Aim This preliminary investigation examined whether pharyngeal clearance time (PCT) measured by a neck‐worn electronic stethoscope (NWES) differed by age and sex. Methods A total of 155 healthy adults consented to participate and were categorized into three age groups: young (20–39 years), middle (40–64 years) and old (≥65 years). The participants were asked to perform two swallows of 5 mL of water. The swallowing acoustics were recorded by the NWES, and the PCT was automatically calculated from the recorded data. Additionally, the seven subcategories of oral hypofunction were assessed. Differences in the PCT between age groups and sexes were tested using two‐way ANOVA ( P < 0.05). Pearson's correlation coefficient was used to confirm the relation between PCT and other oral function measurement items. Linear regression analysis was also performed with PCT as the dependent variable along with age and sex as independent variables. Results PCT was significantly longer in the old group than in the young group ( P = 0.032), although no sex predilection was observed. No significant correlations were found between PCT and other oral function items, including a self‐administered dysphagia questionnaire. However, PCT demonstrated a significant positive correlation with age in a linear regression model (standardized partial correlation coefficient, 0.165; P = 0.005), but not with sex. Conclusions This study demonstrated that PCT measured by the NWES became significantly prolonged in older adults, suggesting the potential of the NWES as a noninvasive, quantitative tool for assessing age‐related changes in swallowing function. Geriatr Gerontol Int ••; ••: ••–•• Geriatr Gerontol Int 2025; ••: ••–•• .

Enhancing Swallowing Function in Tracheotomy Patients with Subglottic Oxygen Flow: A Randomized Self-Controlled Crossover Trial

2025-06-21

Zhi‐Ming Tang , Zhiyong Peng , Zhonghui Shi +5 more | Dysphagia

Risk Factors for Postoperative Dysphagia in Patients with Oral Cavity and Oropharyngeal Cancer: A Systematic Review and Meta-analysis

2025-06-21

Jing Zhang , Yongkang Zhu , Yue Wan +5 more | Dysphagia

Esophageal and Oropharyngeal Dysphagia: Clinical Recommendations From the United European Gastroenterology and European Society for Neurogastroenterology and Motility

2025-06-21

Amir Mari , Francesco Calabrese , Andrea Pasta +7 more | United European Gastroenterology Journal

ABSTRACT Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified … ABSTRACT Dysphagia is a prevalent symptom of the upper gastrointestinal tract causing health related consequences, impacting quality of life and is associated with global economic burden. Swallowing difficulties are classified into oropharyngeal dysphagia (OD) and esophageal dysphagia. Despite its clinical importance, dysphagia is associated with several uncertainties regarding its optimal diagnostic work‐up and management, particularly, considering the progress with diagnostic modalities and technologies. A Delphi consensus was performed with experts from various disciplines who conducted a literature summary and voting process on 41 statements. Quality of evidence was evaluated using the grading of recommendations, assessment, development, and evaluation criteria. Consensus was reached for all the statements. The panel agreed with the definition and prevalence of esophageal and OD types. The role of endoscopy, high‐resolution manometry, EndoFLIP, barium swallow and other imaging tests in evaluating esophageal dysphagia has reached overall strong agreement. Videofluoroscopic swallow study, alongside fiber‐endoscopic evaluation of swallowing, as the methods of choice for the instrumental assessment of oropharyngeal dysfunction is a strong recommendation. Regarding treatment, a weak recommendation was achieved for the use of PPIs, calcium‐channel blockers, nitrates, phosphodiesterase type 5 inhibitors, antidepressants or peppermint oil for the treatment of hypercontractile esophagus. A strong recommendation exists for endoscopic and surgical treatment of achalasia, while a weak recommendation is provided for other esophageal motility disorders. Regarding OD, a weak recommendation was achieved for swallow therapy, to improve swallowing mechanics, reduce symptoms, and enhance quality of life. Swallow therapy could be more effective when using validated assessment tools, consistent treatment parameters, and considering long‐term follow‐up. A multinational group of European experts summarized the current state of consensus on the definition, diagnosis, and management of dysphagia.

Deep learning NTCP model for late dysphagia after radiotherapy for head and neck cancer patients based on 3D dose, CT and segmentations

2025-06-20

Suzanne P.M. de Vette , Harribert Neh , Luuk Van der Hoek +7 more | medRxiv (Cold Spring Harbor Laboratory)

Late radiation-associated dysphagia after head and neck cancer (HNC) significantly impacts patient's health and quality of life. Conventional normal tissue complication probability (NTCP) models use discrete dose parameters to predict … Late radiation-associated dysphagia after head and neck cancer (HNC) significantly impacts patient's health and quality of life. Conventional normal tissue complication probability (NTCP) models use discrete dose parameters to predict toxicity risk but fail to fully capture the complexity of this side effect. Deep learning (DL) offers potential improvements by incorporating 3D dose data for all anatomical structures involved in swallowing. This study aims to enhance dysphagia prediction with 3D DL NTCP models compared to conventional NTCP models. A multi-institutional cohort of 1484 HNC patients was used to train and validate a 3D DL model (Residual Network) incorporating 3D dose distributions, organ-at-risk segmentations, and CT scans, with or without patient- or treatment-related data. Predictions of grade ≥2 dysphagia (CTCAEv4) at six months post-treatment were evaluated using area under the curve (AUC) and calibration curves. Results were compared to a conventional NTCP model based on pre-treatment dysphagia, tumour location, and mean dose to swallowing organs. Attention maps highlighting regions of interest for individual patients were assessed. DL models outperformed the conventional NTCP model in both the independent test set (AUC=0.80-0.84 versus 0.76) and external test set (AUC=0.73-0.74 versus 0.63) in AUC and calibration. Attention maps showed a focus on the oral cavity and superior pharyngeal constrictor muscle. DL NTCP models performed better than the conventional NTCP model, suggesting the benefit of using 3D-input over the conventional discrete dose parameters. Attention maps highlighted relevant regions linked to dysphagia, supporting the utility of DL for improved predictions.

