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Sample records for dysphagia modifications involving

  1. Family Involvement in School-Based Dysphagia Management

    Science.gov (United States)

    Angell, Maureen E.; Bailey, Rita L.; Nicholson, Joanna K.; Stoner, Julia B.

    2009-01-01

    This article provides a practitioner-friendly synthesis of existing literature on family involvement in the management of dysphagia for school-age. Research reviewed includes family perspectives on programs, therapists, and characteristics that comprise effective family involvement in school-based dysphagia management programs. Also included are…

  2. Dysphagia.

    Science.gov (United States)

    Malandraki, Georgia; Robbins, JoAnne

    2013-01-01

    Swallowing is one of the primary functions that enable humans to sustain life. Likewise, it is an important element of healthy life and contributes to quality of life and well-being. When the ability to swallow is lost or impaired, the risk of disability or even death is greatly increased. Rehabilitation potential is diminished and the process is prolonged in the presence of dysphagia. This present chapter describes the anatomical and neurophysiological components of healthy adult swallowing and presbyphagia and the major consequences that swallowing disorders (dysphagia) may have if left untreated. The main neurogenic conditions and diseases leading to dysphagia are also introduced, as well as the major diagnostic and interventional approaches used by swallowing specialists to help patients with dysphagia. The role of the multidisciplinary team is emphasized and screening questions and guidelines are provided to help the neurologist and other professionals provide dysphagic patients with the best swallowing care. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. [Dysphagia rehabilitation].

    Science.gov (United States)

    Saitoh, Eiichi

    2008-11-01

    Recently, many medical professionals become to realize eating problem affect deeply patient's quality of life (QOL), and they are very interested in dysphagia rehabilitation. I overviewed dysphagia rehabilitation along with the followings; (1) impact of dysphagia, (2) assessment of dysphagia, and (3) management of dysphagia. Eating is the most enjoyable activity. Dysphagia changes this enjoyable activity to the most fearful one. Dysphagia makes three major problems: risk of aspiration pneumonia and suffocation, risk of dehydration and malnutrition, and depriving enjoyable activity. As a recent conceptualization of eating, the Process model is the most important, that reveals eating (chew-swallow) is very different from just chewing plus swallowing in physiologically. In assessment, standardized functional tests such as the Repetitive saliva swallowing test, the Modified water swallowing test, and the Graded food test are used. The most important point in clinical assessment is identifying indication of direct therapy using food or starting period of oral feeding. Videofluorographic and videoendoscopic examinations are used as precise diagnostic and management-oriented assessment tools. In management, exercise, posture adjustment, and modification of food promote eating possibility. Oral care is essential in dysphagic patients. Surgical intervention is effective method if a patient has severe dysphagia.

  4. [Transdisciplinary approach for sarcopenia. Sarcopenic Dysphagia].

    Science.gov (United States)

    Wakabayashi, Hidetaka

    2014-10-01

    Sarcopenic dysphagia is difficulty swallowing due to sarcopenia of generalized skeletal muscles and swallowing muscles. Presbyphagia refers to age-related changes in the swallowing mechanism in the elderly associated with a frailty in swallowing. Presbyphagia is different from dysphagia. The most common cause of dysphagia is stroke. However, sarcopenic dysphagia may be common in the elderly with sarcopenia and dysphagia. Frail elderly with aspiration pneumonia can simultaneously experience activity-, disease-, and nutrition-related sarcopenia of generalized skeletal muscles and swallowing muscles, resulting in the development of sarcopenic dysphagia. Consensus diagnostic criteria for sarcopenic dysphagia were proposed at the 19th Annual Meeting of the Japanese Society of Dysphagia Rehabilitation. The concept of rehabilitation nutrition as a combination of both rehabilitation and nutrition care management is useful for treatment of sarcopenic dysphagia. Therapy for sarcopenic dysphagia includes dysphagia rehabilitation, nutrition improvement and sarcopenia treatment. The core components of dysphagia rehabilitation are oral health care, rehabilitative techniques, and food modification. Nutrition improvement is important, because malnutrition contributes to the etiology of secondary sarcopenia and sarcopenic dysphagia. Assessment of the multi-factorial causes of primary and secondary sarcopenia is important because rehabilitation nutrition for sarcopenia differs depending on its etiology. Treatment of age-related sarcopenia should include resistance training and dietary supplements of amino acids. Therapy for activity-related sarcopenia includes reduced bed rest time and early mobilization and physical activity. Treatment for disease-related sarcopenia requires therapies for advanced organ failure, inflammatory disease, or malignancy, while therapy for nutrition-related sarcopenia involves appropriate nutrition management to increase muscle mass.

  5. [Neurogenic dysphagia].

    Science.gov (United States)

    Wirth, R; Dziewas, R

    2017-02-01

    Approximately half of neurological and geriatric inpatients suffer from oropharyngeal dysphagia. This often leads to pneumonia, malnutrition and dehydration; however, the underlying dysphagia is frequently not diagnosed and treated. This is particularly the case for patients with so-called silent aspiration. Knowledge on the physiology of swallowing, including the central nervous system control of swallowing and the therapeutic options have achieved considerable progress in recent years. In particular, the increasing implementation of flexible endoscopic evaluation of swallowing (FEES) has significantly contributed to this knowledge. It provides the ability to identify the individual pattern of oropharyngeal dysphagia leading to a suitable selection of therapeutic and compensatory strategies for individual patients. The various therapeutic options range from modification of the consistency of the diet, over diverse logopedic strategies and stimulation techniques up to interventional procedures.

  6. Radiographer involvement with stent insertion to palliate symptomatic dysphagia resulting from neoplastic obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Law, R.L. [Department of Radiology, Frenchay Hospital, Bristol, BS16 1LE (United Kingdom)], E-mail: robert.law@nbt.nhs.uk

    2008-02-15

    Self-expanding metal stent (SEMS) insertion is recognized as an effective palliative treatment for patients with symptomatic dysphagia resulting from inoperable neoplastic occlusion. This paper reviews radiographer involvement in the fluoroscopic deployment of SEMS. One hundred and fifty-eight SEMS were passed in 136 consecutive patients. Radiographers were responsible for the barium swallow and subsequent passage of an oro-gastric wire across the strictured lumen. One hundred and twenty-seven guide wire insertions under fluoroscopic control transgressed the tumour lumen at first attempt. Nine (6.6%) guide wire insertions were unsuccessful at first attempt however two patients (2.7%) had successful second attempts at fluoroscopically guided wire insertion. Five patients went on to have a joint endoscopic/fluoroscopic SEMS procedure, three were successful, two failed. Due to poor health it was decided not to proceed with further intervention with two other patients. With an overall success rate of 96%, a joint radiographer/clinician approach to guide wire insertion and subsequent SEMS deployment using fluoroscopy alone is a safe, time- and cost-effective procedure.

  7. A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain

    OpenAIRE

    Dable, Rajani A; Wasnik, Pradnya B.; Sunilkumar L Nagmode; Mukkaram Faridi Ali

    2013-01-01

    Herein, presenting a case of a 42-year-old female with the chief complaint of dysphagia. The problem was assumed to be of dental origin, due to the onset of dental pain followed by dysphagia. A cervical radiograph revealed the presence of osteophytic lipping which proved to be the cause of dysphagia. Confusing and overlapping disease entities showing similar symptoms need thorough investigation. Dysphagia related to cervical spondylosis may have a direct connection with the person′s occupatio...

  8. [Dysphagia and swallowing rehabilitation].

    Science.gov (United States)

    Shigematsu, Takashi; Fujishima, Ichiro

    2015-02-01

    Dysphagia is a life-threatening disorder caused by many medical conditions such as stroke, neurological disorders, tumors, etc. The symptoms of dysphagia are quite variable and diagnosed by observation or through screening involving instrumental swallowing examinations such as video-fluoroscopy and video-endoscopy, to determine functional severity and treatment-prognosis. Direct- and indirect-therapy is used with and without food, respectively. Swallowing rehabilitation is very effective, and could be used in conjunction with compensatory techniques. Here we present an overview of dysphagia and swallowing rehabilitation.

  9. A diagnostic and therapeutic challenge involving a case of dysphagia in association with cervical osteophytosis and a dental pain

    Directory of Open Access Journals (Sweden)

    Rajani A Dable

    2013-01-01

    Full Text Available Herein, presenting a case of a 42-year-old female with the chief complaint of dysphagia. The problem was assumed to be of dental origin, due to the onset of dental pain followed by dysphagia. A cervical radiograph revealed the presence of osteophytic lipping which proved to be the cause of dysphagia. Confusing and overlapping disease entities showing similar symptoms need thorough investigation. Dysphagia related to cervical spondylosis may have a direct connection with the person′s occupation. Dentistry is considered a potentially hazardous occupation with regard to musculoskeletal disorders. However, additional studies are required to understand the occupational hazards faced by dentists.

  10. Dysphagia in Parkinson's Disease.

    Science.gov (United States)

    Suttrup, Inga; Warnecke, Tobias

    2016-02-01

    More than 80 % of patients with Parkinson's disease (PD) develop dysphagia during the course of their disease. Swallowing impairment reduces quality of life, complicates medication intake and leads to malnutrition and aspiration pneumonia, which is a major cause of death in PD. Although the underlying pathophysiology is poorly understood, it has been shown that dopaminergic and non-dopaminergic mechanisms are involved in the development of dysphagia in PD. Clinical assessment of dysphagia in PD patients is challenging and often delivers unreliable results. A modified water test assessing maximum swallowing volume is recommended to uncover oropharyngeal dysphagia in PD. PD-specific questionnaires may also be useful to identify patients at risk for swallowing impairment. Fiberoptic endoscopic evaluation of swallowing and videofluoroscopic swallowing study are both considered to be the gold standard for evaluation of PD-related dysphagia. In addition, high-resolution manometry may be a helpful tool. These instrumental methods allow a reliable detection of aspiration events. Furthermore, typical patterns of impairment during the oral, pharyngeal and/or esophageal swallowing phase of PD patients can be identified. Therapy of dysphagia in PD consists of pharmacological interventions and swallowing treatment by speech and language therapists (SLTs). Fluctuating dysphagia with deterioration during the off-state should be treated by optimizing dopaminergic medication. The methods used during swallowing treatment by SLTs shall be selected according to the individual dysphagia pattern of each PD patient. A promising novel method is an intensive training of expiratory muscle strength. Deep brain stimulation does not seem to have a clinical relevant effect on swallowing function in PD. The goal of this review is giving an overview on current stages of epidemiology, pathophysiology, diagnosis, and treatment of PD-associated dysphagia, which might be helpful for neurologists

  11. Electrodiagnostic methods for neurogenic dysphagia.

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    Ertekin, C; Aydogdu, I; Yüceyar, N; Tarlaci, S; Kiylioglu, N; Pehlivan, M; Celebi, G

    1998-08-01

    Swallowing mechanisms and neurogenic dysphagia have not been systematically studied by the EMG technique. It is desirable to evaluate neurogenic dysphagia for diagnostic and possibly for therapeutic purposes using electrophysiological methods. The following methods were described: mechanical upward/downward movements of the larynx were detected using a piezoelectric sensor, while submental integrated EMG activity was recorded during dry and wet swallowing. The EMG activity of cricopharyngeal muscle of the upper oesophageal sphincter was also recorded in some normal subjects and patients. Piecemeal deglutition and the dysphagia limit were determined in all patients to detect dysphagia objectively. In this study 75 normal subjects and 177 neurological patients with various degrees of dysphagia were investigated. Voluntarily triggered oropharyngeal swallowing was commonly pathological in the majority of patients, with or without overt dysphagia. The dysphagia limit appeared to be an objective measure of the degree of dysphagia in more than 90% of patients. Pathophysiological mechanisms were different in at least three groups of patients with neurogenic dysphagia. In the group of patients with muscular disorders, laryngeal elevators were involved while the CP-sphincter was intact. The second group included patients with the clinical signs of corticobulbar fibre involvement such as amyotrophic lateral sclerosis and pseudobulbar palsy. In these patients, there was incoordination between paretic laryngeal elevators and hyperreflexic CP-sphincter. In the third group (patients with Parkinson's disease), the swallowing reflex was delayed and prolonged. EMG methods described in the present study are very useful for the diagnosis of neurogenic dysphagia, objectively and quickly. They are important to understand the physiological mechanisms for deglutition and its disorders.

  12. Dysphagia (Difficulty Swallowing)

    Science.gov (United States)

    ... falls into one of the following categories. Esophageal dysphagia Esophageal dysphagia refers to the sensation of food ... to inflammation and scarring of the esophagus. Oropharyngeal dysphagia Certain conditions can weaken your throat muscles, making ...

  13. People with intellectual disabilities and dysphagia.

    Science.gov (United States)

    Robertson, Janet; Chadwick, Darren; Baines, Susannah; Emerson, Eric; Hatton, Chris

    2017-03-12

    Dysphagia (difficulties in eating, drinking or swallowing) is associated with serious health complications and psychosocial sequelae. This review aims to summarise the state of the evidence regarding dysphagia in people with intellectual disabilities (excluding prevalence), identify gaps in the evidence base and highlight future research priorities. Studies published from 1 January 1990 to 19 July 2016 were identified using Medline, Cinahl, PsycINFO, Web of Science, email requests and cross citations. Studies were reviewed narratively in relation to identified themes. A total of 35 studies were included in the review. Themes identified were as follows: health conditions associated with dysphagia; mortality; health service use; practice and knowledge in supporting people with intellectual disabilities and dysphagia; intervention effectiveness and quality of life. Dysphagia is associated with respiratory infections and choking and may be under-recognised. Silent aspiration is common and may go unnoticed. Management practices exist, but there are few intervention studies and no randomised controlled trials (RCTs), and hence, the effectiveness of these is currently unclear. Dysphagia is a key concern in relation to people with intellectual disabilities. There is urgent need for research on the management of dysphagia in people with intellectual disabilities, including mealtime support offered, positioning, dietary modification and impact on wellbeing. Implications for Rehabilitation Dysphagia is common in people with intellectual disabilities, associated with serious health risks and may be under-recognised. Caregivers of people with intellectual disabilities should be educated about dysphagia. There is an urgent need for research on improving the management of dysphagia in people with intellectual disabilities. Improved recognition and management of dysphagia may reduce the occurrence of associated health conditions and reduce hospital admissions and premature death

  14. Assessing esophageal dysphagia.

    Science.gov (United States)

    Kruger, Danielle

    2014-05-01

    Dysphagia, or difficulty swallowing, is a common problem. Although most cases are attributable to benign disease processes, dysphagia is also a key symptom in several malignancies, making it an important symptom to evaluate. The differential diagnosis of dysphagia requires an understanding of deglutition, in particular the oropharyngeal versus esophageal stages. Stroke is the leading cause of oropharyngeal dysphagia, which is common in older adults and frequently presents as part of a broader complex of clinical manifestations. In esophageal dysphagia, difficulty swallowing is often the main complaint and is caused by localized neuromuscular disorders or obstructive lesions.

  15. Dysphagia in the elderly.

    Science.gov (United States)

    Khan, Abraham; Carmona, Richard; Traube, Morris

    2014-02-01

    Dysphagia, or difficulty swallowing, is a common problem in the elderly. Based on the initial clinical history and physical examination, the dysphagia is assessed as either primarily oropharyngeal or esophageal in origin. Most oropharyngeal dysphagia is of neurologic origin, and management is coordinated with a clinical swallow specialist in conjunction with an ear, nose, and throat (ENT) physician if warning signs imply malignancy. Several structural and functional esophageal disorders can cause dysphagia. If a patient has likely esophageal dysphagia, a video barium esophagram is a good initial test, and referral to a gastroenterologist is generally warranted leading to appropriate treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. DYSPHAGIA AND SIALORRHEA:

    Directory of Open Access Journals (Sweden)

    Denise Hack NICARETTA

    2013-03-01

    Full Text Available ContextDysphagia and sialorrhea in patients with Parkinson's disease are both automatically accepted as dependent on this neurological disease.ObjectiveThe aim were to establish if these two complaints are a consequence or associated manifestations of Parkinson's disease.MethodTwo Parkinson's diseases groups from the same outpatients' population were studied. Patients in the first group, with dysphagia, were studied by videofluoroscopy. The second, with sialorrhea, were studied by the scintigraphic method,ResultsVideofluoroscopic examination of the oral, pharyngeal and esophageal phases of swallowing showed that 94% of Parkinson's diseases patients present, structural causes, not related to Parkinson's diseases, able to produce or intensify the observed disphagia. The scintigraphic examination of Parkinson's diseases patients with sialorrhea showed that there is no increase of serous saliva production. Nevertheless, showed a significantly higher velocity of saliva excretion in the Parkinson's diseases patients.ConclusionsDysphagia can be due to the muscular rigidity often present in the Parkinson's diseases patient, or more usually by non Parkinson's disease associated causes. In Parkinson's diseases patients, sialorrhea is produced by saliva retention. Nevertheless, sialorrhea can produce discomfort in swallowing, although without a formal complaint of dysphagia. In this case, subclinical dysphagia must be considered. Sialorrhea is indicative of dysphagia or at least of subclinical dysphagia. As final conclusion, Parkinson's diseases can be an isolated cause of dysphagia and/or sialorrhea, but frequently, a factor unrelated to Parkinson's diseases is the main cause of or at least aggravates the dysphagia.

  17. Involvement of Histone Modifications in Plant Abiotic Stress Responses

    Institute of Scientific and Technical Information of China (English)

    Lianyu Yuan; Xuncheng Liu; Ming Luo; Songguang Yang; Keqiang Wu

    2013-01-01

    As sessile organisms, plants encounter various environmental stimuli including abiotic stresses during their lifecycle. To survive under adverse conditions, plants have evolved intricate mechanisms to perceive external signals and respond accordingly. Responses to various stresses largely depend on the plant capacity to modulate the transcriptome rapidly and specifically. A number of studies have shown that the molecular mechanisms driving the responses of plants to environmental stresses often depend on nucleosome histone post-translational modifications including histone acetylation, methylation, ubiquitination, and phosphorylation. The combined effects of these modifications play an essential role in the regulation of stress responsive gene expression. In this review, we highlight our current understanding of the epigenetic mechanisms of histone modifications and their roles in plant abiotic stress response.

