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Effects of oral intake of water in patients with oropharyngeal dysphagia
Martha JP Karagiannis, Leonie Chivers, Tom C Karagiannis
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-9
Abstract: We monitored lung related complications, hydration levels and assessed quality of life in two groups of people with dysphagia. The control group was allowed only thickened fluids and patients in the intervention group were allowed access to water for a period of five days.Our findings indicate a significantly increased risk in the development lung complications in patients given access to water (6/42; 14.3%) compared to the control group (0/34; no cases). We have further defined patients at highest risk, namely those with degenerative neurologic dysfunction who are immobile or have low mobility. Our results indicate increased total fluid intake in the patients allowed access to water, and the quality of life surveys, albeit from a limited number of patients (24% of patients), suggest the dissatisfaction of patients to diets composed of only thickened fluids.On the basis of these findings we recommend that acute patients, patients with severe neurological dysfunction and immobility should be strongly encouraged to adhere to a thickened fluid or modified solid consistency diet. We recommend that subacute patients with relatively good mobility should have choice after being well-informed of the relative risk.Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12608000107325Oropharyngeal dysphagia is a common clinical problem, predominantly in the elderly, and is associated with numerous pathologies including, cerebrovascular accident (CVA; stroke), neurodegenerative diseases (e. g. Alzheimer's disease, Parkinson's disease and multiple sclerosis), certain advanced cancers, particularly head and neck, and may result from a traumatic injury [1-6]. Dysphagia has been most widely investigated in the context of CVA where the incidence of swallowing difficulties ranges from 40 to 70% of patients [7-9]. A major complication of dysphagia is aspiration which results in morbidity due to the development of pneumonia - referred to as aspiration pneumonia [8,10-13]. Th
Implementation of Stroke Dysphagia Screening in the Emergency Department  [PDF]
Stephanie K. Daniels,Jane A. Anderson,Nancy J. Petersen
Nursing Research and Practice , 2013, DOI: 10.1155/2013/304190
Abstract: Early detection of dysphagia is critical in stroke as it improves health care outcomes. Administering a swallowing screening tool (SST) in the emergency department (ED) appears most logical as it is the first point of patient contact. However, feasibility of an ED nurse-administered SST, particularly one involving trial water swallow administration, is unknown. The aims of this pilot study were to (1) implement an SST with a water swallow component in the ED and track nurses’ adherence, (2) identify barriers and facilitators to administering the SST through interviews, and (3) develop and implement a process improvement plan to address barriers. Two hundred seventy-eight individuals with stroke symptoms were screened from October 2009 to June 2010. The percentage of patients screened increased from 22.6 in October 2009 to a high of 80.8 in March 2010, followed by a decrease to 61.9% in June (Cochran-Armitage test ). The odds of being screened were 4.0 times higher after implementation compared to two months before implementation. Results suggest that it is feasible for ED nurses to administer an SST with a water swallow component. Findings should facilitate improved quality of care for patients with suspected stroke and improve multidisciplinary collaboration in swallowing screening. 1. Introduction A well-established best practice in the care of patients with stroke is the early detection of dysphagia as it allows for immediate intervention thereby reducing morbidity, length of stay, and healthcare costs [1–3]. The essential first step to ensure early detection of dysphagia, and to prevent dysphagia-related morbidity, is to screen all stroke patients for signs of swallowing impairment prior to oral intake [1]. When a swallowing screening protocol is implemented, there is a decrease in morbidity over each year that the protocol is in place [4]. Moreover, when hospitals implement a formal swallowing screening protocol for patients with stroke, there is improvement in clinicians’ adherence with screening swallowing prior to oral intake [2], and the first dose of aspirin is administered earlier [5]. These findings have led the American Heart Association/American Stroke Association (AHA/ASA) to include screening of swallowing prior to the administration of food, liquid, or medication in individuals presenting with stroke symptoms as part of their guidelines on the early management of adults with acute stroke [6]. Within the Veterans Health Administration (VHA) the importance of dysphagia screening in patient with stroke is reflected in the issuance of