Influence of Liquid Viscosity on Swallowing Dynamics in Healthy Adults: A Study Using a New Noninvasive Laryngeal Motion Evaluation Instrument

2025-06-20

Yuta Nakao , Tomoyuki Haji | Journal of Oral Rehabilitation

ABSTRACT Background A noninvasive laryngeal motion evaluation device using photoelectric distance sensors (Nodomiru) has been newly developed and reported to be useful in evaluating swallowing dynamics. This device can easily … ABSTRACT Background A noninvasive laryngeal motion evaluation device using photoelectric distance sensors (Nodomiru) has been newly developed and reported to be useful in evaluating swallowing dynamics. This device can easily obtain a laryngeal movement velocity curve and a laryngeal movement position curve. In this study, we aimed to examine how liquid viscosity affects the swallowing dynamics after verifying the usefulness of data smoothing in this measurement. Methods This study included 33 healthy adults (mean age: 28.8 ± 9.7 years). They were instructed to swallow saliva and 3 mL of thin and medium‐thickened liquids three times each in a sitting position. Laryngeal movements during these trials were evaluated using Nodomiru. The comma‐separated value data output, which included laryngeal position and time information obtained from Nodomiru, were used to calculate the following parameters: laryngeal elevation time, elevation distance, velocity and laryngeal elevation persistence time with and without smoothing. Results The intraclass correlation coefficient values of elevation peak velocity for the three swallowing trials of liquids were higher with smoothing (0.77) than without smoothing (0.54). Elevation peak velocities were 128.9 ± 56.8, 149.8 ± 47.2, and 173.5 ± 62.7 mm/s for saliva, thin liquid (water), and moderately thick liquid, respectively, demonstrating significant differences. Conclusions Using a smoothing procedure is beneficial for analysing the swallowing dynamics with Nodomiru. Furthermore, increasing liquid thickness promoted increased laryngeal movement velocity in healthy adults.

Association Between Nutritional Status, Food Form, Appetite and Oral Health at the Time of Admission to a Convalescent Hospital: A Cross‐Sectional Study

2025-06-20

Hiroyuki Suzuki , Naoki Todayama , Mika Someya +7 more | Journal of Oral Rehabilitation

ABSTRACT Background Malnutrition negatively impacts the recovery of physical functions such as activities of daily living (ADL) through rehabilitation. However, older patients requiring rehabilitation are at high risk of malnutrition, … ABSTRACT Background Malnutrition negatively impacts the recovery of physical functions such as activities of daily living (ADL) through rehabilitation. However, older patients requiring rehabilitation are at high risk of malnutrition, making appropriate nutritional management essential for effective and efficient outcomes. Factors associated with the nutritional status of patients admitted to convalescent hospitals have been reported; however, only a few studies have comprehensively examined them. Objective To assess the comprehensive relationship between nutritional status and food form, appetite, swallowing function, and oral health status in patients admitted to a convalescent hospital. Methods In this cross‐sectional study, we included 319 patients (155 male and 164 female; mean age, 74.9 ± 12.2 years) admitted to a convalescent hospital between January and December 2021. ADL, nutritional status (Mini Nutritional Assessment‐Short Form), food form (Functional Oral Intake Scale), appetite (Simplified Nutritional Appetite Questionnaire for the Japanese Elderly), swallowing function (Dysphagia Severity Scale), and oral health status (Oral Health Assessment Tool) at admission were retrospectively extracted from medical records. Factors associated with nutritional status were examined through multiple regression analysis. Results Over 70% of the participants had nutritional deficiencies, with 58.0% at risk of malnutrition and 18.5% being malnourished. Multiple regression analysis results revealed that ADL, food form, appetite and oral health status were significantly associated with nutritional status at admission. Conclusion The findings suggest that good food form, appetite and oral health status on admission to a convalescent hospital may be crucial to realising good nutritional status.

A Portable Device for Recording Physiological Risk Factors Associated with Aspiration Pneumonia

2025-06-20

Harry Mander , Le Yang , Laura C Strevens +3 more | Journal of Medical Devices

Abstract Aspiration pneumonia is a respiratory infection that can occur after the inhalation of foreign material or oropharyngeal or gastric contents. It is common among elderly patient populations and in … Abstract Aspiration pneumonia is a respiratory infection that can occur after the inhalation of foreign material or oropharyngeal or gastric contents. It is common among elderly patient populations and in patients with neurological disorders such as stroke. Timely prediction of the disease in at-risk patients is important to reduce its incidence. Speech—language therapists evaluate swallowing function and the efficacy of the cough reflex to assess patients' risk of developing aspiration pneumonia; however, many existing methods of swallowing and coughing assessment are costly, invasive, impractical for highly-impaired patients, or lack accuracy. In this study we present a novel portable medical device intended for the bedside measurement of physiological risk factors for aspiration pneumonia. The developed device comprises an air flow meter and microphones to measure (1) respiratory flow rate surrounding swallowing to characterize swallowing—respiratory coordination; (2) acoustics from the external auditory meatus to detect occurrence of swallowing; and (3) cough audio and air flow rate. The device connects to a computer application via USB for real-time data acquisition and display. Airflow and acoustic measurement systems were compared against commercial flow and sound meters under controlled conditions. A preliminary study was performed with 22 healthy adult volunteers to measure respiratory air flow during volitional and cued swallows as well as air flow and audio during volitional coughs. These tests show that the proposed device is likely capable of appropriately measuring the targeted physiological signals, which provides a solid foundation for future aspiration pneumonia risk estimation development.