  18. Consumer perceptions of food products involving genetic modification

    DEFF Research Database (Denmark)

    Grunert, Klaus G.; Lähteenmäki, L.; Nielsen, Niels Asger

    2001-01-01

    Product descriptions of cheese, candy and salmon products were presented to samples of respondents in four Nordic countries. The descriptions represented various applications of genetic modification (GM), varied along a "distance" dimension and a "what is modified" dimension, and were presented...

  19. Malingering dysphagia and odynophagia electromyographic assessment.

    Science.gov (United States)

    Vaiman, Michael; Shoval, Gal; Gavriel, Haim

    2009-01-01

    The article discusses the usefulness and investigation technique of suspected malingering dysphagia/odynophagia by surface electromyography (sEMG) of deglutition. Forty patients with suspected malingering dysphagia (group 1), 40 patients with dysphagia/odynophagia due to tonsillectomy (group 2), and 40 healthy individuals (group 3) were involved in the study. The timing, amplitude, and graphic patterns of activity of the masseter, submental, and trapezius muscles were examined during voluntary single water swallows ("normal") and continuous drinking of 100 mL of water. The muscle activity in oral, pharyngeal, and initial esophageal stages of swallowing was measured, and graphic records were evaluated in relation to timing and voltage. The main sEMG patterns of malingering dysphagia/odynophagia are prolonged time of the voluntary oral phase of a swallow (80% of cases, n = 32, P swallowing being at the same time absent during continuous drinking. Dysphagia due to malingering has no pathologic sEMG patterns associated with deglutition. Skeletal muscle tension during deglutition, being observed in some cases, has no connection with the act of swallowing itself. Prolonged oral phase of a swallow is factitious, nonpathologic. Surface EMG, being noninvasive, nonradiographic and inexpensive, can be used for patients with suspected malingering dysphagia, thus avoiding expensive and time-consuming investigation.

  20. Presbyphagia and Sarcopenic Dysphagia: Association between Aging, Sarcopenia, and Deglutition Disorders.

    Science.gov (United States)

    Wakabayashi, H

    2014-01-01

    Presbyphagia refers to age-related changes in the swallowing mechanism in the elderly associated with a frailty in swallowing. Presbyphagia is different from dysphagia. Sarcopenic dysphagia is difficulty swallowing due to sarcopenia of generalized skeletal muscles and swallowing muscles. Age-related loss of swallowing muscle mass becomes evident in the geniohyoid muscle and tongue. Elderly subjects with both sarcopenia and dysphagia may have not only disease-related dysphagia but also sarcopenic dysphagia. In cases of aspiration pneumonia, deterioration in activity-, disease-, and nutrition-related sarcopenia of generalized skeletal muscles and swallowing muscles may develop into sarcopenic dysphagia. Assessment of sarcopenic dysphagia includes evaluation of both dysphagia and sarcopenia. The 10-item Eating Assessment Tool (EAT-10) and a water test combined with pulse oximetry are useful for dysphagia screening. Assessment of the multi-factorial causes of sarcopenia including nutritional review is important, because rehabilitation of sarcopenic dysphagia differs depending on its etiology. Consensus diagnostic criteria for sarcopenic dysphagia were proposed at the 19th Annual Meeting of the Japanese Society of Dysphagia Rehabilitation. Rehabilitation for sarcopenic dysphagia includes treatment of both dysphagia and sarcopenia. The core components of dysphagia rehabilitation are oral health care, rehabilitative techniques, and food modification. The causes of adult malnutrition may also contribute to the etiology of secondary sarcopenia and sarcopenic dysphagia. Therefore, nutrition management is indispensable for sarcopenic dysphagia rehabilitation. In cases of sarcopenia with numerous complicating causes, treatment should include pharmaceutical therapies for age-related sarcopenia and comorbid chronic diseases, resistance training, early ambulation, nutrition management, protein and amino acid supplementation, and non-smoking.

  1. Dementia and dysphagia.

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    Easterling, Caryn S; Robbins, Elizabeth

    2008-01-01

    In 2004, more than 12% of the population in the United States was aged 65 years or older. This percentage is expected to increase to 20% of the population by 2030. The prevalence of swallowing disorders, or dysphagia, in older individuals ranges from 7% to 22% and dramatically increases to 40% to 50% in older individuals who reside in long-term care facilities. For older individuals, those with neurologic disease, or those with dementia, the consequence of dysphagia may be dehydration, malnutrition, weight loss, and aspiration pneumonia. Dysphagia can be a result of behavioral, sensory, or motor problems (or a combination of these) and is common in individuals with neurologic disease and dementia. Although there are few studies of the incidence and prevalence of dysphagia in individuals with dementia, it is estimated that 45% of institutionalized dementia patients have dysphagia. The high prevalence of dysphagia in individuals with dementia likely is the result of age-related changes in sensory and motor function in addition to those produced by neuropathology. The following article describes evidence based practices in caring for those individuals with dementia and dysphagia with guidelines for evaluation and management.

  2. Tongue pressure profile training for dysphagia post stroke (TPPT): study protocol for an exploratory randomized controlled trial.

    Science.gov (United States)

    Steele, Catriona M; Bayley, Mark A; Péladeau-Pigeon, Melanie; Stokely, Shauna L

    2013-05-07

    It is estimated that approximately 50% of stroke survivors will experience swallowing difficulty, or dysphagia. The associated sequelae of dysphagia include dehydration, malnutrition, and aspiration pneumonia, all of which have can have serious medical consequences. To improve swallowing safety and efficiency, alternative nutritional intake methods (for example, a feeding tube) or a modified diet texture (such as pureed foods or thickened liquids) may be recommended but these modifications may negatively affect quality of life. An alternative approach to treating dysphagia has emerged over the past few years, targeting stronger lingual muscles through maximal isometric pressure tasks. Although these studies have shown promising results, thin-liquid bolus control continues to be challenging for patients with dysphagia. Previous work investigating lingual pressures when healthy participants swallow has suggested that greater task specificity in lingual exercises may yield improved results with thin liquids. This is a small, exploratory randomized clinical trial being conducted with post-stroke patients 4 to 20 weeks after onset of dysphagia secondary to impaired lingual control. At enrollment, participants are randomly assigned to one of two treatment protocols, either tongue pressure profile training (TPPT) or the control treatment, tongue pressure strength-and-accuracy training (TPSAT). Each treatment protocol consists of 24 sessions of treatment over 8 to 12 weeks with monitoring of tongue pressure as well as a baseline and outcome videofluoroscopic swallowing study. Tongue pressure measures, videofluoroscopic measures, and functional outcome measures will be obtained following training of 60 participants (30 in each condition), to determine whether TPPT yields better outcomes. This study will continue to explore options beyond tube feeding and modified diets for people with neurogenic dysphagia following stroke. Should the novel protocol, TPPT, prove to be more

  3. Diagnostic evaluation of dysphagia.

    Science.gov (United States)

    Cook, Ian J

    2008-07-01

    Taking a careful history is vital for the evaluation of dysphagia. The history will yield the likely underlying pathophysiologic process and anatomic site of the problem in most patients, and is crucial for determining whether subsequently detected radiographic or endoscopic 'anomalies' are relevant or incidental. Although the symptoms of pharyngeal dysphagia can be multiple and varied, the typical features of neurogenic pharyngeal dysphagia are highly specific, and can accurately distinguish pharyngeal from esophageal disorders. The history will also dictate whether the next diagnostic procedure should be endoscopy, a barium swallow or esophageal manometry. In some difficult cases, all three diagnostic techniques may need to be performed to establish an accurate diagnosis. Stroke is the most common cause of pharyngeal dysphagia. A videoradiographic swallow study is vital in such cases to determine the extent and timing of aspiration and the severity and mechanics of dysfunction as a prelude to therapy.

  4. Dysphagia in Huntington's disease

    NARCIS (Netherlands)

    Heemskerk-van den Berg, Willemien Antoinette

    2015-01-01

    Huntington’s disease (HD) is a progressive neurodegenerative disease with an autosomal, dominant mode of inheritance. Patients with HD suffer from dysphagia which can have serious consequences, such as weight loss, dehydration, and pneumonia leading to death. Many patients with HD die of aspiration

  5. Dysphagia in Huntington's disease

    NARCIS (Netherlands)

    Heemskerk-van den Berg, Willemien Antoinette

    2015-01-01

    Huntington’s disease (HD) is a progressive neurodegenerative disease with an autosomal, dominant mode of inheritance. Patients with HD suffer from dysphagia which can have serious consequences, such as weight loss, dehydration, and pneumonia leading to death. Many patients with HD die of aspiration

  6. Postoperative dysphagia versus neurogenic dysphagia: scintigraphic assessment.

    Science.gov (United States)

    Galli, Jacopo; Valenza, Venanzio; D'Alatri, Lucia; Reale, Francesca; Gajate, AnaMaria Samanes; Di Girolamo, Stefano; Paludetti, Gaetano

    2003-01-01

    In order to differentiate the features of dysphagia that occur after supraglottic horizontal laryngectomy from those that occur during neurologic diseases, we divided 38 subjects into 3 groups and submitted them to oropharyngoesophageal scintigraphy. Group 1 (control group) included 15 healthy volunteeers; group 2 comprised 8 patients who had residual dysphagia at least 1 year after supraglottic laryngectomy; and group 3 included 15 patients with various neurologic and neuromuscular disorders. In group 1, the mean values (+/- 2 SD) of selected semiquantitative parameters were consistent with those reported in the literature for normal subjects. In group 2, oral, pharyngeal, and esophageal transit times were not significantly altered, and moderate tracheobronchial post-deglutitive aspiration was present (maximum value, 6.7%; mean value, 2.04%). The pharyngeal retention index was significantly increased (p = .0003) as compared to normal subjects in all cases (maximum value, 40%; mean value, 23%) and was associated in all cases with slight but consistent post-deglutitive aspiration. In group 3, the oral and esophageal phases were significantly prolonged and the retention indices were significantly increased. Statistical analysis documented a significant increase in oral transit time (p = .003), esophageal transit time (p = .01), oral retention index (p = .006), pharyngeal retention index (p = .0007), and esophageal retention index (p = .009) as compared to normal subjects. The swallowing pattern was also altered by 1) an early loss of the bolus from the oral cavity; 2) bolus fragmentation due to double or triple deglutition, reduced lingual propulsion, or the return of a small part of the bolus into the oral cavity during deglutition; and/or 3) double pharyngeal peaks in the activity-time curves. Tracheobronchial aspiration (maximum value, 90%; mean value, 9.70%) was present in some cases, mainly in patients affected by post-stroke dysphagia. On the basis of the

  7. [Dysphagia with lateral medullary infarction (Wallenberg's syndrome)].

    Science.gov (United States)

    Oshima, Fumiko

    2011-11-01

    Dysphagia after lateral medullary infarction (LMI) is common. The dysphagia of LMI is dynamically characterized by a failure in triggering of the pharyngeal-phase swallowing movements, reduced output, and lack of coordination (swallowing pattern abnormality). Based on accurate evaluation, we can select suitable rehabilitative approaches for individual patients, including respiratory therapy, food modification, postural changes, and oral care. We focused on the absence of upper esophageal sphincter (UES) opening of the unaffected side of the medullae. The movement pattern was defined as failure of bolus passage through the intact side of the UES, occurring at least once during the videofluorographic evaluation of each individual. Three abnormal patterns of UES opening were classified. The passage pattern abnormality shows the failure of the stereotyped motor sequence. For severe cases, it is necessary to consider long-term treatment, including botulinum toxin injection or surgery to prevent aspiration and adequate nutritional management.

  8. Team management of dysphagia in the institutional setting.

    Science.gov (United States)

    Robbins, JoAnne; Kays, Stephanie; McCallum, Shirley

    2007-01-01

    The capacity to swallow effectively and safely is a basic human need, yet nearly 40% of Americans over age 60 experience dysphagia. Since the resources in acute-care hospitals often are unavailable in institutional settings, the daily involvement of nursing and the dietitian's screening and continuous assessment are critical to timely, effective dysphagia identification, referral, and management. Upon referral, the speech pathologist executes comprehensive evaluation, leading the design and implementation of a team treatment plan. Literature highlighting a sample of dysphagia screening tools and interventions, care transitions and aspiration prevention strategies is reviewed herein to guide current practice and future research.

  9. [Efficacy of high-frequency cinematography in diagnosis of dysphagia].

    Science.gov (United States)

    Oelerich, M; Mai, R; Müller-Miny, H; Peters, P E

    1995-10-01

    Dysphagia is a common symptom in clinical practice. Due to the broad spectrum of underlying diseases many disciplines are involved in the therapy and diagnosis of dysphagia, where radiology plays a central role. The radiologist is confronted with different diagnostic problems and has to choose the most appropriate type of investigation. In many cases no organic disorder can be demonstrated by clinical examination, endoscopy or conventional radiological techniques. In this setting cineradiography is an outstanding tool for finding functional or structural changes in the swallowing chain. This study underlines the efficiency of cineradiography in the diagnosis of dysphagia.

  10. Dysphagia after laparoscopic Nissen fundoplication

    DEFF Research Database (Denmark)

    Funch-Jensen, Peter; Jacobsen, Bo

    2007-01-01

    OBJECTIVE: To investigate the frequency and severity of dysphagia during the first 8 weeks after laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease. So far, there have been no studies reporting data on day-to-day occurrence of dysphagia after laparoscopic fundoplication...... in a consecutive series of patients. This may explain why the frequency of dysphagia varies greatly in the literature (4-100%). MATERIAL AND METHODS: Forty consecutive patients, undergoing elective laparoscopic Nissen fundoplication, completed a standard dysphagia registration diary each day during the first 8...... weeks after surgery. Patients who preoperatively had suffered from dysphagia were excluded. Thus, none of the patients had dysphagia in the 2-month period before surgery. Ten patients undergoing elective cholecystectomy served as controls. Data were quantified, and a score value of 4 or more...

  11. The Use of Brain Stimulation in Dysphagia Management.

    Science.gov (United States)

    Simons, Andre; Hamdy, Shaheen

    2017-04-01

    Dysphagia is common sequela of brain injury with as many as 50% of patients suffering from dysphagia following stroke. Currently, the majority of guidelines for clinical practice in the management of dysphagia focus on the prevention of complications while any natural recovery takes place. Recently, however, non-invasive brain stimulation (NIBS) techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have started to attract attention and are applied to investigate both the physiology of swallowing and influences on dysphagia. TMS allows for painless stimulation of the brain through an intact skull-an effect which would normally be impossible with electrical currents due to the high resistance of the skull. By comparison, tDCS involves passing a small electric current (usually under 2 mA) produced by a current generator over the scalp and cranium external to the brain. Initial studies used these techniques to better understand the physiological mechanisms of swallowing in healthy subjects. More recently, a number of studies have investigated the efficacy of these techniques in the management of neurogenic dysphagia with mixed results. Controversy still exists as to which site, strength and duration of stimulation yields the greatest improvement in dysphagia. And while multiple studies have suggested promising effects of NIBS, more randomised control trials with larger sample sizes are needed to investigate the short- and long-term effects of NIBS in neurogenic dysphagia.

  12. Dysphagia Secondary to Anterior Osteophytes of the Cervical Spine.

    Science.gov (United States)

    Egerter, Alexander C; Kim, Eric S; Lee, Darrin J; Liu, Jonathan J; Cadena, Gilbert; Panchal, Ripul R; Kim, Kee D

    2015-10-01

    Study Design Retrospective case series. Objective Diffuse idiopathic skeletal hyperostosis (DISH) or Forestier disease involves hyperostosis of the spinal column. Hyperostosis involving the anterior margin of the cervical vertebrae can cause dysphonia, dyspnea, and/or dysphagia. However, the natural history pertaining to the risk factors remain unknown. We present the surgical management of two cases of dysphagia secondary to cervical hyperostosis and discuss the etiology and management of DISH based on the literature review. Methods This is a retrospective review of two patients with DISH and anterior cervical osteophytes. We reviewed the preoperative and postoperative images and clinical history. Results Two patients underwent anterior cervical osteophytectomies due to severe dysphagia. At more than a year follow-up, both patients noted improvement in swallowing as well as their associated pain. Conclusion The surgical removal of cervical osteophytes can be highly successful in treating dysphagia if refractory to prolonged conservative therapy.

  13. Malnutrition, dehydration, and ancillary feeding options in dysphagia patients.

    Science.gov (United States)

    Via, Michael A; Mechanick, Jeffrey I

    2013-12-01

    Patients with dysphagia are at high risk for malnutrition. Several strategies may be used to address the nutritional needs of these patients. Dietary modification, the addition of oral supplements, or the use of nutritional support in the form of enteral tube feeds or parenteral nutrition infusions can greatly impact the overall health of the patient.

  14. Nutritional Aspects of Dysphagia Management.

    Science.gov (United States)

    Gallegos, C; Brito-de la Fuente, E; Clavé, P; Costa, A; Assegehegn, G

    This chapter describes the nutritional aspects of dysphagia management by starting with the definition of these two conditions (dysphagia and malnutrition) that share three main clinical characteristics: (a) their prevalence is very high, (b) they can lead to severe complications, and (c) they are frequently underrecognized and neglected conditions. From an anatomical standpoint, dysphagia can result from oropharyngeal and/or esophageal causes; from a pathophysiological perspective, dysphagia can be caused by organic or structural diseases (either benign or malignant) or diseases causing impaired physiology (mainly motility and/or perception disorders). This chapter gathers up-to-date information on the screening and diagnosis of oropharyngeal dysphagia, the consequences of dysphagia (aspiration pneumonia, malnutrition, and dehydration), and on the nutritional management of dysphagic patients. Concerning this last topic, this chapter reviews the rheological aspects of swallowing and dysphagia (including shear and elongational flows) and its influence on the characteristics of the enteral nutrition for dysphagia management (solid/semisolid foods and thickened liquids; ready-to-use oral nutritional supplements and thickening powders), with special focus on the real characteristics of the bolus after mixing with human saliva. © 2017 Elsevier Inc. All rights reserved.