Correlation between brain injury and dysphagia in adult patients with stroke  [cached]
Nunes, Maria Cristina de Alencar,Jurkiewicz, Ari Leon,Santos, Rosane Sampaio,Furkim, Ana Maria
International Archives of Otorhinolaryngology , 2012,
Abstract: Introduction: In the literature, the incidence of oropharyngeal dysphagia in patients with cerebrovascular accident (AVE) ranges 20-90%. Some studies correlate the location of a stroke with dysphagia, while others do not. Objective: To correlate brain injury with dysphagia in patients with stroke in relation to the type and location of stroke. Method: A prospective study conducted at the Hospital de Clinicas with 30 stroke patients: 18 women and 12 men. All patients underwent clinical evaluation and swallowing nasolaryngofibroscopy (FEES ), and were divided based on the location of the injury: cerebral cortex, cerebellar cortex, subcortical areas, and type: hemorrhagic or transient ischemic. Results: Of the 30 patients, 18 had ischemic stroke, 10 had hemorrhagic stroke, and 2 had transient stroke. Regarding the location, 10 lesions were in the cerebral cortex, 3 were in the cerebral and cerebellar cortices, 3 were in the cerebral cortex and subcortical areas, and 3 were in the cerebral and cerebellar cortices and subcortical areas. Cerebral cortex and subcortical area ischemic strokes predominated in the clinical evaluation of dysphagia. In FEES , decreased laryngeal sensitivity persisted following cerebral cortex and ischemic strokes. Waste in the pharyngeal recesses associated with epiglottic valleculae predominated in the piriform cortex in all lesion areas and in ischemic stroke. A patient with damage to the cerebral and cerebellar cortices from an ischemic stroke exhibited laryngeal penetration and tracheal aspiration of liquid and honey. Conclusion: Dysphagia was prevalent when a lesion was located in the cerebral cortex and was of the ischemic type.
Management of Oropharyngeal Dysphagia in Laryngeal and Hypopharyngeal Cancer  [PDF]
Jose Granell,Laura Garrido,Teresa Millas,Raimundo Gutierrez-Fonseca
International Journal of Otolaryngology , 2012, DOI: 10.1155/2012/157630
Abstract: On considering a function-preserving treatment for laryngeal and hypopharyngeal cancer, swallowing is a capital issue. For most of the patients, achieving an effective and safe deglutition will mark the difference between a functional and a dysfunctional outcome. We present an overview of the management of dysphagia in head and neck cancer patients. A brief review on the normal physiology of swallowing is mandatory to analyze next the impact of head and neck cancer and its treatment on the anatomic and functional foundations of deglutition. The approach proposed underlines two leading principles: a transversal one, that is, the multidisciplinary approach, as clinical aspects to be managed in the oncologic patient with oropharyngeal dysphagia are diverse, and a longitudinal one; that is, the concern for preserving a functional swallow permeates the whole process of the diagnosis and treatment, with interventions required at multiple levels. We further discuss the clinical reports of two patients who underwent a supracricoid laryngectomy, a function-preserving surgical technique that particularly disturbs the laryngeal mechanics, and in which swallowing rehabilitation dramatically conditions the functional results. 1. Introduction Dysphagia is defined as difficulty in swallowing. It is a symptom that expresses a disorder in the transport of food and endogenous secretions (saliva) through the upper digestive tract. Oropharyngeal dysphagia (OD) is a more anatomically restricted term referred to alterations in the transfer of the bolus from the mouth to the esophagus (that means, in bolus propelling from the mouth to the pharynx, in the pharyngeal reconfiguration during the swallow, or in the opening of the upper esophageal sphincter) [1]. OD is an inescapable concern in the management of patients with laryngeal and hypopharyngeal cancer. Being as a symptom at presentation, as an adverse effect during whatever the treatment, or as sequelae compromising the quality of life of the patients, swallowing disorders have to be adequately anticipated and dealt with [2]. Swallowing is one of the vital functions that the larynx is involved in. For an outcome to be considered functional, the patient has to be able to swallow in an effective and safe manner. Actually, preserving a functional deglutition is usually the most important goal of the different function-preserving surgical techniques on the larynx and the hypopharynx, as a larynx that does not prevent aspiration cannot be preserved. Even though OD has been specifically classified in the latest versions of the
Oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease: a systematic review
O'Kane, Lisa;Groher, Michael;
Revista CEFAC , 2009, DOI: 10.1590/S1516-18462009005000040
Abstract: background: oropharyngeal dysphagia in patients with chronic obstructive pulmonary disease. purpose: patients with chronic obstructive pulmonary disease (copd) can be vulnerable to respiratory incompetence that may lead to swallowing impairment. a systematic review was conducted to investigate the relationship between chronic obstructive pulmonary disease and oropharyngeal dysphagia. forty-seven articles were retrieved relating to chronic obstructive pulmonary disease and dysphagia. each article was graded using evidence-based methodology. only 7 articles out of the 47 addressed oropharyngeal swallowing disorders in patients with chronic obstructive pulmonary disease. this review found few studies that documented the relationship between oropharyngeal swallowing disorders and chronic obstructive pulmonary disease. there were no randomized control trials. conclusion: although the evidence is not strong, it appears that patients with chronic obstructive pulmonary disease are prone to oropharyngeal dysphagia during exacerbations. future studies are needed to document the prevalence of oropharyngeal dysphagia in homogeneous groups of patients with chronic obstructive pulmonary disease, and to assess the relationship between respiration and swallowing using simultaneous measures of swallowing biomechanics and respiratory function. these investigations will lead to a better understanding of the characteristics and risk factors of developing oropharyngeal dypshagia in patients with chronic obstructive pulmonary disease.
Dysphagia in Stroke: A New Solution  [PDF]
Claire Langdon,David Blacker
Stroke Research and Treatment , 2010, DOI: 10.4061/2010/570403
Abstract: Dysphagia is extremely common following stroke, affecting 13%–94% of acute stroke sufferers. It is associated with respiratory complications, increased risk of aspiration pneumonia, nutritional compromise and dehydration, and detracts from quality of life. While many stroke survivors experience a rapid return to normal swallowing function, this does not always happen. Current dysphagia treatment in Australia focuses upon prevention of aspiration via diet and fluid modifications, compensatory manoeuvres and positional changes, and exercises to rehabilitate paretic muscles. This article discusses a newer adjunctive treatment modality, neuromuscular electrical stimulation (NMES), and reviews the available literature on its efficacy as a therapy for dysphagia with particular emphasis on its use as a treatment for dysphagia in stroke. There is a good theoretical basis to support the use of NMES as an adjunctive therapy in dysphagia and there would appear to be a great need for further well-designed studies to accurately determine the safety and efficacy of this technique. 1. Introduction Dysphagia (difficulty eating and swallowing) is extremely common following a stroke, affecting 13%–94% of acute stroke sufferers, with incidence relating to lesion size and location [1–3]. Dysphagia has been associated with higher rates of respiratory complications and increased risk of aspiration pneumonia [3–5], dehydration [6] and nutritional compromise [7]. It is also a socially penalising occurrence with a significant impact on sufferers’ quality of life. While there is a rapid return to normal function for many stroke survivors, this is not always the case. Mann et al. found more than half of a group of stroke survivors admitted to hospital with dysphagia continued to demonstrate signs of swallowing impairment on videofluoroscopy when they were followed up at 6 months post stroke [8]. Dysphagia has been associated with poorer outcomes in stroke and increased likelihood of residential placement [7] and adds significantly to the estimated lifetime costs of between $12,031 and $73,542 [9] in Australian stroke survivors. Current treatment for dysphagia in Australia involves prevention of aspiration in the form of diet and fluid modifications, compensatory manoeuvres and positional changes, and rehabilitation exercises. This article discusses a newer treatment modality, neuromuscular electrical stimulation (NMES), and reviews the available literature on its efficacy as a therapy for dysphagia with a particular emphasis on its use as a therapy for dysphagia following stroke.
Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly  [PDF]
Laia Rofes,Viridiana Arreola,Jordi Almirall,Mateu Cabré,Lluís Campins,Pilar García-Peris,Renée Speyer,Pere Clavé
Gastroenterology Research and Practice , 2011, DOI: 10.1155/2011/818979
Abstract: Oropharyngeal dysphagia is a major complaint among older people. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify older people with oropharyngeal dysphagia and to identify those patients who are at risk of aspiration. Videofluoroscopy (VFS) is the gold standard to study the oral and pharyngeal mechanisms of dysphagia in older patients. Up to 30% of older patients with dysphagia present aspiration—half of them without cough, and 45%, oropharyngeal residue; and 55% older patients with dysphagia are at risk of malnutrition. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in older patients. Diagnosis and management of oropharyngeal dysphagia need a multidisciplinary approach. 1. Definition and Prevalence Dysphagia is a symptom that refers to difficulty or discomfort during the progression of the alimentary bolus from the mouth to the stomach. From an anatomical standpoint dysphagia may result from oropharyngeal or esophageal dysfunction and from a pathophysiological standpoint from structure-related or functional causes [1, 2]. The prevalence of oropharyngeal functional dysphagia is very high: it affects more than 30% of patients who have had a cerebrovascular accident; 52%–82% of patients with Parkinson’s disease; 84% of patients with Alzheimer’s disease, up to 40% adults aged 65 years and older, and more than 60% of elderly institutionalized patients [2, 3]. Increase in the percentage of older persons is one of the principal demographic characteristics of the population of developed countries. In Europe, more than 17% of the citizens are older than 65 years. In the last decade, this group has increased by 28% whereas the rest of the population has only grown 0.8 % [1]. It has been estimated that 16,500,000 US senior citizens will require care for dysphagia by the year 2010 [4]. In spite of its enormous impact on the functional capacity, health, and quality of life of the older persons who suffer it, oropharyngeal dysphagia is underestimated and underdiagnosed as a cause of symptoms and major nutritional and respiratory complication in older patients. Oropharyngeal dysphagia fulfills most criteria to be recognized as a major geriatric
A therapeutic maneuver for oropharyngeal dysphagia in patients with parkinson's disease
Felix, Valter Nilton;Corrêa, Sabrina Mello Alves;Soares, Renato José;
Clinics , 2008, DOI: 10.1590/S1807-59322008000500015
Abstract: objective: this study investigates resources to provide better conditions for oropharyngeal swallowing for improvement in the quality of life of parkinson's disease patients. method: three men and one woman with an average age of 70.25 years had been afflicted with parkinson's disease for an average of 9.25 years. the patients were submitted to a rehabilitation program for oropharyngeal dysphagia after a clinical evaluation of swallowing. the rehabilitation program consisted of daily sessions for two consecutive weeks during which a biofeedback resource adapted especially for this study was used. the patients were then reevaluated for swallowing ability at follow-up. results: the patients presenting difficulties with swallowing water displayed no such problems after rehabilitation. only one patient exhibited slow oral transit of food and other discrete oropharyngeal food remnants when swallowing a biscuit. the sample variance was used to analyze the pressure measurements, demonstrating a numerical similarity of the results obtained with the swallowing of saliva or of biscuits (var = 4.41). a statistical difference was observed between the swallowing of saliva and biscuits, showing a significant pressure increase at the end of the rehabilitation program (p < 0.001). conclusion: the effortful swallow maneuver reinforced by using biofeedback appears to be a therapeutic resource in the rehabilitation of oropharyngeal dysphagia in parkinson's disease patients.