Office v <scp>OR</scp> Injection for Retrograde Cricopharyngeal Dysfunction: Evidence‐Based Treatment Algorithm

2025-06-20

Rachel B. Kutler , Sana H. Siddiqui , Courtney B. Tipton +2 more | The Laryngoscope

ABSTRACT Background This prospective study compares the outcomes of operating room (OR) and in‐office (IO) injection of botulinum toxin (BTX) for retrograde cricopharyngeal dysfunction (RCPD). Methods Adult patients diagnosed with … ABSTRACT Background This prospective study compares the outcomes of operating room (OR) and in‐office (IO) injection of botulinum toxin (BTX) for retrograde cricopharyngeal dysfunction (RCPD). Methods Adult patients diagnosed with RCPD receiving IO or OR BTX injections were included in this study. Procedure success was based on patient‐reported symptom improvement. Chi‐squared tests were used to compare success and repeat injection rates between injection approaches. Primary treatment was defined as 1 IO injection, 2 IO injections within 8 weeks, or 1 OR injection. Results One hundred and ninety‐eight patients were included in the study with follow‐up data available for 185 (118 IO, 67 OR). Initial symptom relief was comparable between IO and OR injections (90.7% vs. 91.0%; p = 0.32). However, rates of repeat injection were higher after IO injection, with 26.2% undergoing a contralateral IO injection within 8 weeks and 54.2% undergoing repeat IO injection at any timepoint. Two IO injections had a comparable long‐term success rate to one OR injection (77.8% vs. 70.5%; p = 0.45). For patients with symptom recurrence, secondary treatment with subsequent injection was effective. Patient demographics and medical comorbidities were not predictive of treatment failure. Conclusion This study demonstrates that both OR injection and IO injections are viable options for the treatment of RCPD and further proposes a treatment algorithm that guides injection selection based on response patterns. Future studies are needed to assess longer‐term outcomes (> 1 year), timing between IO injections, and factors influencing repeat treatment rates to optimize patient outcomes. Level of Evidence: 2.

The Pediatric Screening–Priority Evaluation Dysphagia: Validation of a new tool for screening swallowing disorders in infants and children

2025-06-20

Antonella Cerchiari , Giorgia Biondo , Fausto M. Fassari +6 more | Developmental Medicine & Child Neurology

Abstract Aim To assess the psychometric properties of the Pediatric Screening–Priority Evaluation Dysphagia (PS–PED), a novel 14‐item, non‐invasive tool for identifying dysphagia risk in infants and children. Method Internal consistency … Abstract Aim To assess the psychometric properties of the Pediatric Screening–Priority Evaluation Dysphagia (PS–PED), a novel 14‐item, non‐invasive tool for identifying dysphagia risk in infants and children. Method Internal consistency and interrater reliability were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC). Concurrent validity was assessed by correlating PS–PED scores with the Penetration Aspiration Scale (PAS). Analysis of variance examined score differences across neurological and neuromuscular conditions, congenital and musculoskeletal abnormalities, cardiovascular disease, and genetic syndromes. Receiver operating characteristic (ROC) curves determined cut‐offs for optimal sensitivity and specificity. Results The PS–PED was administered to 117 children (59 males and 58 females; mean age 6 years 8 months, SD 4 years 4 months), showing good internal consistency (Cronbach's alpha = 0.716) and strong interrater reliability (ICC = 1). A positive correlation (0.765) was found with the PAS, with significant score differences among diagnostic groups. ROC analysis established cut‐offs for two dysphagia risk levels. Interpretation The PS–PED is a reliable, valid screening tool for dysphagia, facilitating early identification in infants and children across various medical conditions.

Clinical profile and manometry characteristics of patients with motor dysphagia

2025-06-20

Mayank Jain | Indian Journal of Gastroenterology

Dysphagie de l’adulte : évaluation, rééducation

2025-06-19

D. Bleeckx | EMC - Kinésithérapie - Médecine physique - Réadaptation

The Role of Speech and Language Therapists (SLTs) in International Stroke Teams: A Systematic Review

2025-06-19

Marina Charalambous , John E. Pierce , Georgia Pastou +2 more | International Journal of Language & Communication Disorders