  15. Oropharyngeal dysphagia: manifestations and diagnosis.

    Science.gov (United States)

    Rommel, Nathalie; Hamdy, Shaheen

    2016-01-01

    Swallowing disorders (dysphagia) have been recognized by the WHO as a medical disability associated with increased morbidity, mortality and costs of care. With increasing survival rates and ageing of the population, swallowing disorders and their role in causing pulmonary and nutritional pathologies are becoming exceedingly important. Over the past two decades, the study of oropharyngeal dysphagia has been approached from various disciplines with considerable progress in understanding its pathophysiology. This Review describes the most frequent manifestations of oropharyngeal dysphagia and the clinical as well as instrumental techniques that are available to diagnose patients with dysphagia. However, the clinical value of these diagnostic tests and their sensitivity to predict outcomes is limited. Despite considerable clinical research efforts, conventional diagnostic methods for oropharyngeal dysphagia have limited proven accuracy in predicting aspiration and respiratory disease. We contend that incorporation of measurable objective assessments into clinical diagnosis is needed and might be key in developing novel therapeutic strategies.

  16. Consumer perception of food products involving genetic modification: Results from a qualitative study in four Nordic countries

    OpenAIRE

    Klaus G. Grunert; Lähteenmäki, Liisa; Nielsen, Niels Asger; Poulsen, Jacob B.; Ueland, Oydis; Åström, Annika

    2000-01-01

    1. The present study addresses consumer acceptance of food products involving the use of different applications of genetic modification in four Nordic countries. Three food products were used as examples: hard cheese, hard candy, and salmon. Three types of applications of genetic modification were investigated: modification of the raw material, use of genetic modification in enzyme production, and direct use of genetically modified microorganisms. In addition, three levels of presence of the ...

  17. Postmyotomy dysphagia after laparoscopic surgery for achalasia

    Institute of Scientific and Technical Information of China (English)

    Yutaka Shiino; Ziad T. Awad; Gleb R. Haynatzki; Richard E. Davis; Ronald A. Hinder; Charles J. Filipi

    2003-01-01

    AIM: To determine predictive factors for postoperative dysphagia after laparoscopic myotomy for achalasia.METHODS: Logistic regression was used to investigate the possible association between the response (postoperative dysphagia, with two levels: none/mild and moderate/severe)and several plausible predictive factors.RESULTS: Eight patients experienced severe or moderate postoperative dysphagia. The logistic regression revealed that only the severity of preoperative dysphagia (with four levels; mild, moderate, severe, and liquid) was a marginally significant (P=0.0575) predictive factor for postoperative dysphagia.CONCLUSION: The severity of postoperative dysphagia is strongly associated with preoperative dysphagia. Preoperative symptomatology can significantly impact patient outcome.

  18. A Targeted Swallow Screen for the Detection of Postoperative Dysphagia.

    Science.gov (United States)

    Gee, Erica; Lancaster, Elizabeth; Meltzer, Jospeh; Mendelsohn, Abie H; Benharash, Peyman

    2015-10-01

    Postoperative dysphagia leads to aspiration pneumonia, prolonged hospital stay, and is associated with increased mortality. A simple and sensitive screening test to identify patients requiring objective dysphagia evaluation is presently lacking. In this study, we evaluated the efficacy of a novel targeted swallow screen evaluation. This was a prospective trial involving all adult patients who underwent elective cardiac surgery with cardiopulmonary bypass at our institution over an 8-week period. Within 24 hours of extubation and before the initiation of oral intake, all postsurgical patients were evaluated using the targeted swallow screen. A fiberoptic endoscopic evaluation of swallowing was requested for failed screenings. During the study, 50 postcardiac surgery patients were screened. Fifteen (30%) failed the targeted swallow screen, and ten of the fifteen (66%) failed the subsequent fiberoptic endoscopic evaluation of swallowing exam and were confirmed to have dysphagia. The screening test had 100 per cent sensitivity for detecting dysphagia in our patient population, and a specificity of 87.5 per cent. The overall incidence of dysphagia was 20 per cent. We have shown that a targeted swallow evaluation can efficiently screen patients during the postcardiac surgery period. Furthermore, we have shown that the true incidence of dysphagia after cardiac surgery is significantly higher than previously recognized in literature.

  19. Food Culture, Preferences and Ethics in Dysphagia Management.

    Science.gov (United States)

    Kenny, Belinda

    2015-11-01

    Adults with dysphagia experience difficulties swallowing food and fluids with potentially harmful health and psychosocial consequences. Speech pathologists who manage patients with dysphagia are frequently required to address ethical issues when patients' food culture and/ or preferences are inconsistent with recommended diets. These issues incorporate complex links between food, identity and social participation. A composite case has been developed to reflect ethical issues identified by practising speech pathologists for the purposes of illustrating ethical concerns in dysphagia management. The case examines a speech pathologist's role in supporting patient autonomy when patients and carers express different goals and values. The case presents a 68-year-old man of Australian/Italian heritage with severe swallowing impairment and strong values attached to food preferences. The case is examined through application of the dysphagia algorithm, a tool for shared decision-making when patients refuse dietary modifications. Case analysis revealed the benefits and challenges of shared decision-making processes in dysphagia management. Four health professional skills and attributes were identified as synonymous with shared decision making: communication, imagination, courage and reflection.

  20. Dysphagia due to tardive dyskinesia

    Directory of Open Access Journals (Sweden)

    Pookala S Bhat

    2010-01-01

    Full Text Available Tardive dyskinesia (TD, neuroleptic-induced delayed onset movement disorder, remains an enigmatic phenomenon and a therapeutic challenge. Only a few cases of dysphagia also have been reported in world literature and to the best knowledge of the authors no case of TD manifesting as isolated dysphagia has been reported so far from India. We report a case of TD consequent to prolonged exposure to typical neuroleptics, manifesting as isolated dysphagia who responded well to a combination of Quetiapine, Donepezil and Vit E.

  1. Cough responsiveness in neurogenic dysphagia.

    Science.gov (United States)

    Smith, P E; Wiles, C M

    1998-03-01

    In neurogenic dysphagia a good cough is important for airway protection. If triggering of cough, or its effectiveness, is impaired this might result in an increased aspiration risk. Capsaicin, an agent which induces cough through sensory nerve stimulation, was used to test cough sensitivity in groups of patients with and without neurogenic dysphagia. On the basis of swallowing speed (ml/s) in a validated water test 28 alert neurological inpatients (16 women, aged 22-71 years) were classified into 13 with abnormal and 15 with normal swallowing (median swallowing speed 23% and 99%, median volume/swallow 43% and 106% of that predicted for age and sex respectively: pneurogenic dysphagia even after allowing for diagnostic category, the possible presence of a bulbar upper motor neuron lesion, or voluntary respiratory capacity. It is concluded that these patients with neurogenic dysphagia do not have a reduced sensitivity of cough triggering.

  2. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Stroke Heroes Among Us Difficulty Swallowing After Stroke (Dysphagia) Updated:Nov 15,2016 Excerpted and adapted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August ...

  3. Dysphagia after Stroke: an Overview.

    Science.gov (United States)

    González-Fernández, Marlís; Ottenstein, Lauren; Atanelov, Levan; Christian, Asare B

    2013-09-01

    Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this population are discussed.

  4. Dysphagia after Stroke: an Overview

    OpenAIRE

    2013-01-01

    Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this pop...

  5. A posttranslational modification cascade involving p38, Tip60, and PRAK mediates oncogene-induced senescence.

    Science.gov (United States)

    Zheng, Hui; Seit-Nebi, Alim; Han, Xuemei; Aslanian, Aaron; Tat, John; Liao, Rong; Yates, John R; Sun, Peiqing

    2013-06-06

    Oncogene-induced senescence is an important tumor-suppressing defense mechanism. However, relatively little is known about the signaling pathway mediating the senescence response. Here, we demonstrate that a multifunctional acetyltransferase, Tip60, plays an essential role in oncogenic ras-induced senescence. Further investigation reveals a cascade of posttranslational modifications involving p38, Tip60, and PRAK, three proteins that are essential for ras-induced senescence. Upon activation by ras, p38 induces the acetyltransferase activity of Tip60 through phosphorylation of Thr158; activated Tip60 in turn directly interacts with and induces the protein kinase activity of PRAK through acetylation of K364 in a manner that depends on phosphorylation of both Tip60 and PRAK by p38. These posttranslational modifications are critical for the prosenescent function of Tip60 and PRAK, respectively. These results have defined a signaling pathway that mediates oncogene-induced senescence, and identified posttranslational modifications that regulate the enzymatic activity and biological functions of Tip60 and PRAK.

  6. Role of Epigenetic Histone Modifications in Diabetic Kidney Disease Involving Renal Fibrosis

    Directory of Open Access Journals (Sweden)

    Jing Sun

    2017-01-01

    Full Text Available One of the commonest causes of end-stage renal disease is diabetic kidney disease (DKD. Renal fibrosis, characterized by the accumulation of extracellular matrix (ECM proteins in glomerular basement membranes and the tubulointerstitium, is the final manifestation of DKD. The TGF-β pathway triggers epithelial-to-mesenchymal transition (EMT, which plays a key role in the accumulation of ECM proteins in DKD. DCCT/EDIC studies have shown that DKD often persists and progresses despite glycemic control in diabetes once DKD sets in due to prior exposure to hyperglycemia called “metabolic memory.” These imply that epigenetic factors modulate kidney gene expression. There is evidence to suggest that in diabetes and hyperglycemia, epigenetic histone modifications have a significant effect in modulating renal fibrotic and ECM gene expression induced by TGF-β1, as well as its downstream profibrotic genes. Histone modifications are also implicated in renal fibrosis through its ability to regulate the EMT process triggered by TGF-β signaling. In view of this, efforts are being made to develop HAT, HDAC, and HMT inhibitors to delay, stop, or even reverse DKD. In this review, we outline the latest advances that are being made to regulate histone modifications involved in DKD.

  7. Histone modifications involved in cassette exon inclusions: a quantitative and interpretable analysis.

    Science.gov (United States)

    Liu, Hui; Jin, Ting; Guan, Jihong; Zhou, Shuigeng

    2014-12-19

    Chromatin structure and epigenetic modifications have been shown to involve in the co-transcriptional splicing of RNA precursors. In particular, some studies have suggested that some types of histone modifications (HMs) may participate in the alternative splicing and function as exon marks. However, most existing studies pay attention to the qualitative relationship between epigenetic modifications and exon inclusion. The quantitative analysis that reveals to what extent each type of epigenetic modification is responsible for exon inclusion is very helpful for us to understand the splicing process. In this paper, we focus on the quantitative analysis of HMs' influence on the inclusion of cassette exons (CEs) into mature RNAs. With the high-throughput ChIP-seq and RNA-seq data obtained from ENCODE website, we modeled the association of HMs with CE inclusions by logistic regression whose coefficients are meaningful and interpretable for us to reveal the effect of each type of HM. Three type of HMs, H3K36me3, H3K9me3 and H4K20me1, were found to play major role in CE inclusions. HMs' effect on CE inclusions is conservative across cell types, and does not depend on the expression levels of the genes hosting CEs. HMs located in the flanking regions of CEs were also taken into account in our analysis, and HMs within bounded flanking regions were shown to affect moderately CE inclusions. Moreover, we also found that HMs on CEs whose length is approximately close to nucleosomal-DNA length affect greatly on CE inclusion. We suggested that a few types of HMs correlate closely to alternative splicing and perhaps function jointly with splicing machinery to regulate the inclusion level of exons. Our findings are helpful to understand HMs' effect on exon definition, as well as the mechanism of co-transcriptional splicing.

  8. Dysphagia Rehabilitation in Japan.

    Science.gov (United States)

    Inoue, Makoto

    2015-01-01

    In Japan, one of the most common causes of death in elderly people is aspiration pneumonia. Maintenance of oral hygiene and feeding functions are important elements, especially in patients with dysphagia caused by stroke, neurological diseases, and after operations on the head and neck cancer, as well as in the elderly to prevent aspiration pneumonia. It should also be noted that not only oral health care and physical therapy related to feeding functions but also dental treatment is included in the clinical management during interventions whenever needed. On the other hand, for the patients and/or elderly in need of assistance in maintaining a safe diet, it is recommended that a specialized team comprising physicians, dentists, and speech therapists in functional rehabilitation observes meal conditions of the subjects and evaluates such factors as meal contents, posture during meals, usage of dishes and cutlery, meal times, status of consciousness, perception, and motivation. First, I will present the clinical interventions to those patients, which include oral health care, dental treatment, physical therapy and meal assistance, as well as team approaches in those circumstances. In addition, clinical and basic research results will be introduced, which are expected to foster the understanding of physiology in chewing and swallowing. These results are also expected to develop the clinical technology to maintain or recover the feeding functions.

  9. [Dysphagia in Parkinson's Disease: Pathophysiology, Diagnosis and Therapy].

    Science.gov (United States)

    Suttrup, I; Warnecke, T

    2016-07-01

    Oropharyngeal and esophageal dysphagia are a frequent, but seldom diagnosed symptom of Parkinson's disease (PD). More than 80 % of patients with PD develop dysphagia during the course of their disease leading to a reduced quality of life, complicated medication intake, malnutrition and aspiration pneumonia, which is a major cause of death in PD. The underlying pathophysiology is poorly understood. Impaired dopaminergic and non-dopaminergic mechanisms of the cortical swallowing network as well as peripheral neuromuscular involvement have been suggested to contribute to its multifactorial genesis. Diagnostic screening methods include PD-specific questionnaires and a modified water test. Fiber optic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS), which complement each other, are the gold standard for evaluation of PD-related dysphagia. For evaluation of esophageal dysphagia, the high-resolution manometry (HRM) may be a helpful tool. In addition to dysphagia-specific treatment by speech and language therapists (SLTs), optimized dopaminergic medication is a meaningful therapeutic option. A promising novel method is intensive training of expiratory muscle strength (EMST). Deep brain stimulation does not seem to have a clinically relevant effect on swallowing function in PD. © Georg Thieme Verlag KG Stuttgart · New York.

  10. Dysphagia due to Multiple Esophageal Rings

    Directory of Open Access Journals (Sweden)

    Stephen N Sullivan

    1995-01-01

    Full Text Available A 27-year-old Saudi man with dysphagia due to multiple esophageal rings is reported and the literature reviewed. Dysphagia due to multiple esophageal rings is very rare. Only 15 cases have been reported. The patient is usually male and has had dysphagia for many years when presenting. The cause of the rings is unknown. Theories to explain dysphagia are that the rings are either congenital or an unusual manifestation of gastroesophageal reflux.

  11. Relapse with Dysphagia in a Case of Chronic Inflammatory Demyelinating Polyradiculoneuropathy.

    Science.gov (United States)

    Teramoto, Hiroko; Morita, Akihiko; Hara, Makoto; Ninomiya, Satoko; Shigihara, Shuntaro; Kusunoki, Susumu; Kamei, Satoshi

    2015-01-01

    Glossopharyngeal and/or vagus nerve involvement is infrequent in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We herein report the case of a 69-year-old Japanese woman who presented with muscle weakness and numbness of the extremities with dysphagia. The serum anti-ganglioside GM1 immunoglobulin IgM antibody levels were elevated, and treatment with intravenous immunoglobulin (IVIg) resulted in a dramatic improvement; the weakness, numbness and dysphagia all resolved. However, relapse comprising dysphagia alone occurred on hospital day 26, and treatment with IVIg again proved extremely effective. IVIg therapy can be effective against cranial nerve involvement in cases of CIDP.

  12. Consumer perception of food products involving genetic modification: Results from a qualitative study in four Nordic countries

    DEFF Research Database (Denmark)

    Grunert, Klaus G.; Lähteenmäki, Liisa; Nielsen, Niels Asger

    2000-01-01

    1. The present study addresses consumer acceptance of food products involving the use of different applications of genetic modification in four Nordic countries. Three food products were used as examples: hard cheese, hard candy, and salmon. Three types of applications of genetic modification were...... and living/able to function. 2. The results from consumer samples in Denmark, Finland, Norway and Sweden are remarkably similar, showing a strong stability in consumer reactions to the use of genetic modification in food production in these four countries. 3. Consumer perception is characterised by a basic...... dichotomy of GM and non-GM products. Being non-GM is regarded as a major benefit in itself. When a product involves genetic modification, this elicits numerous negative assocations, of which the strongest ones are 'unhealthy' and 'uncertainty.' 4. The level of presence of the genetically modified material...

  13. Predictors of Dysphagia in Acute Pontine Infarction.

    Science.gov (United States)

    Lapa, Sriramya; Luger, Sebastian; Pfeilschifter, Waltraud; Henke, Christian; Wagner, Marlies; Foerch, Christian

    2017-05-01

    Little is known about the frequency and the clinical characteristics of neurogenic dysphagia in pontine strokes. In this study, we sought to identify predictors for dysphagia in a cohort of patients with isolated pontine infarctions. We included all patients admitted to our department between 2008 and 2014 having an acute (dysphagia was the primary end point of the study and was assessed by a Speech-Language Pathologist according to defined criteria. The study recruited 59 patients, 14 with and 45 without dysphagia. Median (interquartile range) stroke severity (in terms of National Institutes of Health Stroke Scale values) was higher in the dysphagic group as compared with patients without dysphagia (8.5 [6-12] versus 2 [1-5]; Pdysphagia. Dysphagia occurs frequently in patients with isolated pontine infarctions. Clinical and imaging predictors of dysphagia may help to provide optimal screening, to prevent complications and to improve long-term prognosis. © 2017 American Heart Association, Inc.

  14. Oropharyngeal Dysphagia in patients with obstructive sleep apnea syndrome.

    Science.gov (United States)

    Schindler, Antonio; Mozzanica, Francesco; Sonzini, Giulia; Plebani, Daniela; Urbani, Emanuele; Pecis, Marica; Montano, Nicola

    2014-02-01

    Although previous studies demonstrated that patients with obstructive sleep apnea syndrome (OSAS) may present subclinical manifestations of dysphagia, in not one were different textures and volumes systematically studied. The aim of this study was to analyze the signs and symptoms of oropharyngeal dysphagia using fiberoptic endoscopic evaluation of swallowing (FEES) with boluses of different textures and volumes in a large cohort of patients with OSAS. A total of 72 OSAS patients without symptoms of dysphagia were enrolled. The cohort was divided in two groups: 30 patients with moderate OSAS and 42 patients with severe OSAS. Each patient underwent a FEES examination using 5, 10 and 20 ml of liquids and semisolids, and solids. Spillage, penetration, aspiration, retention, and piecemeal deglutition were considered. The penetration-aspiration scale (PAS), pooling score (PS), and dysphagia outcome and severity scale (DOSS) were used for quantitative analysis. Each patient completed the SWAL-QOL questionnaire. Forty-six patients (64 %) presented spillage, 20 (28 %) piecemeal deglutition, 26 (36 %) penetration, and 30 (44 %) retention. No differences were found in the PAS, PS, and DOSS scores between patients with moderate and severe OSAS. Patients with severe OSAS scored higher General Burden and Food selection subscales of the SWAL-QOL. Depending on the DOSS score, the cohort of patients was divided into those with and those without signs of dysphagia. Patients with signs of dysphagia scored lower in the General Burden and Symptoms subscales of the SWAL-QOL. OSAS patients show signs of swallowing impairment in about half of the population; clinicians involved in the management of these patients should include questions on swallowing when taking the medical history.