Clinical evaluation of oropharyngeal dysphagia in Machado-Joseph disease
Corrêa, Sabrina Mello Alves;Felix, Valter Nilton;Gurgel, Jonas Lírio;Sallum, Rubens A. A;Cecconello, Ivan;
Arquivos de Gastroenterologia , 2010, DOI: 10.1590/S0004-28032010000400003
Abstract: context: in machado-joseph disease, poor posture, dystonia and peripheral neuropathy are extremely predisposing to oropharyngeal dysphagia, which is more commonly associated with muscular dystrophy. objective: to evaluate the clinical characteristics of oropharyngeal dysphagia in machado-joseph disease patients. method: forty individuals participated in this study, including 20 with no clinical complaints and 20 dysphagic patients with machado-joseph disease of clinical type 1, who were all similar in terms of gender distribution, average age, and cognitive function. the medical history of each patient was reviewed and each subject underwent a clinical evaluation of deglutition. at the end, the profile of dysphagia in patients with machado-joseph disease was classified according to the severity scale of dysphagia, as described by o'neil and collaborators. results: comparison between dysphagic patients and controls did not reveal many significant differences with respect to the clinical evaluation of the oral phase of deglutition, since afflicted patients only demonstrated deficits related to the protrusion, retraction and tonus of the tongue. however, several significant differences were observed with respect to the pharyngeal phase. dysphagic patients presented pharyngeal stasis during deglutition of liquids and solids, accompanied by coughing and/or choking as well as penetration and/or aspiration; these signs were absent in the controls. conclusions: oropharyngeal dysphagia is part of the machado-joseph disease since the first neurological manifestations. there is greater involvement of the pharyngeal phase, in relation to oral phase of the deglutition. the dysphagia of these patients is classified between mild and moderate.
The sensitivity and specificity of the Chinese eating assessment tool (EAT-10) for screening oropharyngeal dysphagia in acute stroke patients

- , 2017,
Abstract: 目的 探讨进食评估问卷调查工具-10(EAT-10)中文版在急性期脑卒中患者口咽期吞咽障碍(OD)筛查中的敏感度及特异度。 方法 采用EAT-10中文版对130名急性期脑卒中后住院患者进行筛查评估,筛查当天行视频透视检查(VFS),选用受试者工作曲线(ROC曲线)调整分界值,用敏感度、特异度、Youden指数、阳性预测值、阴性预测值、阳性似然比、阴性似然比进行筛查效果评价。 结果 根据ROC曲线调查分界值,分界值选1时,EAT-10中文版的敏感度较高(77.9%)、阴性预测值也较高(73.2%),特异度为66.1%,Youden指数0.46,阳性预测值71.6%,阳性似然比2.30,阴性似然比0.33。EAT-10中文版重测信度均0.7以上,不同调查员信度较好,显示条目2有1位调查员的结果是恒定值。量表其余9个条目的一致相关系数均>0.7,各亚项和总分均值间一致性较高。 结论 EAT-10中文版重测信度和不同调查员信度较好,分界值选1为最理想分界值,EAT-10中文版得分≥1时判断吞咽异常有较高的敏感度及阴性预测值,推荐作为急性期脑卒中后吞咽障碍筛查工具。
Objective To study the sensitivity and specificity of the Chinese eating assessment tool (EAT-10) in screening acute stroke patients for oropharyngeal dysphagia (OD). Methods A total of 130 inpatients with acute stroke were screened using the Chinese EAT-10. On the same day they were also screened using the gold stan-dard technique for diagnosing dysphasia—videofluoroscopy. A receiver operating characteristics (ROC) curve was developed to study EAT-10′s sensitivity and specificity. A Youden index, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LHR+ and LHR-) were quantified. Results According to the ROC curve, a cut-off point of 1 (EAT-10 score≥1) gave the best sensitivity (77.9%), the highest NPV (73.2%), with 66.1% specificity, 71.6% PPV, 2.30 LHR+ and 0.33 LHR- in screening for OD. The test-retest reliability was above 0.7. An investigator consistency reliability test showed good repeatability, and the consistency between each item and the mean total score was high. Conclusion The Chinese EAT-10 has good test-retest reliability and investigator consistency. The optimal cut-off point is 1, with good sensitivity and NPV at scores≥1. The test can be recommended as a screening tool for OD in acute stroke patients
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