ABSTRACT Background Current published guidelines suggest that speech and language therapists (SLTs) should be part of stroke teams, but their involvement and roles according to country income are unknown. Aims … ABSTRACT Background Current published guidelines suggest that speech and language therapists (SLTs) should be part of stroke teams, but their involvement and roles according to country income are unknown. Aims This review aims to (1) investigate the level of involvement of SLTs in acute stroke management, rehabilitation, and long‐term care, and (2) examine whether the roles and contributions of SLTs in stroke care vary according to a country's income level. Methods A systematic review methodology was conducted by an expert librarian and three independent researchers based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. This systematic review was registered on the PROSPERO website. The search strategy involved using MESH Terms ‘speech and language therapy’ AND stroke AND team* across six databases as follows: MEDLINE Complete, APA PsycInfo, CINAHL Plus, PubMed, Embase, and Scopus. The review was conducted using the Covidence software. Results Out of 1142 titles identified, 42 studies met the criteria: 34 studies (80%) were from high‐income countries, five (12%) were from upper–middle‐income countries, and three (8%) were from low–middle‐income countries. No studies were published in low‐income countries. Conclusion Lack of SLTs reported in stroke and rehabilitation teams in low‐ and low–middle‐income countries raises concern for patients' access to specialized SLT services. Healthcare policy should highlight the need for greater investment in SLT resources and the role of SLTs in managing aphasia, dysphagia, and chronic rehabilitation needs to improve patient outcomes. WHAT THIS PAPER ADDS What is already known on the subject Stroke is a leading cause of acquired disability with rehabilitation requiring a multidisciplinary approach. Speech and language therapists (SLTs) play a significant role in stroke care, addressing communication, swallowing, and cognitive disorders. Despite the recognized importance, SLTs’ involvement in stroke care teams varies significantly across healthcare systems, especially in lower‐income countries. What this paper adds to existing knowledge This study reveals global discrepancies in SLT involvement in stroke care, with high‐income countries benefiting from structured, specialized roles across all phases of rehabilitation, while low‐ and middle‐income countries face ad hoc, limited involvement due to systemic changes. The findings highlight the need for standardized protocols and greater investment in SLT resources to ensure equitable stroke rehabilitation services worldwide. What are the potential or actual clinical implications of this work? The clinical implications of this study are as follows: (a) integrating SLTs in stroke teams, especially in underrepresented regions, is essential to improve rehabilitation outcomes, (b) advocacy efforts prioritize equal access to SLT services globally, supported by policy changes and education and (c) participatory research must involve patients as equal partners to address community‐specific rehabilitation priorities as involving stroke survivors and caregivers in the design of rehabilitation services has been shown to identify local barriers to access and shape more culturally appropriate interventions.

Sensitivity of Swallow Screen Protocol (SSP) in Critical Care

2025-06-19

Divya Sivagnanapandian , Jerusha Biju | Indian Journal of Otolaryngology and Head & Neck Surgery

Mapping dysphagia in pediatric dystonia

2025-06-18

Müşerrefe Nur Keleş , Esra Serdaroğlu | PLoS ONE

Objectives Dystonia is a significant movement disorder in childhood, yet swallowing functions in this population remain largely unexplored. Dysphagia, however, can result in severe complications, including aspiration, underscoring the critical … Objectives Dystonia is a significant movement disorder in childhood, yet swallowing functions in this population remain largely unexplored. Dysphagia, however, can result in severe complications, including aspiration, underscoring the critical need for research in this area. This study, therefore, aimed to evaluate dysphagia in children with dystonia. Methods Children diagnosed with dystonia as the predominant movement disorder were included. Medical histories were recorded, and Gross Motor Function Classification System (GMFCS) and Functional Oral Intake Scale (FOIS) levels were determined. Oral structure characteristics were assessed, and chewing performance was evaluated using the Turkish version of Mastication Observation and Evaluation (T-MOE) and the Karaduman Chewing Performance Scale (KCPS). Swallowing safety was screened with the Pediatric Eating Assessment Tool-10 (PEDI-EAT-10) and the 3-ounce Water Swallow Test. The Dysphagia Disorders Survey (DDS) was used to assess swallowing disorder severity, while the Dysphagia Management Staging Scale (DMSS) was applied to determine the severity level of dysphagia. Results Twenty-five children (mean age: 11.32 ± 3.95 years) participated in the study. Of these 56% were classified as level V according to the GMFCS. Three children (12%) had a FOIS level of 4 or below. The mean T-MOE score was 15.62 ± 7.51, and 60% of the children could bite but could not chew effectively according to the KCPS. Oropharyngeal dysphagia was present in all children, with abnormal swallowing (PEDI-EAT-10 score ≥4) and increased aspiration risk (PEDI-EAT-10 score ≥13) observed in 100% and 88% of the participants, respectively. Additionally, 52.0% of the children failed the 3-ounce Water Swallow Test. The mean DDS raw score was 23.08 ± 7.70, and 68% of the children were classified as having severe or profound dysphagia based on the DMSS. Conclusion Swallowing dysfunction was observed in almost all children with dystonia, with the majority presenting with severe dysphagia and an elevated risk of aspiration. Close monitoring of oral structures and functions, along with continuous evaluation of swallowing performance, is crucial to ensure safe oral feeding and to mitigate life-threatening complications in this population.

Eating and Swallowing Problems in People With Advanced Dementia

2025-06-18

Leah V. Estrada , Preeti Malani , Caroline A. Vitale | JAMA

This JAMA Patient Page describes management of eating and swallowing problems in people with advanced dementia. This JAMA Patient Page describes management of eating and swallowing problems in people with advanced dementia.

A Case of Bilateral Spiller Syndrome

2025-06-18

S Sravan Kumar , Sandhya Manorenj , Chillapuram Shashanka | Neurology India

Effectivity of neuromuscular electrical stimulation and oral sensorimotor stimulation as therapeutic interventions for pediatric dysphagia: A comparative study of swallowing outcomes.

2025-06-17

Rizky Kusuma Wardhani , Luh Karunia Wahyuni , Budiati Laksmitasari +3 more | PubMed

BackgroundPediatric dysphagia poses risks to feeding safety, nutrition, and overall health, especially in those with developmental or neurological disorders. While various treatments exist, including therapeutic, medical, and surgical options, oral … BackgroundPediatric dysphagia poses risks to feeding safety, nutrition, and overall health, especially in those with developmental or neurological disorders. While various treatments exist, including therapeutic, medical, and surgical options, oral sensorimotor stimulation (OSMS) and neuromuscular electrical stimulation (NMES) are commonly used non-invasive interventions. However, their relative effectiveness remains uncertain, with limited evidence on their advantages in managing specific types of dysphagia.ObjectiveThis prospective cohort study aimed to compare the effectiveness of NMES and OSMS in managing pediatric dysphagia.MethodsThis study recruited pediatric dysphagia patients for a two-month rehabilitation program, with either NMES or OSMS with pre- and post-intervention evaluations using video-fluoroscopic swallow studies, Modified Barium Swallow Impairment Profile (MBSImP) scores, and the 8-point Penetration-Aspiration Scale (PAS).ResultsA total of 26 children participated in the study. NMES significantly reduced MBSImP scores in both oral and pharyngeal impairments, and PAS. OSMS showed significant improvement in MBSImP scores, particularly in oral impairment.ConclusionsThe study suggests NMES benefits oropharyngeal dysphagia and reduces penetration and aspiration, while OSMS is effective for improving oral dysphagia.