  15. Modification of carbon nanotubes and synthesis of polymeric composites involving the nanotubes

    Energy Technology Data Exchange (ETDEWEB)

    Badamshina, E R; Gafurova, M P; Estrin, Yakov I [Institute of Problems of Chemical Physics, Russian Academy of Sciences, Chernogolovka, Moscow Region (Russian Federation)

    2010-12-29

    The results of studies, mainly published in recent years, on modification of carbon nanotubes and design of composites with these nanotubes for the manufacture of new-generation materials are generalized and analyzed. The methods of modification of the nanotubes by low- and high-molecular compounds and methods of polymer modification by carbon nanotubes are considered. Data on the properties of modified nanotubes are presented. The current and potential applications of materials based on the nanotubes are indicated.

  16. Oxidative post-translational modifications and their involvement in the pathogenesis of autoimmune diseases

    Directory of Open Access Journals (Sweden)

    Brent J. Ryan

    2014-01-01

    Full Text Available Tissue inflammation results in the production of numerous reactive oxygen, nitrogen and chlorine species, in addition to the products of lipid and sugar oxidation. Some of these products are capable of chemically modifying amino acids. This in turn results in changes to the structure and function of proteins. Increasing evidence demonstrates that such oxidative post-translational modifications result in the generation of neo-epitopes capable of eliciting both innate and adaptive immune responses. In this paper, we focus on how free radicals and related chemical species generated in inflammatory environments modulate the antigenicity of self-proteins, resulting in immune responses which involve the generation of autoantibodies against key autoantigens in autoimmune diseases. As examples, we will focus on Ro-60 and C1q in systemic lupus erythematosus, along with type-II collagen in rheumatoid arthritis. This review also covers some of the emerging literature which demonstrates that neo-epitopes generated by oxidation are conserved, as exemplified by the evolutionarily conserved pathogen-associated molecular patterns (PAMPs. We discuss how these observations relate to the pathogenesis of both human autoimmune diseases and inflammatory disease, such as atherosclerosis. The potential for these neo-epitopes and the immune responses against them to act as biomarkers or therapeutic targets is also discussed.

  17. novPTMenzy: a database for enzymes involved in novel post-translational modifications.

    Science.gov (United States)

    Khater, Shradha; Mohanty, Debasisa

    2015-01-01

    With the recent discoveries of novel post-translational modifications (PTMs) which play important roles in signaling and biosynthetic pathways, identification of such PTM catalyzing enzymes by genome mining has been an area of major interest. Unlike well-known PTMs like phosphorylation, glycosylation, SUMOylation, no bioinformatics resources are available for enzymes associated with novel and unusual PTMs. Therefore, we have developed the novPTMenzy database which catalogs information on the sequence, structure, active site and genomic neighborhood of experimentally characterized enzymes involved in five novel PTMs, namely AMPylation, Eliminylation, Sulfation, Hydroxylation and Deamidation. Based on a comprehensive analysis of the sequence and structural features of these known PTM catalyzing enzymes, we have created Hidden Markov Model profiles for the identification of similar PTM catalyzing enzymatic domains in genomic sequences. We have also created predictive rules for grouping them into functional subfamilies and deciphering their mechanistic details by structure-based analysis of their active site pockets. These analytical modules have been made available as user friendly search interfaces of novPTMenzy database. It also has a specialized analysis interface for some PTMs like AMPylation and Eliminylation. The novPTMenzy database is a unique resource that can aid in discovery of unusual PTM catalyzing enzymes in newly sequenced genomes. Database URL: http://www.nii.ac.in/novptmenzy.html

  18. [Videofluoroscopy study of swallowing in neurogenic dysphagia].

    Science.gov (United States)

    Avdiunina, I A; Popova, L M; Dokuchaeva, N V; Bragina, L K; Dokuchaeva, N F

    2000-01-01

    Videofluoroscopy (VFS) was for the first time used for examining swallowing in 49 patients with nervous diseases. Disturbances in each phase of swallowing act are analyzed with evaluation of the time parameters and defects, causes of aspiration in neurogenic dysphagia are discussed, and cricopharyngeal insufficiency is described. Neurogenic dysphagia is characterized by a combination of disorders which determine the degree of dysphagia. The most severe swallowing disorders were observed in patients with multiple foci in the brain stem and in diphtheritic polyneuropathies. The authors conclude that VFS is the optimal method for the diagnosis of neurogenic dysphagia.

  19. Oropharyngeal Dysphagia: neurogenic etiology and manifestation.

    Science.gov (United States)

    Sebastian, Swapna; Nair, Prem G; Thomas, Philip; Tyagi, Amit Kumar

    2015-03-01

    To determine the type, severity and manifestation of dysphagia in patients with neurogenic etiology. Clinical documentation was done on the different etiologies, its manifestation, assessment findings and management strategies taken for patients with neurogenic oropharyngeal dysphagia who were referred for assessment and management of dysphagia over a period of three months in a tertiary care teaching hospital. Flexible endoscopic examination was done in all the patients. The severity of dysphagia in these patients were graded based on Gugging Swallowing Screen (GUSS). A total of 53 patients with neurogenic oropharyngeal dysphagia were evaluated by an otolaryngologist and a speech language pathologist over a period of three months. The grading of severity based on GUSS for these patients were done. There were 30 patients with recurrent laryngeal nerve injury due to various etiologies, one patient with Neurofibroma-vestibular schwanoma who underwent surgical excision, 16 patients with stroke, two patients with traumatic brain injury, two patients with Parkinsonism and two patients with myasthenia gravis. The manifestation of dysphagia was mainly in the form of prolonged masticatory time, oral transit time, and increased number of swallows required for each bolus, cricopharyngeal spasms and aspiration. Among the dysphagia patients with neurogenic etiology, dysphagia is manifested with a gradual onset and is found to have a progressive course in degenerative disorders. Morbidity and mortality may be reduced with early identification and management of neurogenic dysphagia.

  20. The South African dysphagia screening tool (SADS: A screening tool for a developing context

    Directory of Open Access Journals (Sweden)

    Calli Ostrofsky

    2016-02-01

    Full Text Available Background: Notwithstanding its value, there are challenges and limitations to implementing a dysphagia screening tool from a developed contexts in a developing context. The need for a reliable and valid screening tool for dysphagia that considers context, systemic rules and resources was identified to prevent further medical compromise, optimise dysphagia prognosis and ultimately hasten patients’ return to home or work.Methodology: To establish the validity and reliability of the South African dysphagia screening tool (SADS for acute stroke patients accessing government hospital services. The study was a quantitative, non-experimental, correlational cross-sectional design with a retrospective component. Convenient sampling was used to recruit 18 speech-language therapists and 63 acute stroke patients from three South African government hospitals. The SADS consists of 20 test items and was administered by speech-language therapists. Screening was followed by a diagnostic dysphagia assessment. The administrator of the tool was not involved in completing the diagnostic assessment, to eliminate bias and prevent contamination of results from screener to diagnostic assessment. Sensitivity, validity and efficacy of the screening tool were evaluated against the results of the diagnostic dysphagia assessment. Cohen’s kappa measures determined inter-rater agreement between the results of the SADS and the diagnostic assessment.Results and conclusion: The SADS was proven to be valid and reliable. Cohen’s kappa indicated a high inter-rater reliability and showed high sensitivity and adequate specificity in detecting dysphagia amongst acute stroke patients who were at risk for dysphagia. The SADS was characterised by concurrent, content and face validity. As a first step in establishing contextual appropriateness, the SADS is a valid and reliable screening tool that is sensitive in identifying stroke patients at risk for dysphagia within government

  1. Clinical Variables Associated with Hydration Status in Acute Ischemic Stroke Patients with Dysphagia.

    Science.gov (United States)

    Crary, Michael A; Carnaby, Giselle D; Shabbir, Yasmeen; Miller, Leslie; Silliman, Scott

    2016-02-01

    Acute stroke patients with dysphagia are at increased risk for poor hydration. Dysphagia management practices may directly impact hydration status. This study examined clinical factors that might impact hydration status in acute ischemic stroke patients with dysphagia. A retrospective chart review was completed on 67 ischemic stroke patients who participated in a prior study of nutrition and hydration status during acute care. Prior results indicated that patients with dysphagia demonstrated elevated BUN/Cr compared to non-dysphagia cases during acute care and that BUN/Cr increased selectively in dysphagic patients. This chart review evaluated clinical variables potentially impacting hydration status: diuretics, parenteral fluids, tube feeding, oral diet, and nonoral (NPO) status. Exposure to any variable and number of days of exposure to each variable were examined. Dysphagia cases demonstrated significantly more NPO days, tube fed days, and parenteral fluid days, but not oral fed days, or days on diuretics. BUN/Cr values at discharge were not associated with NPO days, parenteral fluid days, oral fed days, or days on diuretics. Patients on modified solid diets had significantly higher mean BUN/Cr values at discharge (27.12 vs. 17.23) as did tube fed patients (28.94 vs. 18.66). No difference was noted between these subgroups at baseline (regular diet vs. modified solids diets). Any modification of solid diets (31.11 vs. 17.23) or thickened liquids (28.50 vs. 17.81) resulted in significantly elevated BUN/Cr values at discharge. Liquid or diet modifications prescribed for acute stroke patients with dysphagia may impair hydration status in these patients.

  2. Defining and Measuring Dysphagia Following Stroke

    Science.gov (United States)

    Daniels, Stephanie K.; Schroeder, Mae Fern; DeGeorge, Pamela C.; Corey, David M.; Foundas, Anne L.; Rosenbek, John C.

    2009-01-01

    Purpose: To continue the development of a quantified, standard method to differentiate individuals with stroke and dysphagia from individuals without dysphagia. Method: Videofluoroscopic swallowing studies (VFSS) were completed on a group of participants with acute stroke (n = 42) and healthy age-matched individuals (n = 25). Calibrated liquid…

  3. Dysphagia in children with repaired oesophageal atresia

    NARCIS (Netherlands)

    Coppens, C.H.; Engel-Hoek, L. van den; Scharbatke, H.E.; Groot, S.A. de; Draaisma, J.M.T.

    2016-01-01

    Dysphagia is a common problem in children with repaired oesophageal atresia (OA). Abnormalities in the oropharyngeal and oesophageal phase have hardly been studied. The aims of this study were to assess the prevalence of dysphagia in children with repaired OA and to identify and differentiate oral

  4. Identification of Glutaminyl Cyclase Genes Involved in Pyroglutamate Modification of Fungal Lignocellulolytic Enzymes

    Directory of Open Access Journals (Sweden)

    Vincent W. Wu

    2017-01-01

    Full Text Available The breakdown of plant biomass to simple sugars is essential for the production of second-generation biofuels and high-value bioproducts. Currently, enzymes produced from filamentous fungi are used for deconstructing plant cell wall polysaccharides into fermentable sugars for biorefinery applications. A post-translational N-terminal pyroglutamate modification observed in some of these enzymes occurs when N-terminal glutamine or glutamate is cyclized to form a five-membered ring. This modification has been shown to confer resistance to thermal denaturation for CBH-1 and EG-1 cellulases. In mammalian cells, the formation of pyroglutamate is catalyzed by glutaminyl cyclases. Using the model filamentous fungus Neurospora crassa, we identified two genes (qc-1 and qc-2 that encode proteins homologous to mammalian glutaminyl cyclases. We show that qc-1 and qc-2 are essential for catalyzing the formation of an N-terminal pyroglutamate on CBH-1 and GH5-1. CBH-1 and GH5-1 produced in a Δqc-1 Δqc-2 mutant, and thus lacking the N-terminal pyroglutamate modification, showed greater sensitivity to thermal denaturation, and for GH5-1, susceptibility to proteolytic cleavage. QC-1 and QC-2 are endoplasmic reticulum (ER-localized proteins. The pyroglutamate modification is predicted to occur in a number of additional fungal proteins that have diverse functions. The identification of glutaminyl cyclases in fungi may have implications for production of lignocellulolytic enzymes, heterologous expression, and biotechnological applications revolving around protein stability.

  5. Identification of Glutaminyl Cyclase Genes Involved in Pyroglutamate Modification of Fungal Lignocellulolytic Enzymes

    Science.gov (United States)

    Wu, Vincent W.; Dana, Craig M.; Iavarone, Anthony T.; Clark, Douglas S.

    2017-01-01

    ABSTRACT The breakdown of plant biomass to simple sugars is essential for the production of second-generation biofuels and high-value bioproducts. Currently, enzymes produced from filamentous fungi are used for deconstructing plant cell wall polysaccharides into fermentable sugars for biorefinery applications. A post-translational N-terminal pyroglutamate modification observed in some of these enzymes occurs when N-terminal glutamine or glutamate is cyclized to form a five-membered ring. This modification has been shown to confer resistance to thermal denaturation for CBH-1 and EG-1 cellulases. In mammalian cells, the formation of pyroglutamate is catalyzed by glutaminyl cyclases. Using the model filamentous fungus Neurospora crassa, we identified two genes (qc-1 and qc-2) that encode proteins homologous to mammalian glutaminyl cyclases. We show that qc-1 and qc-2 are essential for catalyzing the formation of an N-terminal pyroglutamate on CBH-1 and GH5-1. CBH-1 and GH5-1 produced in a Δqc-1 Δqc-2 mutant, and thus lacking the N-terminal pyroglutamate modification, showed greater sensitivity to thermal denaturation, and for GH5-1, susceptibility to proteolytic cleavage. QC-1 and QC-2 are endoplasmic reticulum (ER)-localized proteins. The pyroglutamate modification is predicted to occur in a number of additional fungal proteins that have diverse functions. The identification of glutaminyl cyclases in fungi may have implications for production of lignocellulolytic enzymes, heterologous expression, and biotechnological applications revolving around protein stability. PMID:28096492

  6. Impaired methylation modifications of FZD3 alter chromatin accessibility and are involved in congenital hydrocephalus pathogenesis.

    Science.gov (United States)

    Wang, Li; Shangguan, Shaofang; Chang, Shaoyan; Wang, Zhen; Lu, Xiaolin; Wu, Lihua; Li, Rui; Bao, Yihua; Qiu, Zhiyong; Niu, Bo; Zhang, Ting

    2014-06-20

    Congenital hydrocephalus is heterogeneous in its etiology, and in addition to a genetic component, has been shown to be caused by environmental factors. Until now, however, no methylation alterations of target genes have been connected with congenital hydrocephalus in humans. Frizzled 3(FZD3) is a planar cell polarity (PCP) gene required for PCP signaling. Partial restoration of frizzled 3 activities in FZD3 mutant mice results in hydrocephalus. To analyze the possible roles of epigenetic modifications of the FZD3 gene in congenital hydrocephalus pathogenesis, DNA methylation in the promoter region of FZD3 was assayed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Gene expression and chromatin accessibility were also determined to assess the role of methylation alterations. Our study found methylation levels of the FZD3 gene were increased in congenital hydrocephalus, especially in males (10.57 ± 3.90 vs. 7.08 ± 0.94, p=0.001). Hypermethylation of FZD3 increased congenital hydrocephalus risk, with an odds ratio of 10.125 (p=0.003). Aberrant methylation modification of FZD3 altered both chromatin structure in this region and FZD3 expression levels. Totally, aberrant methylation modification of the FZD3 gene increases the risk of congenital hydrocephalus by altering chromatin structure and disturbing gene expression.

  7. N-terminal modifications of cellular proteins: The enzymes involved, their substrate specificities and biological effects

    Science.gov (United States)

    Varland, Sylvia; Osberg, Camilla; Arnesen, Thomas

    2015-01-01

    The vast majority of eukaryotic proteins are N-terminally modified by one or more processing enzymes. Enzymes acting on the very first amino acid of a polypeptide include different peptidases, transferases, and ligases. Methionine aminopeptidases excise the initiator methionine leaving the nascent polypeptide with a newly exposed amino acid that may be further modified. N-terminal acetyl-, methyl-, myristoyl-, and palmitoyltransferases may attach an acetyl, methyl, myristoyl, or palmitoyl group, respectively, to the α-amino group of the target protein N-terminus. With the action of ubiquitin ligases, one or several ubiquitin molecules are transferred, and hence, constitute the N-terminal modification. Modifications at protein N-termini represent an important contribution to proteomic diversity and complexity, and are essential for protein regulation and cellular signaling. Consequently, dysregulation of the N-terminal modifying enzymes is implicated in human diseases. We here review the different protein N-terminal modifications occurring co- or post-translationally with emphasis on the responsible enzymes and their substrate specificities. PMID:25914051

  8. Posterior mediastinal melanoma causing severe dysphagia: A case report

    Directory of Open Access Journals (Sweden)

    Meacci Elisa

    2008-09-01

    Full Text Available Abstract Introduction We describe an original case of progressive severe dysphagia caused by a posterior mediastinal metastatic melanoma of unknown origin. To the best of our knowledge, such an event has never been described before in the literature. Case presentation A progressive severe dysphagia case is reported induced by a melanoma of unknown origin (metastatic to a posterior mediastinal lymph node. At the time of diagnosis, the lesion appeared as a large posterior mediastinal mass mimicking a neurogenic tumour with oesophageal involvement. After complete resection, pathological assessment of the tumour by immunohistochemistry was consistent with nodal metastatic melanoma. Conclusion This report of a posterior mediastinal lymph node melanoma is unique. The nodal origin is definitely unusual: a primary melanoma should always be carefully ruled out. In fact no other evidence, a part from the absence of the tumour elsewhere, can support the diagnosis of a primary nodal melanoma.

