Assessment of swallowing in motor neuron disease and Asidan/SCA36 patients with new methods
Nobutoshi MorimotoToru YamashitaKota SatoTomoko KurataYoshio IkedaToshimasa KusuharaNaomichi MurataKoji Abe
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Dysarthria
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Background: Dysphagia management is vital in individuals reporting swallowing difficulties post-stroke. The literature review recommends the effortful swallow maneuver as a simple technique with multiple benefits for treating patients with oropharyngeal dysphagia due to stroke. No studies have documented the effect of effortful swallow and progressive resistance in individuals with swallowing difficulties post-stroke. Aim: To investigate whether the effortful swallow with added progressive resistance helps alleviate the swallowing function in individuals with dysphagia following stroke. Case report: In this case report, we describe a 30-year-old male who presented with left middle cerebral artery infarction and subsequent swallowing difficulty. The treatment procedure included 20 sessions of swallowing therapy incorporating effortful swallow with progressive resistance. Conclusion: Following 20 sessions of swallow treatment, significant improvement was seen in oro-facial measurements such as anterior and posterior tongue strength, anterior and posterior tongue endurance, and typical and effortful swallow tongue pressure. Functional oral intake level, dysphagia outcome and severity levels also improved significantly, contributing to better quality of life. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) examination showed improved swallow safety and efficiency post-therapy. Conclusion: Effortful swallow with progressive resistance effectively improved oro-pharyngeal swallow functions in an individual who presented with dysphagia following stroke. The case study highlights the effect of effortful swallow with progressive resistance in treating swallowing difficulties in a participant who presented with dysphagia following stroke.
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Objective To observe the curative effect of dysphagia therapeutic equipment combined with deglutition training to dysphagia after stroke.Method 100 cases of patients who had dysphagia after stroke were randomly divided into observation group and control group,each group was 50 cases.The two groups were treated with conventional drug treatment.In observation group,we added dysphagia therapic equipment combined with deglutition training.We had water swallow test and Shima Ichiro swallowing function score,clinical assessment before and after treatment in two groups.Results 15 days after hospitalization,the score of water swallow test and Shima Ichiro swallowing function of the observation group was significantly higher than those in the control group(P 0.05);Clinical curative effect comparison,two groups of swallowing function were improved,but the effect of the observation group was significantly higher than that of control group(P 0.05).Conclusion Dysphagia therapeutic equipment combined with rehabilitation training on dysphagia after stroke effect is significant,and can significantly improve the swallowing dysfunction,improve the quality of life of patients,improve the prognosis.
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Although dysphagia is an important symptom associated with prognosis in patients with Parkinson's disease (PD), dysphagia tends to be overlooked until swallowing difficulties reach an advanced phase. We assessed dysphagia with videofluoroscopic examination of swallowing in 31 patients with mainly mild or moderate PD. Swallowing problems were observed in the pharyngeal phase in 28 patients, oral phase in 19 patients, esophageal phase in 15 patients, and oral preparatory phase in 1 patient. Therefore, dysphagia in the pharyngeal phase was observed in almost all patients with mild or moderate PD. In contrast, no dysfunction was detected in most patients when screening was conducted via questionnaire or other methods. Assessment of clinical parameters in the present study suggests that latent swallowing dysfunction may be present even in the early disease stage in PD. A future prospective study to follow swallowing functions in a pre-symptomatic phase in PD would be fruitful to find whether swallowing dysfunction is one of the prodromal symptoms.
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Purpose: Patients with a neuromuscular disease (NMD) can present with dysarthria and/or dysphagia. Literature regarding prevalence rates of dysarthria and dysphagia is scarce. The purpose of this study was to determine prevalence rates, severity and co-presence of dysarthria and dysphagia in adult patients with NMD. Method: Two groups of adult patients with NMD were included: 102 consecutive outpatients (the "unselected cohort") and 118 consecutive patients who were referred for multidisciplinary assessment (the "selected cohort"). An experienced speech-language pathologist examined each patient in detail. Results: The pooled prevalence of dysarthria was 46% (95% CI: 36.5–55.9) and 62% (95% CI: 53.3–70.8) in the unselected and selected cohorts, respectively. The pooled prevalence of dysphagia was 36% (95% CI: 27.1–45.7) and 58% (95% CI: 49.4–67.2) in the unselected and selected cohorts, respectively. There was a modest but significant association between the presence of dysarthria and dysphagia (rs = 0.40; p < 0.01). Although the dysphagia was generally mild, dysarthria was moderate to severe in 15% of the dysarthric patients. Conclusion: The prevalence rates of dysarthria and dysphagia among patients with various types of NMD are high. Physicians should therefore be aware of this prevalence and consider referring NMD patients to a speech-language pathologist.Implicatons of RehabilitationBoth dysarthria and dysphagia are highly prevalent among patients with neuromuscular diseases; moreover, although often mild, these disorders can occur relatively early in the course of the disease.Clinicians should routinely check for signs and symptoms related to dysarthria and/or dysphagia in patients who present with a neuromuscular disease, preferably using standardised instruments.