Effects of Active Interferential Current Stimulation on Swallowing Function in Patients with Dysphagia: A Cross-Sectional Study of Interferential Current Stimulation on Swallowing Function in Patients with Dysphagia: A Cross-Sectional Study

2025-06-17

Shinsuke Nagami , M. Kouda , Katsuya Nakamura +5 more | Dysphagia

Effects of Combined Repetitive Transcranial Magnetic Stimulation and Chin-tuck Against Resistance Dual Stimulation on Swallowing: An fNIRS and EMG Study

2025-06-17

Jinbo Peng , Siyu Huang , Wei Zhang +4 more | Dysphagia

Effects of Neuromuscular Electrical Stimulation on Chronic Dysphagia in a Single Subject after Anterior Cervical Discectomy and Fusion Surgery: A Case Report

2025-06-17

Anna Munson , Matthew Dumican , Katherine Rigley | Case Reports in Gastroenterology

Introduction: The purpose of this single subject study was to describe the dysphagia presentation, treatment course, and post-treatment swallowing function in a patient with chronic dysphagia after anterior cervical discectomy … Introduction: The purpose of this single subject study was to describe the dysphagia presentation, treatment course, and post-treatment swallowing function in a patient with chronic dysphagia after anterior cervical discectomy and fusion (ACDF) surgery. Case Presentation: An 83-year-old male experienced dysphagia >2 months post-ACDF. The patient presented with a narrowed pharyngoesophageal segment due to cervical hardware and reduced epiglottic inversion due to pharyngeal narrowing on videofluoroscopic swallow study (VFSS). He completed dysphagia therapy using neuromuscular electrical stimulation (NMES). Structural alterations and a complicated medical course after treatment impacted therapeutic outcomes. Reductions in penetration or aspiration and improved hyoid excursion were found post-treatment, though impairment persisted. The patient ended therapy after the post-treatment VFSS and began to experience odynophagia and submental pain. The patient experienced a complicated post-treatment course including bilateral cancerous masses at the base of tongue with subsequent surgery and chemoradiation. Conclusions: While considered rare, these findings present a post-operative course of chronic dysphagia post-ACDF surgery where morphological changes to the pharynx significantly altered swallowing function. Swallowing function should be tracked routinely and longitudinally in post-ACDF surgery patients. NMES may be a potential dysphagia therapy modality to explore.

Assessing Feeding and Swallowing Function in Breastfeeding Infants Via Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

2025-06-17

Tina M. Tan | Journal of Human Lactation

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a procedure utilized by speech language pathologists to evaluate swallowing function in infants and children. FEES has been found to be a valid … Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a procedure utilized by speech language pathologists to evaluate swallowing function in infants and children. FEES has been found to be a valid and reliable procedure for the assessment of pediatric dysphagia. It is the only option for instrumental examination of swallowing in breastfeeding infants. This article describes the differences between the more common videofluoroscopic swallow study (VFSS) and FEES, as well as management of interprofessional collaboration.

Dysphagia in Head and Neck Cancer Patients: A Qualitative Meta‐Synthesis of Patient and Caregiver Experiences and Perspectives

2025-06-17

Yu Zhang , Yiqiao Wang , Wenjie Xu +3 more | Journal of Advanced Nursing

ABSTRACT Background Dysphagia not only affects the nutritional intake of head and neck cancer (HNC) patients but may also lead to social avoidance, emotional fluctuations, and a decline in life … ABSTRACT Background Dysphagia not only affects the nutritional intake of head and neck cancer (HNC) patients but may also lead to social avoidance, emotional fluctuations, and a decline in life confidence. Furthermore, dysphagia places an additional psychological and physical burden on caregivers, significantly altering their lifestyles. Method This study employed a qualitative systematic review approach to comprehensively analyse the experiences and coping strategies of HNC patients and their caregivers in relation to dysphagia. Relevant qualitative studies published from the inception of the database through September 2024 were selected. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research (2016), and a meta‐aggregation method was applied to synthesise and categorise the research themes. This study standardised the presentation of results in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines. Results A total of 14 studies were included, resulting in 63 research outcomes, which were consolidated into 12 new categories and integrated into 4 main themes: (1) the impact of dysphagia on daily life; (2) coping with the changes caused by dysphagia; (3) understanding of dysphagia and related needs; and (4) the physiological and psychological challenges faced, and the efforts to seek support. Conclusions The dual physiological and psychological challenges posed by dysphagia profoundly affect patients' daily lives, prompting ongoing adjustments to cope with these changes. Both patients and caregivers have a limited understanding of dysphagia but exhibit a strong need for support. These findings underscore the importance of providing comprehensive, individualised support for patients and caregivers to improve their quality of life and coping experiences. Patient or Public Contribution No Patient or Public Contribution. This study aims to analyse and synthesise the experiences and perspectives of patients and their caregivers reported in existing research. As no original data were collected and no direct interaction with patients or the public occurred, specific patient or public contributions are not included.