  9. Vocal Variability Post Swallowing in Individuals with and without Oropharyngeal Dysphagia

    Directory of Open Access Journals (Sweden)

    Santos, Karoline Weber dos

    2014-10-01

    Full Text Available Introduction Voice modification after swallowing may indicate changes in the transit of the bolus. Objective The aim of this study is to verify the use of perceptual voice analysis to detect oropharyngeal dysphagia. Study Design Case series. Methods Twenty-seven patients with dysphagia as diagnosed by videofluoroscopy and 25 without were evaluated. The sustained vowel /a/ was recorded before this exam and after swallowing different consistencies (pasty, liquid and solid. For the voice evaluation, the GRBAS scale (grade, roughness, breathiness, asthenia and strain and the parameter “wet voice” were used. Three judges blinded to study group and time of emission performed voice analysis. Results Individuals with dysphagia showed significant decrease in grade of voice and asthenia and increase in strain after swallowing pasty substances, differing from individuals without dysphagia who showed no modification of the parameters after swallowing. The wet voice parameter showed no difference after swallowing in both study groups. Conclusion The decrease in grade and asthenia and increased strain are indicative of a swallowing disorder, indicating increased vocal strain to clean the vocal tract of food. The modification of vocal production after swallowing proved to be a trusted resource for detection of swallowing disorders.

  10. Body mass-related modifications involved in starvation at pumpkinseed Lepomis gibbosus (Linnaeus, 1758 (Teleostei, Centrarchidae

    Directory of Open Access Journals (Sweden)

    Cătălina F. Radu

    2009-01-01

    Full Text Available The authors analyze the modifications observed on a population of pumpkinseed (Lepomis gibbosus (Linnaeus, 1758 after a 60 days period of exposure to starvation and attempt to correlate the obtained results to other body-related characteristics, either linearly-measured (such as length, volume and density or weight-related, in order to achieve an estimation of a weight-loss allowance for the species of interest, that may be interpreted, if of a low daily value, as an advantage in the invasion process.

  11. Dysphagia

    African Journals Online (AJOL)

    evaluations, treatments and rehabilitation options available to patients with ... control via the cortical and subcortical areas of the brain. Once sensory .... compensatory strategies. Contrary to ... Dysarthria. Speech .... Modify rate of delivery.

  12. Dysphagia

    Science.gov (United States)

    ... Wexler Medical Center ( 2/27/2017 ) The dyslexia paradox: Differences in how the brain adapts to sights ... gov More Info Follow us on Contact Us Privacy Accessibility Freedom of Information Act Website Policies Free ...

  13. Dose-volume-related dysphagia after constrictor muscles definition in head and neck cancer intensity-modulated radiation treatment.

    Science.gov (United States)

    Mazzola, R; Ricchetti, F; Fiorentino, A; Fersino, S; Giaj Levra, N; Naccarato, S; Sicignano, G; Albanese, S; Di Paola, G; Alterio, D; Ruggieri, R; Alongi, F

    2014-12-01

    Dysphagia remains a side effect influencing the quality of life of patients with head and neck cancer (HNC) after radiotherapy. We evaluated the relationship between planned dose involvement and acute and late dysphagia in patients with HNC treated with intensity-modulated radiation therapy (IMRT), after a recontouring of constrictor muscles (PCs) and the cricopharyngeal muscle (CM). Between December 2011 and December 2013, 56 patients with histologically proven HNC were treated with IMRT or volumetric-modulated arc therapy. The PCs and CM were recontoured. Correlations between acute and late toxicity and dosimetric parameters were evaluated. End points were analysed using univariate logistic regression. An increasing risk to develop acute dysphagia was observed when constraints to the middle PCs were not respected [mean dose (Dmean) ≥50 Gy, maximum dose (Dmax) >60 Gy, V50 >70% with a p = 0.05]. The superior PC was not correlated with acute toxicity but only with late dysphagia. The inferior PC was not correlated with dysphagia; for the CM only, Dmax >60 Gy was correlated with acute dysphagia ≥ grade 2. According to our analysis, the superior PC has a major role, being correlated with dysphagia at 3 and 6 months after treatments; the middle PC maintains this correlation only at 3 months from the beginning of radiotherapy, but it does not have influence on late dysphagia. The inferior PC and CM have a minimum impact on swallowing symptoms. We used recent guidelines to define dose constraints of the PCs and CM. Two results emerge in the present analysis: the superior PC influences late dysphagia, while the middle PC influences acute dysphagia.

  14. Neurogenic [corrected] and oropharyngeal dysphagia.

    Science.gov (United States)

    Rofes, Laia; Clavé, Pere; Ouyang, Ann; Scharitzer, Martina; Pokieser, Peter; Vilardell, Natalia; Ortega, Omar

    2013-10-01

    Oropharyngeal dysphagia (OD) is a swallowing disorder caused by congenital abnormalities and structural damage and disease-associated damage of the oral cavity, pharynx, and upper esophageal sphincter. Patients with OD lack the protective mechanisms necessary for effective swallowing, exhibiting difficulty controlling food in the mouth and initiating a swallow, leading to choking, coughing, and nasal regurgitation. OD is a major risk factor for malnutrition, dehydration, and aspiration pneumonia. The following on OD includes commentaries on the application of simulation of oropharyngeal transient receptor potential vanilloid 1 (TRPV1) and maneuvers like the Shaker exercise to improve the safety and efficacy of swallow in OD patients; the prevalence of esophageal pathologies in OD patients and the need to evaluate the esophagus, esophagogastric junction, and stomach; and strategies for clinical screening to detect OD and aspiration among high-risk patients and to improve oral health care, maintain nutrition and hydration, and prevent aspiration pneumonia. © 2013 New York Academy of Sciences.

  15. Dysphagia in the elderly stroke patient.

    Science.gov (United States)

    Lugger, K E

    1994-04-01

    Of all strokes 75% occur in people over age 65, and the incidence of stroke rises with age. Because swallowing problems often result, the elderly stroke patient is at risk for dysphagia and its complications. Acute and chronic swallowing problems are associated with many complications including dehydration, malnutrition, aspiration, pneumonitis, depression and even death. These complications make swallowing problems in the aged stroke patient an important focus for nursing attention. Nurses must be aware of the complexity of normal swallowing mechanisms, knowledgeable about the aged stroke patient's risk for dysphagia, aware of the importance of early detection and treatment of dysphagia and confident about their role in dysphagia assessment and treatment regimen. This information can be used in the assessment, treatment and rehabilitation of the elderly dysphagic stroke patient.

  16. Feeding and Swallowing Disorders (Dysphagia) in Children

    Science.gov (United States)

    ... for the Public / Speech, Language and Swallowing / Swallowing Feeding and Swallowing Disorders (Dysphagia) in Children What are ... children with feeding and swallowing disorders ? What are feeding and swallowing disorders? Feeding disorders include problems gathering ...

  17. [Dysphagia: Forestier and Rotes Querol disease].

    Science.gov (United States)

    Cruz-Ruiz, M A; López-Saúz, M; Padierna-Luna, J L; García-Pescador, D; Franco-Grande, M A; Núñez-Sánchez, A

    2008-01-01

    Inside of the study of Dysphagia, until 38% of the greater patients of 50 years, they present/display cervical Osteophytes like cause of Dysphagia; frequently I diagnose passes for the methods of radiology and endoscopy unnoticed. The disease of Forestier and Rotes better well known Querol or like skeletal hiperostosis diffuse idiophatic it is characterized by the formation of spinal and cervical Osteophytes, ossification of ligaments and muscles for vetebrates of the cervical column. Frequently it produces affectation to medullar that it can pronounce like Dysphagia and crosstalk. We presented/displayed the case of a patient of 78 years with chronic pneumopathy, that presents/displays Dysphagia and progressive crosstalk with pondered loss, in where radiology of the cervical column they show cervical osteofitos with espondilolistesis, rectification of the cervical lordosis and diminution of the intersomatic spaces that they compress the trachea and column of air and an extrinsic compression below the cricopharyngeal is documented by endoscopy.

  18. Glycosyltransferases:key players involved in the modification of plant secondary metabolites

    Institute of Scientific and Technical Information of China (English)

    Jun WANG; Bingkai HOU

    2009-01-01

    Glycosyltransferases are members of the multigene superfamily in plants that can transfer single or multiple activated sugars to a range of plant molecules,resulting in the glycosylation of plant compounds.Although the activities of many glycosyltransferases and their products have been recognized for a long time,only in recent years were some glycosyltransferase genes identified and a few functionally characterized in detail.Glycosylation is thought to be one of the most important modification reactions towards plant secondary metabolites,and plays a key role in maintaining cell homeostasis,thus likely participating in the regulation of plant growth,development and in defense responses to stress environments.With advances in plant genome projects and the development of novel technologies in analyzing gene function,significant progress could be made in gaining new insights into the properties and precise biological roles of plant secondary product glycosyltransferases,and the new knowledge will have extensive application prospects in the catalytic synthesis of glycoconjugates and metabolic engineering of crops.In this review,we summarize the current research,highlighting the possible biological roles,of plant secondary metabolite glycosyltransferases and discuss their potential applications as well as aspects to be further studied in the near future.

  19. Spiroketal formation and modification in avermectin biosynthesis involves a dual activity of AveC.

    Science.gov (United States)

    Sun, Peng; Zhao, Qunfei; Yu, Futao; Zhang, Hua; Wu, Zhuhua; Wang, Yinyan; Wang, Yan; Zhang, Qinglin; Liu, Wen

    2013-01-30

    Avermectins (AVEs), which are widely used for the treatment of agricultural parasitic diseases, belong to a family of 6,6-spiroketal moiety-containing, macrolide natural products. AVE biosynthesis is known to employ a type I polyketide synthase (PKS) system to assemble the molecular skeleton for further functionalization. It remains unknown how and when spiroketal formation proceeds, particularly regarding the role of AveC, a unique protein in the pathway that shares no sequence homology to any enzyme of known function. Here, we report the unprecedented, dual function of AveC by correlating its activity with spiroketal formation and modification during the AVE biosynthetic process. The findings in this study were supported by characterizing extremely unstable intermediates, products and their spontaneous derivative products from the simplified chemical profile and by comparative analysis of in vitro biotransformations and in vivo complementations mediated by AveC and MeiC (the counterpart in biosynthesizing the naturally occurring, AVE-like meilingmycins). AveC catalyzes the stereospecific spiroketalization of a dihydroxy-ketone polyketide intermediate and the optional dehydration to determine the regiospecific saturation characteristics of spiroketal diversity. These reactions take place between the closures of the hexene ring and 16-membered macrolide and the formation of the hexahydrobenzofuran unit. MeiC can replace the spirocyclase activity of AveC, but it lacks the independent dehydratase activity. Elucidation of the generality and specificity of AveC-type proteins allows for the rationalization of previously published results that were not completely understood, suggesting that enzyme-mediated spiroketal formation was initially underestimated, but is, in fact, widespread in nature for the control of stereoselectivity.

  20. Histone Modification Is Involved in Okadaic Acid (OA Induced DNA Damage Response and G2-M Transition Arrest in Maize.

    Directory of Open Access Journals (Sweden)

    Hao Zhang

    Full Text Available Histone modifications are involved in regulation of chromatin structure. To investigate the relationship between chromatin modification and cell cycle regulation during plant cell proliferation, Okadaic acid (OA, a specific inhibitor of serine/threonine protein phosphatase, was applied in this study. The results showed that OA caused the cell cycle arrest at preprophase, leading to seedling growth inhibition. Western blotting assay revealed that the spatial distribution of phosphorylation of Ser10 histone H3 tails (H3S10ph signals was altered under OA treatment. Reactive oxygen species (ROS was found to be at higher levels and TdT-mediated dUTP nick end labeling (TUNEL assay displayed DNA breaks happened at the chromatin after treatment with OA, companied with an increase in the acetylation of histone H4 at lysine 5 (H4K5ac level. From these observations, we speculated that the alteration of the spatial distribution of H3S10ph and the level of H4K5ac was involved in the procedure that OA induced DNA breaks and G2-M arrested by the accumulation of ROS, and that the histone H3S10ph and H4K5ac might facilitate DNA repair by their association with the chromatin decondensation.

  1. Prediction of novel families of enzymes involved in oxidative and other complex modifications of bases in nucleic acids.

    Science.gov (United States)

    Iyer, Lakshminarayan M; Tahiliani, Mamta; Rao, Anjana; Aravind, L

    2009-06-01

    Modified bases in nucleic acids present a layer of information that directs biological function over and beyond the coding capacity of the conventional bases. While a large number of modified bases have been identified, many of the enzymes generating them still remain to be discovered. Recently, members of the 2-oxoglutarate- and iron(II)-dependent dioxygenase super-family, which modify diverse substrates from small molecules to biopolymers, were predicted and subsequently confirmed to catalyze oxidative modification of bases in nucleic acids. Of these, two distinct families, namely the AlkB and the kinetoplastid base J binding proteins (JBP) catalyze in situ hydroxylation of bases in nucleic acids. Using sensitive computational analysis of sequences, structures and contextual information from genomic structure and protein domain architectures, we report five distinct families of 2-oxoglutarate- and iron(II)-dependent dioxygenase that we predict to be involved in nucleic acid modifications. Among the DNA-modifying families, we show that the dioxygenase domains of the kinetoplastid base J-binding proteins belong to a larger family that includes the Tet proteins, prototyped by the human oncogene Tet1, and proteins from basidiomycete fungi, chlorophyte algae, heterolobosean amoeboflagellates and bacteriophages. We present evidence that some of these proteins are likely to be involved in oxidative modification of the 5-methyl group of cytosine leading to the formation of 5-hydroxymethylcytosine. The Tet/JBP homologs from basidiomycete fungi such as Laccaria and Coprinopsis show large lineage-specific expansions and a tight linkage with genes encoding a novel and distinct family of predicted transposases, and a member of the Maelstrom-like HMG family. We propose that these fungal members are part of a mobile transposon. To the best of our knowledge, this is the first report of a eukaryotic transposable element that encodes its own DNA-modification enzyme with a

  2. Recovery from Dysphagia Symptoms after Oral Endotracheal Intubation in Acute Respiratory Distress Syndrome Survivors. A 5-Year Longitudinal Study.

    Science.gov (United States)

    Brodsky, Martin B; Huang, Minxuan; Shanholtz, Carl; Mendez-Tellez, Pedro A; Palmer, Jeffrey B; Colantuoni, Elizabeth; Needham, Dale M

    2017-03-01

    Nearly 60% of patients who are intubated in intensive care units (ICUs) experience dysphagia after extubation, and approximately 50% of them aspirate. Little is known about dysphagia recovery time after patients are discharged from the hospital. To determine factors associated with recovery from dysphagia symptoms after hospital discharge for acute respiratory distress syndrome (ARDS) survivors who received oral intubation with mechanical ventilation. This is a prospective, 5-year longitudinal cohort study involving 13 ICUs at four teaching hospitals in Baltimore, Maryland. The Sydney Swallowing Questionnaire (SSQ), a 17-item visual analog scale (range, 0-1,700), was used to quantify patient-perceived dysphagia symptoms at hospital discharge, and at 3, 6, 12, 24, 36, 48, and 60 months after ARDS. An SSQ score greater than or equal to 200 was used to indicate clinically important dysphagia symptoms at the time of hospital discharge. Recovery was defined as an SSQ score less than 200, with a decrease from hospital discharge greater than or equal to 119, the reliable change index for SSQ score. Fine and Gray proportional subdistribution hazards regression analysis was used to evaluate patient and ICU variables associated with time to recovery accounting for the competing risk of death. Thirty-seven (32%) of 115 patients had an SSQ score greater than or equal to 200 at hospital discharge; 3 died before recovery. All 34 remaining survivors recovered from dysphagia symptoms by 5-year follow-up, 7 (23%) after 6 months. ICU length of stay was independently associated with time to recovery, with a hazard ratio (95% confidence interval) of 0.96 (0.93-1.00) per day. One-third of orally intubated ARDS survivors have dysphagia symptoms that persist beyond hospital discharge. Patients with a longer ICU length of stay have slower recovery from dysphagia symptoms and should be carefully considered for swallowing assessment to help prevent complications related to dysphagia.

  3. Methylated H3K4, a transcription-associated histone modification, is involved in the DNA damage response pathway.

    Science.gov (United States)

    Faucher, David; Wellinger, Raymund J

    2010-08-26

    Eukaryotic genomes are associated with a number of proteins such as histones that constitute chromatin. Post-translational histone modifications are associated with regulatory aspects executed by chromatin and all transactions on genomic DNA are dependent on them. Thus, it will be relevant to understand how histone modifications affect genome functions. Here we show that the mono ubiquitylation of histone H2B and the tri-methylation of histone H3 on lysine 4 (H3K4me3), both known for their involvement in transcription, are also important for a proper response of budding yeast cells to DNA damaging agents and the passage through S-phase. Cells that cannot methylate H3K4 display a defect in double-strand break (DSB) repair by non-homologous end joining. Furthermore, if such cells incur DNA damage or encounter a stress during replication, they very rapidly lose viability, underscoring the functional importance of the modification. Remarkably, the Set1p methyltransferase as well as the H3K4me3 mark become detectable on a newly created DSB. This recruitment of Set1p to the DSB is dependent on the presence of the RSC complex, arguing for a contribution in the ensuing DNA damage repair process. Taken together, our results demonstrate that Set1p and its substrate H3K4me3, which has been reported to be important for the transcription of active genes, also plays an important role in genome stability of yeast cells. Given the high degree of conservation for the methyltransferase and the histone mark in a broad variety of organisms, these results could have similar implications for genome stability mechanisms in vertebrate and mammalian cells.