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Dysarthria
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The purpose of this study was to identify the frequency of swallowing dysfunction after extubation in a sample of patients with no preexisting dysphagia.Mechanically ventilated patients in the ICU with no prior history of dysphagia received a flexible endoscopic evaluation of swallowing (FEES) exam within 72 hours after extubation. The FEES was then analyzed for variables related to swallowing patterns and laryngeal pathology. Univariate analyses were performed to identify relationships between variables.Fifty-nine patients were included in this study. After extubation, 21 (35.6%) penetrated and 13 (22.0%) aspirated. The mean days intubated was 9.4 ± 6.1. Various forms of laryngeal injury were associated with worse swallowing scores, and delayed onset of the swallow was a common finding in all patients post extubation. Of the 44 participants evaluated ≤ 24 hours post extubation, 56.8% penetrated/aspirated. Of the 15 patients evaluated >24 hours post extubation, 60.0% penetrated/aspirated.This study found a high frequency of dysphagia after prolonged intubation in patients with no preexisting dysphagia. Important variables leading to dysphagia are often overlooked, such as swallowing delay and laryngeal pathology. The timing of swallowing assessments did not reveal any difference in dysphagia frequency, suggesting that it might not be necessary to wait to perform dysphagia screens or evaluations.
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There is a high prevalence of dysphagia among patients with neuromuscular diseases and cerebrovascular diseases, and its consequences can be profound. However, the correlation between dysarthria and oral-oropharyngeal dysphagia remains unclear. We conducted a literature review to define the clinical presentation of both dysarthria and dysphagia in patients with neuromuscular and cerebrovascular diseases. We performed a systematic PubMed search of the English-language literature since 1995. Objective and subjective outcomes instruments were identified for both dysarthria and dysphagia. Studies that included the incidence of concomitant presentations were included. Inclusion and exclusion criteria were applied according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Of the 1,056 articles we reviewed, we selected 24 for analysis. We found that dysarthria and dysphagia were common among patients with neuromuscular and cerebrovascular diseases. Overall, there was a higher prevalence of dysarthria than dysphagia. Of those patients with dysphagia, some reports found that 76 to 90% of patients with neuromuscular disease also had dysarthria. Dysarthria is a strong clinical clue to the presence of dysphagia. Existing subjective questionnaires may not reveal the presence of oropharyngeal dysphagia; objective measures are obviously more revealing. Further studies to correlate the degree of dysarthria and the severity of oral-oropharyngeal dysphagia are warranted.
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Abstract Dysphagia is common in Parkinson’s disease (PD) and is assumed to complicate medication intake. This study comprehensively investigates dysphagia for medication and its association with motor complications in PD. Based on a retrospective analysis, a two-dimensional and graduated classification of dysphagia for medication was introduced differentiating swallowing efficiency and swallowing safety. In a subsequent prospective study, sixty-six PD patients underwent flexible endoscopic evaluation of swallowing, which included the swallowing of 2 tablets and capsules of different sizes. Dysphagia for medication was present in nearly 70% of PD patients and predicted motor complications according to the MDS-UPDRS-part-IV in a linear regression model. Capsules tended to be swallowed more efficiently compared to tablets, irrespective of size. A score of ≥1 on the swallow-related-MDS-UPDRS-items can be considered an optimal cut-off to predict dysphagia for medication. Swallowing impairment for oral medication may predispose to motor complications.
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Speech and swallowing functioning was assessed in 10 patients diagnosed as having the degenerative disease multisystem atrophy (MSA). Swallowing was assessed using clinical and radiographic examinations. The results showed that three of the 10 subjects were aspirating. The aspiration was silent and therefore not evident on clinical swallowing assessment, although there were indications of laryngeal dysfunction. The remaining subjects all had some degree of swallowing dysfunction and presented with at least a mild dysarthria. This suggests that any MSA patient presenting with even mild dysarthria should have a detailed swallowing assessment. The role of the speech therapist in the multidisciplinary management of patients with MSA is discussed.
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