Nutrition Support in Dysphagia: Japan Nationwide Hospital Survey on Nutritional Values, Diet Characteristics, and Dietitians' Roles in Texture-Modified Diets

2025-06-17

Yuka Shirai , Junko Ueshima , Keisuke Maeda +4 more | Cureus

Prognostic value of cough force measured by peak expiratory flow in a 4-year longitudinal cohort study of geriatric patients with oropharyngeal dysphagia

2025-06-17

Kiril Stoev , Rainer Wirth , Bendix Labeit +6 more | Frontiers in Aging

Introduction and objective Oropharyngeal dysphagia (OD) is a potentially life-threatening disorder of the swallowing process that may significantly impair a patient’s prognosis and quality of life. This study aimed to … Introduction and objective Oropharyngeal dysphagia (OD) is a potentially life-threatening disorder of the swallowing process that may significantly impair a patient’s prognosis and quality of life. This study aimed to investigate the association between cough force (measured by peak expiratory flow) and pneumonia incidence in older hospitalized patients with OD and to assess the relationship between peak flow, dysphagia severity and mortality over a 4-year follow-up period. Methods In this retrospectively longitudinal cohort study, OD was evaluated using flexible endoscopic examination of swallowing (FEES). Patients with suspected OD underwent Peak Flow (PF) measurement prior to initiation of FEES. Follow-up data were collected on pneumonia incidence, episodes, and patient survival via telephone surveys. Cox regression models, adjusted for potential confounding variables such as age and gender, were used to explore the relationship between pneumonia incidence, PF and dysphagia severity. Results Among 98 patients (mean age 80.4 ± 8.2 years, 67% male), the median PEF was 220 L/min (IQR 150–300). Post-discharge, 38% developed pneumonia—11% had one episode and 27% had multiple episodes. Dysphagia severity was mild to medium in 40% and severe in 20% of patients. Over an average follow-up of 1,334 days (3.7 years), the mortality rate was 64%. Patients with lower PF experienced a significantly higher risk of developing pneumonia compared to those with higher PF (p = 0.030). Patients with severe dysphagia had a substantially lower survival rate compared to those with light or moderate dysphagia, as demonstrated by the Cox-models. Conclusion Reduced cough force as measured by peak expiratory flow was significantly associated with an increased risk of pneumonia in older hospitalized patients with OD.

Physiological barriers to oral intake in survivors of critical illness: A scoping review

2025-06-17

Breanna J. Teleki , Elizabeth Viner Smith , Amy Freeman–Sanderson +2 more | Nutrition in Clinical Practice

Abstract Oral nutrition is the predominant mode of nutrition delivery on the post–Intensive Care Unit (ICU) ward; yet, it is associated with lower intake than via enteral or parenteral nutrition. … Abstract Oral nutrition is the predominant mode of nutrition delivery on the post–Intensive Care Unit (ICU) ward; yet, it is associated with lower intake than via enteral or parenteral nutrition. There are limited data on barriers that influence oral intake in ICU survivors. Therefore, we conducted a scoping review to map and describe physiological nutrition‐impacting symptoms following ICU discharge. Database searches of MEDLINE, Emcare, and CINAHL identified primary research in English that included adult patients eating orally throughout the post‐ICU period. Data were extracted on study design, aim, population, post‐ICU setting, and the physiological nutrition‐impacting symptoms reported, including method of reporting and symptom prevalence. Twenty‐nine studies comprising between 11 and 357 participants were included, most of which were prospective and observational in design. Post‐ICU settings varied and were inclusive of acute care wards ( n = 7, 23%), rehabilitation facilities ( n = 5, 16%), and various timepoints following hospital discharge ( n = 19, 61%). Key physiological nutrition‐impacting symptoms reported were dysphagia ( n = 25, 86%) and poor appetite ( n = 10, 34%). Other common symptoms included early satiety, fatigue, and nausea. Variations occurred in both the method used to quantify symptoms and the prevalence of each symptom across isolated timepoints. The proportion of patients reporting at least one nutrition‐impacting symptom at each time point was 16%–78% on the acute care ward, 29%–95% in rehabilitation facilities, and 10%–71% following hospital discharge. Further studies are required to determine which symptoms ICU survivors experience and their trajectory and impact on oral intake.

Post-extubation dysphagia in the ICU−a narrative review: epidemiology, mechanisms and clinical management (Update 2025)

2025-06-16

Daniela Bertschi , Francesco Rotondo , Jan Waskowski +3 more | Critical Care

Dysphagia (i.e. an impairment in swallowing function that impacts on safety or efficiency) is present in many intensive care unit (ICU) survivors, in particular following extubation ("post-extubation dysphagia", PED). Despite … Dysphagia (i.e. an impairment in swallowing function that impacts on safety or efficiency) is present in many intensive care unit (ICU) survivors, in particular following extubation ("post-extubation dysphagia", PED). Despite the fact that pathomechanisms leading to PED are currently incompletely understood, local as well as central neurological and neuromuscular dysfunctions may be key to development of PED. Data from prospective large-scale clinical investigations with systematic screening demonstrate that PED affects about one out of five (about 20%) of mixed medical-surgical unplanned (emergency) ICU admissions. PED is associated with an increased risk for aspiration, aspiration-induced pneumonia, malnutrition, increased ICU resource use, decreased quality of life, prolonged ICU- and hospital length of stay and increased overall morbidity and mortality. Data demonstrate that PED is an independent predictor of 90-day mortality with increased risk of death up to about one year after ICU admission. PED may be a somewhat overlooked medical problem since in many ICUs, PED is currently not routinely screened for in all patients at risk (i.e. all ICU patients) following extubation. In this review, we update the available data on PED with a focus on epidemiology, risk factors, potential aetiology and treatment approaches, as well as clinical management on ICUs.