  4. Methylated H3K4, a transcription-associated histone modification, is involved in the DNA damage response pathway.

    Directory of Open Access Journals (Sweden)

    David Faucher

    2010-08-01

    Full Text Available Eukaryotic genomes are associated with a number of proteins such as histones that constitute chromatin. Post-translational histone modifications are associated with regulatory aspects executed by chromatin and all transactions on genomic DNA are dependent on them. Thus, it will be relevant to understand how histone modifications affect genome functions. Here we show that the mono ubiquitylation of histone H2B and the tri-methylation of histone H3 on lysine 4 (H3K4me3, both known for their involvement in transcription, are also important for a proper response of budding yeast cells to DNA damaging agents and the passage through S-phase. Cells that cannot methylate H3K4 display a defect in double-strand break (DSB repair by non-homologous end joining. Furthermore, if such cells incur DNA damage or encounter a stress during replication, they very rapidly lose viability, underscoring the functional importance of the modification. Remarkably, the Set1p methyltransferase as well as the H3K4me3 mark become detectable on a newly created DSB. This recruitment of Set1p to the DSB is dependent on the presence of the RSC complex, arguing for a contribution in the ensuing DNA damage repair process. Taken together, our results demonstrate that Set1p and its substrate H3K4me3, which has been reported to be important for the transcription of active genes, also plays an important role in genome stability of yeast cells. Given the high degree of conservation for the methyltransferase and the histone mark in a broad variety of organisms, these results could have similar implications for genome stability mechanisms in vertebrate and mammalian cells.

  5. Rehabilitation of neurogenic dysphagia with percutaneous endoscopic gastrostomy.

    Science.gov (United States)

    Klor, B M; Milianti, F J

    1999-01-01

    Neurogenic oropharyngeal dysphagia is common in nursing home populations, and the risk of aspiration is sufficient to indicate the need for percutaneous endoscopid gastrostomy (PEG) feedings. Although intake provided through the PEG may meet the nutritional and hydration requirements for this group of patients, the risk of complication, e.g., aspiration of reflux, skin breakdown at the site of insertion, potential for infection, digestive difficulties, higher risk of rehospitalization, pneumonia, prolonged nursing home stay, and greater morbidity than for those without PEG tubes, may compromise the gains accrued from the ease of feeding. In an attempt to reduce these complications and return individuals to per orum (PO) diets, a program was developed to treat the dysphagia. Sixteen male nursing home patients were enrolled in a treatment program based on videofluoroscopic examination. Interventions included combinations of dietary consistency modifications, compensatory techniques, and direct swallow retraining. Results indicated such an approach reintroduced successful oral feeding in all patients, improved dietary consistency, resulted in a mean weight gain of 5.1 pounds, yielded a mean albumin increase of 0.5 g/dl, and allowed PEG tubes to be removed in 10 of the 16 patients. As a result of intervention, these findings suggest significant benefits in both quality of life issues and health care savings for this neurogenically based population.

  6. [Medication-induced dysphagia : A review].

    Science.gov (United States)

    Schwemmle, C; Jungheim, M; Miller, S; Kühn, D; Ptok, M

    2015-07-01

    As a highly differentiated physiological process, swallowing may be affected by a variety of confounding factors. Primarily described are swallowing disorders caused by mechanical anatomic changes (e. g., alteration of the cervical spine, goiter), surgery for head and neck tumors, thyroid abnormalities, and neuromuscular disorders. Age-related cerebral neurological and blood vessel-associated changes can also cause dysphagia (so-called presbyphagia) or worsen the condition.Medication-associated dysphagia is recognized far less frequently, not paid due attention, or accepted in silence; particularly in older patients. Furthermore, pharmacological interference of different medications is frequently inadequately considered, particularly in the case of polypharmacy.Initial treatment of medication-induced dysphagia includes a critical review of medication status, with the aim of reducing/discontinuing the causative medication by giving precise instructions regarding its administration; as well as antacid medication, diet, and professional oral stimulation or swallowing training.To date, medication-induced dysphagia has not occupied the focus of physicians and therapists. This is despite the fact that many active agents can have a negative effect on swallowing and medication-induced dysphagia caused by polypharmacy is not uncommon, particularly in old age. This article presents an overview of the different classes of drugs in terms of their direct or indirect negative effects on the swallowing function.

  7. Refractory myasthenia gravis, dysphagia and malnutrition: a case report to suggest disease-specific nutritional issues.

    Science.gov (United States)

    Cereda, Emanuele; Beltramolli, Dario; Pedrolli, Carlo; Costa, Antonio

    2009-10-01

    We describe a case of refractory myasthenia gravis with bulbar involvement and the nutritional treatment solutions proposed to treat the associated dysphagia and malnutrition. A 39-y-old woman with refractory myasthenia gravis was referred to our clinical nutrition unit for deteriorating dysphagia and progressive malnutrition. The first-line nutritional approach consisted of dietary counseling and thickened meals. Unfortunately, no adequate oral intake was achieved and an enteral nutrition treatment was proposed. A nasogastric tube was removed after a few days due to local pain and poor quality of life. Despite consistent weight loss and overt malnutrition, the patient refused percutaneous endoscopic gastrostomy placement. Neurologic symptoms did not show any improvement but unexpectedly the patient's weight started to increase to previous values. Anamnestic recall revealed that the patient learned by herself how to position the nasogastric tube that is now temporarily used for formula infusion coinciding with neurologic poussés. Current guidelines consider chronic neurologic diseases with associated dysphagia, where refractory myesthania gravis has also been considered, a unique category. Chronic neurogenic dysphagia with high risk of aspiration, long-term inability to obtain adequate oral intakes, and malnutrition are established indications for percutaneous endoscopic gastrostomy placement. However, patients may need different forms of nutritional intervention during the course of their illness and choices and indications should contemplate ethical reasons, clinical benefits, minimal risks, and acceptable quality of life. Minimally invasive intermittent enteral nutrition might be considered a possible clue for nutritional management of exacerbating dysphagia.

  8. Clinical and electrophysiological evaluation of dysphagia in myasthenia gravis

    OpenAIRE

    1998-01-01

    OBJECTIVE—To evaluate dysphagia at the oropharyngeal stage of swallowing and to determine the pathophysiological mechanisms of dysphagia in patients with myasthenia gravis.
METHODS—Fifteen patients with myasthenia gravis with dysphagia and 10 patients without dysphagia were investigated by a combined electrophysiological and mechanical method described previously. Laryngeal movements were detected by a piezoelectric transducer and the related submental EMG (SM-EMG) and somet...

  9. [Efficacy of rehabilitation in oropharyngeal dysphagia].

    Science.gov (United States)

    Silva, Roberta Gonçalves da

    2007-01-01

    efficacy of rehabilitation in oropharyngeal dysphagia. In our country the practice of speech-language pathology in oropharyngeal dysphagia has increased significantly and, at this moment, deserves attention since practice needs to be based on scientific evidence. Therapeutic techniques and the outcome of rehabilitation in oropharyngeal dysphagia have been studied since the 70s, reaching its high point during the 80s and 90s. Few studies have investigated the efficacy of therapy in the rehabilitation of oropharyngeal dysphagia, the vast majority have tried to prove the effects of therapy on the dynamics of swallowing. In Brazil, the studies about oropharyngeal dysphagia have, in great part, investigated assessment procedures, and only a few have worried about rehabilitation. to present a critical analysis about the efficacy of rehabilitation in oropharyngeal dysphagia. this review of the literature indicates that non-randomized studies have compromised the results, once the casuistic of the researches are very heterogeneous--they include neurogenic and mechanical oropharyngeal dyshagia caused by different etiologies. Besides that, therapeutic programs which are used are not sufficiently described, compromising the reproduction of the methodology by other researchers. These results suggest the need for more randomized studies, which can be initially developed as case studies in order to exclude the control variables of therapy efficacy. Another suggestion is, as proposed by present researches, to use scales that can measure the impact of swallowing training in the nutritional and pulmonary condition of dysphagic patients. An important research area, related to the control of therapeutic efficacy and efficiency, are the studies that aim to establish the decrease in hospital and home care costs as a consequence of speech-language intervention with patients with oropharyngeal dyspahgia.

  10. Assessment of Pediatric Dysphagia and Feeding Disorders: Clinical and Instrumental Approaches

    Science.gov (United States)

    Arvedson, Joan C.

    2008-01-01

    Assessment of infants and children with dysphagia (swallowing problems) and feeding disorders involves significantly more considerations than a clinical observation of a feeding. In addition to the status of feeding in the child, considerations include health status, broad environment, parent-child interactions, and parental concerns.…

  11. Diagnostic value of "dysphagia limit" for neurogenic dysphagia: 17 years of experience in 1278 adults.

    Science.gov (United States)

    Aydogdu, Ibrahim; Kiylioglu, Nefati; Tarlaci, Sultan; Tanriverdi, Zeynep; Alpaydin, Sezin; Acarer, Ahmet; Baysal, Leyla; Arpaci, Esra; Yuceyar, Nur; Secil, Yaprak; Ozdemirkiran, Tolga; Ertekin, Cumhur

    2015-03-01

    Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up are critical for early diagnosis and management which can mitigate its complications and be cost-saving. The aims of this study are to provide a comprehensive investigation of the dysphagia limit (DL) in a large diverse cohort and to provide a longitudinal assessment of dysphagia in a subset of subjects. We developed a quantitative and noninvasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. DL is the volume at which second or more swallows become necessary to swallow the whole amount of bolus. This study represents 17 years experience with the DL approach in assessing ND in a cohort of 1278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia, and 202 patients without dysphagia. A total of 192 of all patients were also reevaluated longitudinally over a period of 1-19 months. DL has 92% sensitivity, 91% specificity, 94% positive predictive value, and 88% negative predictive value with an accuracy of 0.92. Patients with ALS, stroke, and movement disorders have the highest sensitivity (85-97%) and positive predictive value (90-99%). The clinical severity of dysphagia has significant negative correlation with DL (r=-0.67, pdysphagia and it can be performed in an EMG laboratory. Our study provides specific quantitative features of DL test that can be readily utilized by the neurologic community and nominates DL as an objective and robust method to evaluate dysphagia in a wide range of neurologic conditions. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  12. The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study.

    Science.gov (United States)

    Malandraki, Georgia A; Rajappa, Akila; Kantarcigil, Cagla; Wagner, Elise; Ivey, Chandra; Youse, Kathleen

    2016-04-01

    To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia. Intervention study; before-after trial with 4-week follow-up through an online survey. Outpatient university clinics. A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study. Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45 min/d. Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey). The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (PDysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. Altered resting-state functional and white matter tract connectivity in stroke patients with dysphagia.

    Science.gov (United States)

    Li, Shasha; Ma, Zhenxing; Tu, Shipeng; Zhou, Muke; Chen, Sihan; Guo, Zhiwei; Gong, Qiyong; He, Li; Huang, Xiaoqi; Yao, Dezhong; Lui, Su; Yu, Bo; Wang, Xiaotong; Zhou, Dong; He, Chengqi

    2014-01-01

    Swallowing dysfunction is intractable after acute stroke. Our understanding of the alterations in neural networks of patients with neurogenic dysphagia is still developing. The aim was to investigate cerebral cortical functional connectivity and subcortical structural connectivity related to swallowing in unilateral hemispheric stroke patients with dysphagia. We combined a resting-state functional connectivity with a white matter tract connectivity approach, recording 12 hemispheric stroke patients with dysphagia, 12 hemispheric stroke patients without dysphagia, and 12 healthy controls. Comparisons of the patterns in swallowing-related functional connectivity maps between patient groups and control subjects included (a) seed-based functional connectivity maps calculated from the primary motor cortex (M1) and the supplementary motor area (SMA) to the entire brain, (b) a swallowing-related functional connectivity network calculated among 20 specific regions of interest (ROIs), and (c) structural connectivity described by the mean fractional anisotropy of fibers bound through the SMA and M1. Stroke patients with dysphagia exhibited dysfunctional connectivity mainly in the sensorimotor-insula-putamen circuits based on seed-based analysis of the left and right M1 and SMA and decreased connectivity in the bilateral swallowing-related ROIs functional connectivity network. Additionally, white matter tract connectivity analysis revealed that the mean fractional anisotropy of the white matter tract was significantly reduced, especially in the left-to-right SMA and in the corticospinal tract. Our results indicate that dysphagia secondary to stroke is associated with disruptive functional and structural integrity in the large-scale brain networks involved in motor control, thus providing new insights into the neural remodeling associated with this disorder.

  14. Palliation of Dysphagia from Esophageal Cancer

    NARCIS (Netherlands)

    M.Y.V. Homs (Marjolein)

    2004-01-01

    textabstractThe prognosis of esophageal cancer is poor with a 5-year survival of 10-15%. In addition, over 50% of patients with esophageal cancer already have an inoperable disease at presentation. The majority of these patients require palliative treatment to relieve progressive dysphagia. Metal

  15. The Neurobiology of Swallowing and Dysphagia

    Science.gov (United States)

    Miller, Arthur J.

    2008-01-01

    The neurobiological study of swallowing and its dysfunction, defined as dysphagia, has evolved over two centuries beginning with electrical stimulation applied directly to the central nervous system, and then followed by systematic investigations that have used lesioning, transmagnetic stimulation, magnetoencephalography, and functional magnetic…

  16. The Neurobiology of Swallowing and Dysphagia

    Science.gov (United States)

    Miller, Arthur J.

    2008-01-01

    The neurobiological study of swallowing and its dysfunction, defined as dysphagia, has evolved over two centuries beginning with electrical stimulation applied directly to the central nervous system, and then followed by systematic investigations that have used lesioning, transmagnetic stimulation, magnetoencephalography, and functional magnetic…

  17. Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention: a review and summary of an international expert meeting

    Science.gov (United States)

    Wirth, Rainer; Dziewas, Rainer; Beck, Anne Marie; Clavé, Pere; Hamdy, Shaheen; Heppner, Hans Juergen; Langmore, Susan; Leischker, Andreas Herbert; Martino, Rosemary; Pluschinski, Petra; Rösler, Alexander; Shaker, Reza; Warnecke, Tobias; Sieber, Cornel Christian; Volkert, Dorothee

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies. PMID:26966356

  18. Oropharyngeal dysphagia in older persons - from pathophysiology to adequate intervention: a review and summary of an international expert meeting.

    Science.gov (United States)

    Wirth, Rainer; Dziewas, Rainer; Beck, Anne Marie; Clavé, Pere; Hamdy, Shaheen; Heppner, Hans Juergen; Langmore, Susan; Leischker, Andreas Herbert; Martino, Rosemary; Pluschinski, Petra; Rösler, Alexander; Shaker, Reza; Warnecke, Tobias; Sieber, Cornel Christian; Volkert, Dorothee

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation of swallowing is increasingly utilized because it has several advantages. Besides making a diagnosis, fiberoptic endoscopic evaluation of swallowing is applied to evaluate the effectiveness of therapeutic maneuvers and texture modification of food and liquids. In addition to swallowing training and nutritional interventions, newer rehabilitation approaches of stimulation techniques are showing promise and may significantly impact future treatment strategies.

  19. Guided implant surgery with modification of the technique involving the raising of a semicircular miniflap: a preliminary study.

    Science.gov (United States)

    Peñarrocha, María; Viña, José; Maestre, Laura; Peñarrocha, David; Balaguer, José

    2012-09-01

    An evaluation is made of pain, swelling and peri-implant attached mucosal width after implant-based rehabilitation involving guided surgery and a modification of the technique with the raising of a semicircular miniflap, in single and partial replacements. A case-control study was carried out. The study group consisted of 12 patients with the placement of 19 implants using a guided surgery and miniflap technique. The control group consisted of 12 patients with the placement of 22 implants using the conventional technique. Each patient scored postoperative swelling and pain by means of a visual analog scale (VAS). Attached vestibular mucosa width was evaluated 12 weeks after implant placement. Twelve operations were carried out in each group. Immediate aesthetics were established for all implants of the study group. One implant failed in each group. Maximum pain was recorded after 6 hours in both groups (mean VAS score 4 and 4.9 in the study and control group, respectively). Maximum swelling was recorded after 24 hours (mean VAS score 2.5) in the study group and on the second day (mean VAS score 3.4) in the control group. The mean attached vestibular mucosa width was 2.9 mm in the study group and 3.2 mm in the control group. In this preliminary study, guided implant surgery with a semicircular miniflap in single and partial replacements resulted in slightly less postoperative pain and swelling than with the conventional implant technique. The attached vestibular mucosa width was greater in the control group, though the differences were very small.

  20. Management of oropharyngeal neurogenic dysphagia in adults.

    Science.gov (United States)

    Miles, Anna; Allen, Jacqui E

    2015-12-01

    This article reviews recent literature in the management of neurogenic oropharyngeal dysphagia (OPD) including assessment processes and treatments, with a specific focus on OPD as a result of stroke and Parkinson's disease. A large number of high-quality systematic reviews were published that provide an excellent summary of current evidence across assessment and treatment of swallowing disorders. There is building interest and knowledge in technology in both the understanding and treatment of OPD including functional MRI, manometry, and noninvasive brain stimulation. Neurologic disorders demonstrate a high prevalence of OPD resulting in significant decrement to health and healthcare costs. Novel technologies were reported in assessment and tracking of dysphagia as well as emerging innovative therapeutic options.

  1. [Neurogenic dysphagia: physiology, physiopathology and rehabilitative treatment].

    Science.gov (United States)

    Patti, F; Emmi, N; Restivo, D A; Liberto, A; Pappalardo, A; Torre, L M; Reggio, A

    2002-01-01

    Swallowing is both a voluntary than a reflex function. It consist in transporting feeding from mouth to the stomach. Swallowing function occurs with very frequency during the day and needs complex neuromuscular coordination. Several neurologic diseases determine swallowing disorders. Dysphagia, is the difficulty in swallowing. In slight disorders, swallowing function is sufficiently compensated, symptoms are few or absent. Sometimes the patient is able to compensate and obtains a safe deglutition. Rehabilitation of swallowing disorders is based on the assessment of all symptoms and troubles causing dysphagia and on the improvement of the specific disabilities. Rehabilitation is aimed to make patient able for a safe oral feeding. We can use classic specific physiotherapy, compensatory movements of head and neck, electrostimulation, and the chemical myotomia by botulinum toxin injection.

  2. Dysphagia in patients with cerebrovascular disease. Update.

    Directory of Open Access Journals (Sweden)

    Amarilis Barbié Rubiera

    2009-03-01

    Full Text Available An important number of patients with cerebrovascular disease also present dysphagia as a result of damage in cerebral hemispheres or brainstem, which contributes to negative morbility and functional rehabilitation prognosis due to the complications liked with this condition. It is a significant cause of nutritional dysfunctions, including increased in-hospital undernourishment, increased per patient expenditure and longer in-hospital stay. One of the objectives of the Nutritional Support Team of the Neuroscience and Neurology Institute is to reduce undernourishment causes in patients with neurological diseases. A wide review of the subject was performed including experts´ opinions, from the above mentioned institutions, in order to gather an updated report related with the significance of early diagnosis of dysphagia in patients with ictus and the opportune and correct use of therapeutic measures to reduce complication risk.