The Effect of Repetitive Transcranial Magnetic Stimulation With Different Stimulation Methods on Post‐Stroke Dysphagia: A Network Meta‐Analysis

2025-06-16

Li Jiayao , Liu Zejian , Zhao Henan +4 more | Journal of Oral Rehabilitation

ABSTRACT Background Multiple studies have substantiated that repetitive transcranial magnetic stimulation (rTMS) is effective in improving the swallowing function of patients with post‐stroke dysphagia (PSD). Nevertheless, the choice of stimulation … ABSTRACT Background Multiple studies have substantiated that repetitive transcranial magnetic stimulation (rTMS) is effective in improving the swallowing function of patients with post‐stroke dysphagia (PSD). Nevertheless, the choice of stimulation methods diverges, underpinned by different recovery theories. Among the distinct stimulation approaches currently in use, which one yields the most optimal therapeutic outcomes remains unexplored. Objective To evaluate the rehabilitation efficacy of different rTMS methods on the swallowing function of PSD patients through network meta‐analysis and traditional meta‐analysis. Methods We searched eight databases to identify articles on rTMS treatment for PSD from inception to May 5, 2024, and screened them using EndNote 20.0. The quality of articles was evaluated by Cochrane risk bias assessment criteria, and Stata 17.0 was adopted for meta‐analysis. Standardised swallowing assessment (SSA), penetration aspiration scale (PAS), and dysphagia outcome and severity scale (DOSS) served as the outcome measures of the study. Results A total of 27 articles involving 1694 patients were selected. The studies encompassed five types of stimulation methods: high‐frequency rTMS on the ipsilateral hemisphere (iHF‐rTMS), low‐frequency rTMS on the contralateral hemisphere (cLF‐rTMS), high‐frequency rTMS on the contralateral hemisphere (cHF‐rTMS), high‐frequency rTMS on the bilateral hemispheres (biHF‐rTMS), and iHF‐rTMS + cLF‐rTMS (iHF‐cLF‐rTMS). Compared with placebo, iHF‐cLF‐rTMS [mean difference (MD) = −11.34, 95% confidence interval (CI): −14.57 to −8.12], biHF‐rTMS (MD = −6.52, 95% CI: −8.50 to −4.55), cHF‐rTMS (MD = −2.84, 95% CI: −4.37 to −1.31), and iHF‐rTMS (MD = −1.89, 95% CI: −2.82 to −0.96) showed significantly better effects on improving SSA of patients with PSD. According to traditional meta‐analysis, for patients with post‐stroke time < 1 month, iHF‐rTMS (MD = −0.558, 95% CI: −0.966 to −0.150) demonstrated a superior therapeutic outcome of SSA, while for those with post‐stroke time ≥ 1 month, SSA was more significantly improved in cHF‐rTMS (MD = −0.760, 95% CI: −1.193 to −0.327) and iHF‐rTMS (MD = −0.428, 95% CI: −0.665 to −0.129) groups, when compared with placebo. Conclusions Bilateral stimulation protocols (biHF‐rTMS and iHF‐cLF‐rTMS) confer superior efficacy over unilateral approaches. Early application of iHF‐rTMS shows advantages. However, methodological limitations, including heterogeneity in stimulation parameters, small sample sizes in subgroup analyses, and insufficient long‐term follow‐up, warrant cautious interpretation. Future high‐powered RCTs with standardised protocols are imperative to optimise rTMS‐based precision rehabilitation.

Modified Transoral Resection of Diverticulum (<scp>MTORD</scp>) for Zenker's Diverticulum

2025-06-16

Christina Hui Lee Ng , Edward J. Damrose | The Laryngoscope

This article shows our preferred method of surgical treatment for Zenker's diverticulum. This article shows our preferred method of surgical treatment for Zenker's diverticulum.

Incidence and Risk Factors of Dysphagia After Cardiac Surgery: A Scoping Review

2025-06-16

Christos Kourek , Vassiliki Labropoulou , Emilia Michou +1 more | Journal of Clinical Medicine

Dysphagia is a serious complication following cardiac surgery, associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. Variability in the incidence and risk factors highlights the need for consolidated … Dysphagia is a serious complication following cardiac surgery, associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. Variability in the incidence and risk factors highlights the need for consolidated evidence. This scoping review aimed to analyze the incidence of dysphagia after cardiac surgery and identify the associated risk factors. A search was conducted in the PubMed, Embase, Web of Sciences, and PEDro databases for observational studies reporting dysphagia incidence and risk factors in adult cardiac surgery patients. The Newcastle-Ottawa Scale was used to assess the studies' quality and out of 2920 studies identified, 15 met the inclusion criteria for inclusion in this review. Dysphagia incidence ranged from 2.7% to 60%, with higher rates observed when objective assessments such as FEES or VFSS were employed. Key risk factors included advanced age, prolonged intubation, cerebrovascular events, and complex operative procedures. Post-operative dysphagia was linked to complications like aspiration pneumonia, prolonged ICU/hospital stays, and increased healthcare costs. In conclusion, dysphagia is a significant but under-recognized complication of cardiac surgery. Advanced age, prolonged intubation, and surgical complexity are major risk factors. Standardized assessment protocols and early interventions are crucial to mitigating its impact and improving patient clinical outcomes.

Dysphagia associated with portal hypertension and hepatocellular carcinoma, singular coincidence or hidden pathway?

2025-06-16

T Cúrdia Gonçalves , Léa Letrillart , Claire Carlier +2 more | Journal of Hepatology

Aspiration pneumonia highlighted on a barium swallow study

2025-06-15

Sonieya Nagarajah , Elissa Greco , Peter E. Wu | Journal of Hospital Medicine

Incidence of Aspiration and Dysphagia in Geriatric Trauma Patients

2025-06-15

Bennett R. Auker , Julie M. Reichert , Xander A. Stone +4 more | The American Surgeon

Background Trauma is a leading cause of death worldwide. Dysphagia and aspiration are potential sequelae of traumatic brain injury (TBI), yet these conditions are not always readily apparent. Fiberoptic endoscopic … Background Trauma is a leading cause of death worldwide. Dysphagia and aspiration are potential sequelae of traumatic brain injury (TBI), yet these conditions are not always readily apparent. Fiberoptic endoscopic evaluation of swallowing (FEES) is a bedside procedure enabling real-time diagnosis of swallowing dysfunction. The aim of this study was to assess the incidence of dysphagia and aspiration in geriatric TBI patients, identify associated risk factors, and ultimately establish specific indications for FEES as a method of formal swallowing evaluation. Methods A retrospective review was completed on all geriatric (65 or older) trauma patients evaluated in our level I trauma center from July 2021 to July 2023 who had a TBI defined by Abbreviated Injury Scale (AIS) head ≥3. Rates of dysphagia and aspiration were collected in addition to risk factors and associated clinical characteristics. Univariate and multivariable analyses were performed with significance defined by a P -value <0.05. Results In this study (n = 417), 21.8% of participants were found to have dysphagia and 6.9% aspirated. Both dysphagia and aspiration were associated with more hospital and ICU days, lower functional status at discharge (FSD), and lower likelihood of being discharged home. Glasgow Coma Scale (GCS) score less than 15 was an individual predictor of dysphagia as well as mortality. Discussion By identifying factors associated with dysphagia and aspiration, we can risk stratify geriatric TBI patients to receive a standardized swallowing evaluation with FEES in an effort to prevent unnecessary morbidity and mortality.

Investigating Speech and Swallowing Disorders in Cervical and Upper Thoracic Spinal Cord Injury Patients

2025-06-14

Morteza Farazi , Elham Loni , Sepideh Faraji +3 more | Indian Journal of Otolaryngology and Head & Neck Surgery

310-OR: Randomized Controlled Study of Algorithmic CGM-Based Degludec Titration in People with Type 2 Diabetes

2025-06-13

ANAS EL FATHI , Ralf Nass , Carol J. Levy +7 more | Diabetes

Introduction and Objective: People with type 2 diabetes (T2D) may require insulin therapy. As CGM is increasingly used in T2D, this study evaluated the feasibility of a CGM titration algorithm … Introduction and Objective: People with type 2 diabetes (T2D) may require insulin therapy. As CGM is increasingly used in T2D, this study evaluated the feasibility of a CGM titration algorithm for basal insulin treatment. Methods: We conducted a 16-week, two-site, randomized controlled trial (NCT06111508) involving CGM-naïve adults with T2D (≥18yo, HbA1c: 7-9%) using degludec and other antidiabetic medications. Participants were randomized 2:1 to weekly CGM-based titration (EXP) or a standard of care SMBG-based titration with blinded CGM (CTR). Both groups received dose notifications via a phone app. The primary endpoint was the change in CGM time in range (TIR: 70-180 mg/dL) from baseline to week 16, tested for non-inferiority (5% margin). Results: Thirty participants were randomized (EXP: 20, CTR: 10). At week 16, estimated mean changes in TIR were higher in EXP (+20.3%) compared to CTR (+8.3%) with adjusted difference +14.6% [4.0; +∞] (non-inferiority p=0.001). The overall rate of confirmed hypoglycemia (SMBG &lt; 70 mg/dL) was similar (17±20 vs 14±18 events per patient-year, p=0.67). Clinically significant hypoglycemia events (SMBG &lt; 54 mg/dL) were low (7 in each group). No severe hypoglycemia was reported. Conclusion: This CGM-based titration algorithm is a feasible alternative to standard approaches in adults with T2D. Outcomes favored participants using open CGM with CGM-based titration. Disclosure A. El Fathi: None. R. Nass: None. C.J. Levy: Research Support; Tandem Diabetes Care, Inc. Advisory Panel; Tandem Diabetes Care, Inc. Research Support; MannKind Corporation, Dexcom, Inc., Novo Nordisk, Eli Lilly and Company. C. Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. G. O'Malley: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc, Novo Nordisk, MannKind Corporation. N. Shah: None. E. Emory: None. D. Flanagan: None. P.W. Hansen: Employee; Novo Nordisk A/S. M.D. Breton: Speaker's Bureau; Sinocare Inc, Tandem Diabetes Care, Inc. Consultant; Roche Diabetes Care, Boydsense. Funding Novo Nordisk

THE IMPORTANCE OF SELF-FEEDING TRAINING AND DYSPHAGIA REGIMENS IN A RESIDENTIAL SOCIAL SERVICE USER WITH A COMBINED DISABILITY

2025-06-13

Petra Křížkovská , Kateřina Kroupová | Listy klinické logopedie

Detection and management of pill swallowing difficulties: a community pharmacy-based observational study

2025-06-12

Goedele Craye , Els Mehuys , Sien Schelfhout +5 more | International Journal of Clinical Pharmacy

Reducing Knowledge Gaps for Mechanical Insufflation-Exsufflation

2025-06-12

L Denise Willis | Respiratory Care