  3. Mesothelioma - A rare cause of dysphagia

    Directory of Open Access Journals (Sweden)

    Vishwanathan Swati

    2016-08-01

    Full Text Available A 81-year-old elderly Caucasian male presented with progressive dysphagia and unintentional weight loss over four months. His history was significant for asbestos exposure; however there was no history of asbestos related lung disease. Barium swallow showed achalasia and a subsequent CT chest showed a posterior mediastinal mass 11.8×9.1×5.8cm, compressing the distal oesophagus. Laparoscopic biopsy of the mass showed an epitheloid mesothelioma. Mass was deemed unresectable and patient was started on chemotherapy with Cisplatin/Pemetrexed. Localised mesothelioma is extremely rare, and dysphagia can be uncommon presenting feature. 7.4 per cent of cases of Pseudoachalasia are attributed to mesothelioma

  4. Pemphigus vulgaris: a rare cause of dysphagia.

    Science.gov (United States)

    Al-Janabi, Ali; Greenfield, Simon

    2015-10-22

    Pemphigus vulgaris is a rare autoimmune blistering disease of the skin and mucous membranes. The case reported presented unusually with dyspepsia that was not responsive to protein pump inhibitor (PPI) therapy. This progressed to severe dysphagia and odynophagia. An esophagogastroduodenoscopy showed extensive ulceration of the esophagus, and direct immunofluorescence of an esophageal biopsy showed bright intercellular staining with C3 and IgG, confirming the diagnosis of pemphigus vulgaris. Immunological remission was achieved after a number of courses of pulsed intravenous methylprednisolone and cyclophosphamide. The patient has remained in remission for 5 years, but has required regular dilation of esophageal strictures for symptom relief. During this period, a chronic lymphocytosis was incidentally noted on routine blood tests, and chronic lymphocytic leukaemia was diagnosed. It is essential to investigate PPI-resistant symptoms, dysphagia and odynophagia, as they may indicate a serious underlying cause.

  5. Thyrotoxic Dysphagia in an 82-Year-Old Male

    Directory of Open Access Journals (Sweden)

    Konstantinos Parperis

    2011-01-01

    Full Text Available Dysphagia is a common problem in elderly patients and a rare manifestation of Graves' disease. We report a case of an 82-year-old male who presented with a 4-week history of dysphagia and weight loss. Workup for his dysphagia with upper endoscopy, MRI brain, electromyography, acetyl-cholinesterase receptor antibodies, and voltage-gated calcium channel antibodies were negative. Modified Barium swallow test showed oropharyngeal dysphagia. Thyroid function tests that revealed hyperthyroidism and antibodies to TSH-receptor were positive. Based on the above findings, we considered Graves' disease as the most likely diagnosis. Patient was treated with methimazole and beta-blockers and subsequently his dysphagia resolved. This paper highlights the importance to clinicians of considering thyrotoxicosis as possible diagnosis in an elderly patient presenting with unexplained dysphagia.

  6. Dysphagia associated with cervical spine and postural disorders.

    Science.gov (United States)

    Papadopoulou, Soultana; Exarchakos, Georgios; Beris, Alexander; Ploumis, Avraam

    2013-12-01

    Difficulties with swallowing may be both persistent and life threatening for the majority of those who experience it irrespective of age, gender, and race. The purpose of this review is to define oropharyngeal dysphagia and describe its relationship to cervical spine disorders and postural disturbances due to either congenital or acquired disorders. The etiology and diagnosis of dysphagia are analyzed, focusing on cervical spine pathology associated with dysphagia as severe cervical spine disorders and postural disturbances largely have been held accountable for deglutition disorders. Scoliosis, kyphosis–lordosis, and osteophytes are the primary focus of this review in an attempt to elucidate the link between cervical spine disorders and dysphagia. It is important for physicians to be knowledgeable about what triggers oropharyngeal dysphagia in cases of cervical spine and postural disorders. Moreover, the optimum treatment for dysphagia, including the use of therapeutic maneuvers during deglutition, neck exercises, and surgical treatment, is discussed.

  7. Surface electromyography as a screening method for evaluation of dysphagia and odynophagia.

    Science.gov (United States)

    Vaiman, Michael; Eviatar, Ephraim

    2009-02-20

    Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG) to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition. Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949-2007) and EMBASE (1975-2007). Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc. According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia. With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

  8. Cortical processing of swallowing in ALS patients with progressive dysphagia--a magnetoencephalographic study.

    Directory of Open Access Journals (Sweden)

    Inga K Teismann

    Full Text Available Amyotrophic lateral sclerosis (ALS is a rare disease causing degeneration of the upper and lower motor neuron. Involvement of the bulbar motor neurons often results in fast progressive dysphagia. While cortical compensation of dysphagia has been previously shown in stroke patients, this topic has not been addressed in patients suffering from ALS. In the present study, we investigated cortical activation during deglutition in two groups of ALS patients with either moderate or severe dysphagia. Whole-head MEG was employed on fourteen patients with sporadic ALS using a self-paced swallowing paradigm. Data were analyzed by means of time-frequency analysis and synthetic aperture magnetometry (SAM. Group analysis of individual SAM data was performed using a permutation test. We found a reduction of cortical swallowing related activation in ALS patients compared to healthy controls. Additionally a disease-related shift of hemispheric lateralization was observed. While healthy subjects showed bilateral cortical activation, the right sensorimotor cortex was predominantly involved in ALS patients. Both effects were even stronger in the group of patients with severe dysphagia. Our results suggest that bilateral degeneration of the upper motor neuron in the primary motor areas also impairs further adjusted motor areas, which leads to a strong reduction of 'swallowing related' cortical activation. While both hemispheres are affected by the degeneration a relatively stronger activation is seen in the right hemisphere. This right hemispheric lateralization of volitional swallowing observed in this study may be the only sign of cortical plasticity in dysphagic ALS patients. It may demonstrate compensational mechanisms in the right hemisphere which is known to predominantly coordinate the pharyngeal phase of deglutition. These results add new aspects to our understanding of the pathophysiology of dysphagia in ALS patients and beyond. The compensational

  9. Oropharyngeal dysphagia, an underestimated disorder in pediatrics

    OpenAIRE

    Esther Vaquero-Sosa; Laura Francisco-González; Andrés Bodas-Pinedo; Cristina Urbasos-Garzón; Antonio Ruiz-de-León-San-Juan

    2015-01-01

    Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additiona...

  10. Pill swallowing by adults with dysphagia.

    Science.gov (United States)

    Carnaby-Mann, Giselle; Crary, Michael

    2005-11-01

    To evaluate differences in swallowing physiology and safety in patients with dysphagia between conventional tablets and a new method of tablet transportation, orally disintegrating technology (ODT) (RapiTab; Schwarz Pharma Inc, Milwaukee, Wis). The study observed a single group, crossover design. Outpatient clinic within an academic teaching hospital. A total of 36 adult dysphagic patients referred to the clinic. All subjects underwent simultaneous nasopharyngeal endoscopic evaluation, surface electromyographic (sEMG) measurement, and respiratory monitoring during swallowing. Subjects were evaluated swallowing the ODT and a conventional tablet formulation. Tablets were randomly and blindly presented to each subject. Subjects completed a preference survey subsequent to swallowing both tablets. Significant differences included greater sEMG amplitude and longer apneic duration when swallowing a conventional tablet compared with the ODT (Pswallow durations (Pswallows per tablet (Pswallow. On a postevaluation survey, patients reported that they preferred the ODT preparation for most of the parameters assessed. Patients with dysphagia frequently complain of trouble swallowing medication. In this study, an ODT formulation provided a method of delivery that required less effort to swallow, did not result in increased levels of airway compromise, and was preferred by dysphagic patients. The ODT medication delivery technology may provide benefit to adults with dysphagia in convenience, compliance, and accuracy of dosing.

  11. Dysphagia Post Subcortical and Supratentorial Stroke.

    Science.gov (United States)

    Wan, Ping; Chen, Xuhui; Zhu, Lequn; Xu, Shuangjin; Huang, Li; Li, Xiangcui; Ye, Qing; Ding, Ruiying

    2016-01-01

    Studies have recognized that the damage in the subcortical and supratentorial regions may affect voluntary and involuntary aspects of the swallowing function. The current study attempted to explore the dysphagia characteristics in patients with subcortical and supratentorial stroke. Twelve post first or second subcortical and supratentorial stroke patients were included in the study. The location of the stroke was ascertained by computed tomography and magnetic resonance imaging. The characteristics of swallowing disorder were assessed by video fluoroscopic swallowing assessment/fiberoptic endoscopic evaluation of swallowing. The following main parameters were analyzed: oral transit time, pharyngeal delay time, presence of cricopharyngeal muscle achalasia (CMA), distance of laryngeal elevation, the amounts of vallecular residue and pyriform sinus residue (PSR), and the extent of pharyngeal contraction. Eighty-three percent of the 12 patients were found suffering from pharyngeal dysphagia, with 50% having 50%-100% PSRs, 50% having pharyngeal delay, and 41.6% cases demonstrating CMA. Simple regression analysis showed PSRs were most strongly associated with CMA. Pharyngeal delay in the study can be caused by infarcts of basal ganglia/thalamus, infarcts of sensory tract, infarcts of swallowing motor pathways in the centrum semiovale, or a combination of the three. Subcortical and supratentorial stroke may result in pharyngeal dysphagia such as PSR and pharyngeal delay. PSR was mainly caused by CMA. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Foramen Magnum Meningioma: Dysphagia of Atypical Etiology

    Science.gov (United States)

    Tsang, Matthew W.; Mobley, Bret C.; Cheng, Walter W.

    2007-01-01

    INTRODUCTION We present a case of a foramen magnum meningioma that highlights the importance of the neurologic exam when evaluating a patient with dysphagia. A 58-year-old woman presented with an 18-month history of progressive dysphagia, chronic cough and 30-pound weight loss. Prior gastroenterologic and laryngologic workup was unrevealing. Results Her neurologic examination revealed an absent gag reflex, decreased sensation to light touch on bilateral distal extremities, hyperreflexia, and tandem gait instability. Repeat esophagogastroduodenoscopy was normal, whereas laryngoscopy and video fluoroscopy revealed marked hypopharyngeal dysfunction. Brain magnetic resonance imaging demonstrated a 3.1 × 2.7 × 2.9 cm foramen magnum mass consistent with meningioma. The patient underwent neurosurgical resection of her mass with near complete resolution of her neurologic symptoms. Pathology confirmed diagnosis of a WHO grade I meningothelial meningioma. Conclusion CNS pathology is an uncommon but impressive cause of dysphagia. Our case demonstrates the importance of a thorough neurologic survey when evaluating such a patient. PMID:18080720

  13. Dysphagia-gastroesophageal reflux complex: complications due to dysfunction of solitary tract nucleus-mediated vago-vagal reflex.

    Science.gov (United States)

    Saito, Y; Kawashima, Y; Kondo, A; Chikumaru, Y; Matsui, A; Nagata, I; Ohno, K

    2006-06-01

    We report on the complication of gastroesophageal reflux (GER) in four patients with lower brainstem dysfunction. These patients suffered from perinatal asphyxia, cerebellar hemorrhage, or congenital dysphagia of unknown origin and showed facial nerve palsy, inspiratory stridor due to vocal cord paralysis, central sleep apnea, and dysphagia, in various combinations. Naso-intestinal tube feeding was introduced in all of the patients due to recurrent vomiting and aspiration pneumonia resulting from GER. T2-weighted magnetic resonance (MR) imaging revealed symmetrical high intensity lesions in the tegmentum of the lower pons and the medulla oblongata in two of the patients, and pontomedullary atrophy in another patient. In normal subjects, lower esophageal sphincter contraction is provoked by distension of the gastric wall, through a vago-vagal reflex. Since this reflex arc involves the solitary tract nucleus, where the swallowing center is located, the association of dysphagia and GER in the present patients is thought to result from the lesions in the tegmentum of medulla oblongata. We propose the term "dysphagia-GER complex" to describe the disturbed motility of the upper digestive tract due to lower brainstem involvement. In children with brainstem lesions, neurological assessment of GER is warranted, in addition to the examination of other signs of brainstem dysfunction, including dysphagia and respiratory disturbance.

  14. Dysphagia in Duchenne muscular dystrophy: practical recommendations to guide management.

    Science.gov (United States)

    Toussaint, Michel; Davidson, Zoe; Bouvoie, Veronique; Evenepoel, Nathalie; Haan, Jurn; Soudon, Philippe

    2016-10-01

    Duchenne muscular dystrophy (DMD) is a rapidly progressive neuromuscular disorder causing weakness of the skeletal, respiratory, cardiac and oropharyngeal muscles with up to one third of young men reporting difficulty swallowing (dysphagia). Recent studies on dysphagia in DMD clarify the pathophysiology of swallowing disorders and offer new tools for its assessment but little guidance is available for its management. This paper aims to provide a step-by-step algorithm to facilitate clinical decisions regarding dysphagia management in this patient population. This algorithm is based on 30 years of clinical experience with DMD in a specialised Centre for Neuromuscular Disorders (Inkendaal Rehabilitation Hospital, Belgium) and is supported by literature where available. Dysphagia can worsen the condition of ageing patients with DMD. Apart from the difficulties of chewing and oral fragmentation of the food bolus, dysphagia is rather a consequence of an impairment in the pharyngeal phase of swallowing. By contrast with central neurologic disorders, dysphagia in DMD accompanies solid rather than liquid intake. Symptoms of dysphagia may not be clinically evident; however laryngeal food penetration, accumulation of food residue in the pharynx and/or true laryngeal food aspiration may occur. The prevalence of these issues in DMD is likely underestimated. There is little guidance available for clinicians to manage dysphagia and improve feeding for young men with DMD. This report aims to provide a clinical algorithm to facilitate the diagnosis of dysphagia, to identify the symptoms and to propose practical recommendations to treat dysphagia in the adult DMD population. Implications for Rehabilitation Little guidance is available for the management of dysphagia in Duchenne dystrophy. Food can penetrate the vestibule, accumulate as residue or cause aspiration. We propose recommendations and an algorithm to guide management of dysphagia. Penetration/residue accumulation

  15. [Oropharyngeal dysphagia associated with Chiari I malformation and syringomyelia J].

    Science.gov (United States)

    Cortés-Medina, Julio César; Cárdenas-Lara, Armando; Guerrero-Rascón, Carlos Alberto; Rodríguez-Bautista, Heber

    2014-01-01

    Dysphagia associated with neurological disease is an important clinical manifestation in the diagnosis of injury that justifies the compression of the brainstem and lower cranial nerves. To emphasize the study of dysphagia in a patient with Chiari I malformation associated with syringomyelia in the absence of primary gastroenterological symptoms. We describe the case of a 62 year-old woman with oropharyngeal dysphagia of six years of evolution, cervicobrachialgia, ptosis and facial diplexia. Magnetic resonance imaging is an essential element for establishing the etiologic diagnosis of neurogenic dysphagia.

  16. Dysphagia in the elderly: management and nutritional considerations

    Science.gov (United States)

    Sura, Livia; Madhavan, Aarthi; Carnaby, Giselle; Crary, Michael A

    2012-01-01

    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. PMID:22956864

  17. Dysphagia in the elderly: management and nutritional considerations.

    Science.gov (United States)

    Sura, Livia; Madhavan, Aarthi; Carnaby, Giselle; Crary, Michael A

    2012-01-01

    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.

  18. Dysphagia research in the 21st century and beyond: proceedings from Dysphagia Experts Meeting, August 21, 2001.

    Science.gov (United States)

    Robbins, JoAnne; Langmore, Susan; Hind, Jacqueline A; Erlichman, Martin

    2002-01-01

    Swallowing problems (dysphagia) can occur at any age but are most prevalent in elderly individuals and are a growing healthcare concern as the geriatric population expands. Without effective diagnosis and treatment, dysphagia may lead to serious medical conditions such as pneumonia, dehydration, and malnutrition. Experts in the field of dysphagia met on August 21, 2001, in Rockville, Maryland, to respond to this heightened healthcare need and to determine the course of dysphagia research. Presentations at the meeting included epidemiological data, geriatric-specific issues, diagnostic techniques, risk factors for pneumonia, and recent relevant trials. The experts identified outstanding issues in dysphagia research, such as study design, population selection, and the standardization of diagnostic and treatment protocols. They designed a clinical trial that represents what they deem is one of the greatest needs in dysphagia research, providing a critical springboard for research endeavors with far-reaching implications.

  19. Granulocytic Sarcoma of the Stomach Presenting as Dysphagia during Pregnancy

    Directory of Open Access Journals (Sweden)

    Anuradha Sekaran

    2011-01-01

    Full Text Available Granulocytic sarcoma also known as extramedullary myeloid sarcoma or chloroma is an uncommon manifestation of leukemia and presents as a deposit of leukemic cells outside the bone marrow. We report a case of a twenty-five-year-old pregnant woman who presented with progressive dysphagia and recurrent postprandial vomiting. Upper GI endoscopy had shown large flat laterally spread nodular lesions in the cardia and proximal body of stomach. Biopsies from the gastric lesion showed granulocytic sarcoma of the stomach. Concurrent peripheral and bone marrow picture was suggestive of acute myeloid leukemia (AML–M4. There is limited reported literature on granulocytic sarcoma of the stomach. Concurrent gastric granulocytic sarcoma involving cardia and AML in pregnancy has not been reported till date.

  20. Reversible histone acetylation/deacetylation modification by p300 and HDAC3 is involved in the regulation of IL-18 promoter activity

    Institute of Scientific and Technical Information of China (English)

    SUN Haijing; LU Jun; XU Xin; WEI Liang; HUANG Baiqu

    2004-01-01

    Interleukin-18 (IL-18) is a pleiotropic cytokine involved in the development of T helper type 1 (Thl) cells, and it plays important roles in regulation of both the innate and acquired immune responses. The aim of this study was to elucidate whether the reversible histone acetylation/ deacetylation modification participates in the regulation of IL-18 transcription expression. The transcription coactivator p300 containing the histone acetyltransferase (HAT) activity, and the histone deacetylase 3 (HDAC3) were used in this study to analyze the effect of this modification in the regulation of mouse IL-18 gene. The results demonstrate that transfection of p300-expression plasmid promotes the endogenous IL-18 mRNA synthesis in J774 cells, and stimulates the activation of IL-18 promoter. It has been found that this stimulating effect of p300 was reversed by HDAC3, indicating the involvement of the reversible histone acetylation/deacetylation modification in IL-18 regulation. Furthermore, the data show that the HAT activity of p300 was essential to its function in activating IL-18 promoter. In addition, p300 was shown to be able to work synergistically with the transcription factor c-Fos on activation of IL-18 promoter and this effect could also be impaired by HDAC3. Results presented in this paper indicate that the reversible histone acetylation/deacetylation modification plays an important role in the transcriptional regulation of IL-18.

  1. Predicting the pathway involved in post-translational modification of Elongation factor P in a subset of bacterial species

    Directory of Open Access Journals (Sweden)

    de Crécy-Lagard Valérie

    2010-01-01

    Full Text Available Abstract Background The bacterial elongation factor P (EF-P is strictly conserved in bacteria and essential for protein synthesis. It is homologous to the eukaryotic translation initiation factor 5A (eIF5A. A highly conserved eIF5A lysine is modified into an unusual amino acid derived from spermidine, hypusine. Hypusine is absolutely required for eIF5A's role in translation in Saccharomyces cerevisiae. The homologous lysine of EF-P is also modified to a spermidine derivative in Escherichia coli. However, the biosynthesis pathway of this modification in the bacterial EF-P is yet to be elucidated. Presentation of the Hypothesis Here we propose a potential mechanism for the post-translational modification of EF-P. By using comparative genomic methods based on physical clustering and phylogenetic pattern analysis, we identified two protein families of unknown function, encoded by yjeA and yjeK genes in E. coli, as candidates for this missing pathway. Based on the analysis of the structural and biochemical properties of both protein families, we propose two potential mechanisms for the modification of EF-P. Testing the hypothesis This hypothesis could be tested genetically by constructing a bacterial strain with a tagged efp gene. The tag would allow the purification of EF-P by affinity chromatography and the analysis of the purified protein by mass spectrometry. yjeA or yjeK could then be deleted in the efp tagged strain and the EF-P protein purified from each mutant analyzed by mass spectrometry for the presence or the absence of the modification. This hypothesis can also be tested by purifying the different components (YjeK, YjeA and EF-P and reconstituting the pathway in vitro. Implication of the hypothesis The requirement for a fully modified EF-P for protein synthesis in certain bacteria implies the presence of specific post-translational modification mechanism in these organisms. All of the 725 bacterial genomes analyzed, possess an efp gene

  2. Myotonic dystrophy (DM1) and dysphagia: the need for dysphagia management guidelines and an assessment tool

    NARCIS (Netherlands)

    LaDonna, K.A.; Koopman, W.J.H.; Venance, S.L.

    2011-01-01

    Myotonic dystrophy (DM1) is the most prevalent muscular dystrophy occurring in adulthood. DM1 is a multi-systemic disorder resulting in early-onset cataracts, cardiac rhythm problems, muscle weakness, ptosis, and cognitive and psychiatric manifestations. Dysphagia is one of the most problematic

  3. Palliation of dysphagia with radiotherapy for exophytic base tongue metastases in a case of renal cell carcinoma

    Directory of Open Access Journals (Sweden)

    Tabassum Wadasadawala

    2011-01-01

    Full Text Available Base tongue involvement is a rare presentation of lingual metastases from renal cell carcinoma. A 48-year-old gentleman was treated with open radical nephrectomy and adjuvant radiotherapy for Stage II Furhman grade I clear cell carcinoma of the left kidney at an outside hospital. He presented metachronously 5 years later with progressive dysphagia and change of voice. Clinicoradiological evaluation revealed a large exophytic mass in the oropharynx with epicenter in the right base of tongue. Metastatic workup revealed widespread dissemination to multiple organs and bone. In view of predominant symptom of dysphagia, base tongue metastasis was treated with protracted course of palliative radiotherapy to a dose of 50 Gy in conventional fractionation over 5 weeks. This resulted in excellent and durable response at the base tongue lesion (till the time of last follow-up. Radiation therapy is an acceptable palliative strategy for advanced lingual metastasis as it produces prompt relief of pain, bleeding, and dysphagia.

  4. [Factors associated with post-stroke oropharingeal dysphagia].

    Science.gov (United States)

    Peña-Chávez, Rodolfo; López-Espinoza, Miguel; Guzmán-Inostroza, Madelein; Jara-Parra, Mirna; Sepúlveda-Arriagada, Claudia; Sepulveda-Arriagada, Constanza; Zapata-Sepúlveda, Priscila

    2015-10-01

    Neurogenic dysphagia is a consequence of stroke that sometimes threatens the patient's life. The magnitude of the brain damage commonly generated by stroke generates the emergence of other disorders that accompany dysphagia and worsen the patient's health. To analyze possible associations between communication disorders, disease factors, demographic factors and comorbidities with post-stroke dysphagia in years 2009 to 2011. We studied 1519 medical records of patients that suffered stroke between 2009 and 2011. From medical records reviewed, 206 had dysphagia (13.6%). 80,1% from dysphagic patients had between 60 to 89 years old. 66% from them stayed hospitalized for more than 11 days. Age (odds ratio = 2.36; p dysphagia. Finally, 73,3% from dysphagic patients they had dysphagia with aphasia or dysarthria or apraxia of speech, however, 26,7% only had dysphagia. Neurogenic dysphagia seems to be associated with communication disorders, increase the time of hospitalization and associated with a hypertension. However, prospective studies consider a great time to confirm these findings are required.

  5. Challenges in oral drug delivery in patients with esophageal dysphagia

    NARCIS (Netherlands)

    Kappelle, W.F.; Siersema, P.D.; Bogte, A.; Vleggaar, F.P.

    2016-01-01

    INTRODUCTION: Esophageal dysphagia is a commonly reported symptom with various benign and malignant causes. Esophageal dysphagia can impede intake of oral medication, which often poses a major challenge for both patients and physicians. The best way to address this challenge depends of the cause of

  6. Schoolchildren with Dysphagia Associated with Medically Complex Conditions

    Science.gov (United States)

    Lefton-Greif, Maureen A.; Arvedson, Joan C.

    2008-01-01

    Purpose: This article reviews population trends and general characteristics of children with dysphagia in schools, provides an overview of dysphagia teams and the roles of the speech-language pathologist (SLP) in school and hospital settings, and describes assessment and treatment of swallowing and feeding problems in children with complex medical…

  7. Frailty measurements and dysphagia in the outpatient setting.

    Science.gov (United States)

    Hathaway, Bridget; Vaezi, Alec; Egloff, Ann Marie; Smith, Libby; Wasserman-Wincko, Tamara; Johnson, Jonas T

    2014-09-01

    Deconditioning and frailty may contribute to dysphagia and aspiration. Early identification of patients at risk of aspiration is important. Aspiration prevention would lead to reduced morbidity and health care costs. We therefore wondered whether objective measurements of frailty could help identify patients at risk for dysphagia and aspiration. Consecutive patients (n = 183) were enrolled. Patient characteristics and objective measures of frailty were recorded prospectively. Variables tested included age, body mass index, grip strength, and 5 meter walk pace. Statistical analysis tested for association between these parameters and dysphagia or aspiration, diagnosed by instrumental swallowing examination. Of variables tested for association with grip strength, only age category (P = .003) and ambulatory status (P dysphagia or aspiration, ambulatory status was significantly associated with dysphagia and aspiration in multivariable model building. Nonambulatory status is a predictor of aspiration and should be included in risk assessments for dysphagia. The relationship between frailty and dysphagia deserves further investigation. Frailty assessments may help identify those at risk for complications of dysphagia. © The Author(s) 2014.

  8. Dysphagia in amyotrophic lateral sclerosis: prevalence and clinical findings.

    Science.gov (United States)

    Ruoppolo, G; Schettino, I; Frasca, V; Giacomelli, E; Prosperini, L; Cambieri, C; Roma, R; Greco, A; Mancini, P; De Vincentiis, M; Silani, V; Inghilleri, M

    2013-12-01

    To characterize swallowing deficits in amyotrophic lateral sclerosis (ALS); investigate the delay in dysphagia onset; estimate correlations between dysphagia severity and patients' functional status; identify the symptom(s) most likely to predict dysphagia. A group of 49 consecutive patients with ALS, 14 with bulbar onset and 35 with spinal onset, underwent swallowing evaluation including bedside and fiberoptic endoscopic examination to detect dysphagia. Patients with dysphagia were more likely than those without to have bulbar onset ALS (P = 0.02); more severely impaired chewing (P = 0.01); and tongue muscle deficits (P = 0.001). The only variable measured at first examination significantly associated with dysphagia was a more than mild tongue muscle deficit. The only variable useful in predicting dysphagia was a chewing deficit. In 10 of the 49 patients studied, swallowing evaluation disclosed an impaired cough reflex. Dysphagia in patients with ALS correlates significantly with bulbar onset and with oral swallowing impairment. Fiberoptic swallowing evaluation is a useful tool for detecting swallowing deficits and laryngeal sensitivity in patients with ALS. An impaired cough reflex is an unexpected finding in many patients with ALS. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Dysphagia in Duchenne Muscular Dystrophy Assessed by Validated Questionnaire

    Science.gov (United States)

    Archer, Sally K.; Garrod, Rachel; Hart, Nicholas; Miller, Simon

    2013-01-01

    Background: Duchenne muscular dystrophy (DMD) leads to progressive muscular weakness and death, most typically from respiratory complications. Dysphagia is common in DMD; however, the most appropriate swallowing assessments have not been universally agreed and the symptoms of dysphagia remain under-reported. Aims: To investigate symptoms of…

  10. Risks associated with suspected dysphagia in infants admitted to a ...

    African Journals Online (AJOL)

    dysphagia and nutritional problems than typically developing, ... appears that a close relationship exists between dysphagia, the infant's ... nutrition and hydration.[13] ... participants were referred by medical doctors, nurses, audiologists,. SLTs ... Being a retrospective study, there was no direct ... HIV status of mother (N=196).

  11. Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke

    DEFF Research Database (Denmark)

    Bath, Philip M W; Scutt, Polly; Love, Jo

    2016-01-01

    BACKGROUND AND PURPOSE: Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. METHODS:...

  12. Dysphagia in Duchenne Muscular Dystrophy Assessed by Validated Questionnaire

    Science.gov (United States)

    Archer, Sally K.; Garrod, Rachel; Hart, Nicholas; Miller, Simon

    2013-01-01

    Background: Duchenne muscular dystrophy (DMD) leads to progressive muscular weakness and death, most typically from respiratory complications. Dysphagia is common in DMD; however, the most appropriate swallowing assessments have not been universally agreed and the symptoms of dysphagia remain under-reported. Aims: To investigate symptoms of…

  13. High resolution impedance manometric findings in dysphagia of Huntington's disease

    Institute of Scientific and Technical Information of China (English)

    Tae Hee Lee; Joon Seong Lee; Wan Jung Kim

    2012-01-01

    Conventional manometry presents significant challenges,espedally in assessment of pharyngeal swallowing,because of the asymmetry and deglutitive movements of oropharyngeal structures.It only provides information about intraluminal pressure and thus it is difficult to study functional details of esophageal motility disorders.New technology of solid high resolution impedance manometry (HRIM),with 32 pressure sensors and 6 impedance sensors,is likely to provide better assessment of pharyngeal swallowing as well as more information about esophageal motility disorders.However,the clinical usefulness of application of HRIM in patients with oropharyngeal dysphagia or esophageal dysphagia is not known.We experienced a case of Huntington's disease presenting with both oropharyngeal and esophageal dysphagia,in which HRIM revealed the mechanism of oropharyngeal dysphagia and provided comprehensive information about esophageal dysphagia.

  14. Dysphagia in the patient after stroke: consequences and nurse intervention

    Directory of Open Access Journals (Sweden)

    Ana Frias

    2015-12-01

    Full Text Available Objectives: to check the consequences of poststroke dysphagia and to reflect on the nurse’s intervention in dysphagia rehabilitation. Methodology: it was performed a systematic literature review of the topic in question; research based on international databases EBSCOhost, LILACS, SciELO.We were able to identify some studies publications between 2006 and 2014. We intend to answer the guiding question: What are the consequences of dysphagia in the patient after stroke? » Results vs. Discussion: after a thorough analysis, we have selected 11 articles and found that the most frequent consequences of dysphagia are the pulmonary complications by saliva and/or food suction. The nurse specialist still has a barely visible role, but his/her interventions are critical in these patients rehabilitation. Conclusions: rehabilitation is essential to avoid the consequences of poststroke dysphagia. The rehabilitation process must go through a multidisciplinary team of which nurses are an integral and essential part.

  15. PALLIATIVE TREATMENT OF DYSPHAGIA: FAILURES AND COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    E. A. Drobyazgin

    2017-01-01

    Full Text Available Background. Dysphagia is the main clinical symptom in patients with locally advanced esophageal carcinoma and proximal part of the stomach. Esophageal stenting is a highly effective and safe method to restore esophageal lumen patency. Published data indicate a high rate of stent-related complications. Material and methods. A retrospective, two-centered study included 166 patients (102 males and 64 females, who underwent endoscopically-guided esophageal stenting from 2004 to 2015. The age of the patients ranged from 36 to 92 years. Expandable metal stents were used for all patients. In most cases (81.3%, drug-eluting stents (22 mm diameter, 120 mm length were preferable. Treatment outcomes and complications were analyzed. Results. Complications during stent placement (incorrect stent disclosure were observed in 7 patients. All these complications were eliminated by relocating the stent to the desired position. Postoperative complications were noted in 29 patients (stent migration in 9 patients, stent fracture and migration in 2 patients, stent obstruction in 1 patient, destruction of stent coating and fragmentation in 5 patients, and dysphagia recurrence due to continuing tumor growth in 11 patients. All stent-related complications were corrected by re-endoscopy. Conclusions. The data obtained indicate the need for lifelong surveillance of patients after stenting.

  16. Ubiquitin modifications

    OpenAIRE

    Swatek, Kirby N.; Komander, David

    2016-01-01

    Protein ubiquitination is a dynamic multifaceted post-translational modification involved in nearly all aspects of eukaryotic biology. Once attached to a substrate, the 76-amino acid protein ubiquitin is subjected to further modifications, creating a multitude of distinct signals with distinct cellular outcomes, referred to as the 'ubiquitin code'. Ubiquitin can be ubiquitinated on seven lysine (Lys) residues or on the N-terminus, leading to polyubiquitin chains that can encompass complex top...

  17. Sensory ataxic neuropathy with dysarthria/dysphagia and ophthalmoplegia (SANDO). Two case reports.

    Science.gov (United States)

    Gáti, István; Danielsson, Olof; Jonasson, Jon; Landtblom, Anne-Marie

    2011-12-01

    Case histories of two unrelated patients suffering from sensory ataxic neuropathy, dysarthria/dysphagia and external ophthalmoplegia (SANDO) are reported. Both patients showed compound heterozygosity for POLG1 gene mutations, and presented with symptom of the clinical characteristics of SANDO. A patient with a p.A467T and p.W748S, well-known mutations showed a progressive course with early onset and multisystem involvement, including symptoms characteristics for mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). The second patient showed a less well-known p.T251I and p.G848S mutations with late onset and dysphagia/dysarthria dominated, moderate symptoms. This later is the second published case history, when these POLG1 gene mutations are the possible background of late onset SANDO, dominantly presenting with bulbar symptoms.

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

    Science.gov (United States)

    Cichero, Julie A. Y.; Lam, Peter; Steele, Catriona M.; Hanson, Ben; Chen, Jianshe; Dantas, Roberto O.; Duivestein, Janice; Kayashita, Jun; Lecko, Caroline; Murray, Joseph; Pillay, Mershen; Riquelme, Luis; Stanschus, Soenke

    2016-01-01

    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. PMID:27913916

  19. Transcriptome-wide N⁶-methyladenosine profiling of rice callus and leaf reveals the presence of tissue-specific competitors involved in selective mRNA modification.

    Science.gov (United States)

    Li, Yuli; Wang, Xiliang; Li, Cuiping; Hu, Songnian; Yu, Jun; Song, Shuhui

    2014-01-01

    N(6)-methyladenosine (m(6)A) is the most prevalent internal modification present in mRNAs of all higher eukaryotes. With the development of MeRIP-seq technique, in-depth identification of mRNAs with m(6)A modification becomes feasible. Here we present a transcriptome-wide m(6)A modification profiling effort for rice transcriptomes of differentiated callus and leaf, which yields 8,138 and 14,253 m(6)A-modified genes, respectively. The m(6)A peak (m(6)A-modified nucleotide position on mRNAs) distribution exhibits preference toward both translation termination and initiation sites. The m(6)A peak enrichment is negatively correlated with gene expression and weakly positively correlated with certain gene features, such as exon length and number. By comparing m(6)A-modified genes between the 2 samples, we define 1,792 and 6,508 tissue-specific m(6)A-modified genes (TSMGs) in callus and leaf, respectively. Among which, 626 and 5,509 TSMGs are actively expressed in both tissues but are selectively m(6)A-modified (SMGs) only in one of the 2 tissues. Further analyses reveal characteristics of SMGs: (1) Most SMGs are differentially expressed between callus and leaf. (2) Two conserved RNA-binding motifs, predicted to be recognized by PUM and RNP4F, are significantly over-represented in SMGs. (3) GO enrichment analysis shows that SMGs in callus mainly participate in transcription regulator/factor activity whereas SMGs in leaf are mainly involved in plastid and thylakoid. Our results suggest the presence of tissue-specific competitors involved in SMGs. These findings provide a resource for plant RNA epitranscriptomic studies and further enlarge our knowledge on the function of RNA m(6)A modification.

  20. POSTFUNDOPLICATION DYSPHAGIA CAUSES SIMILAR WATER INGESTION DYNAMICS AS ACHALASIA.

    Science.gov (United States)

    Dantas, Roberto Oliveira; Santos, Carla Manfredi; Cassiani, Rachel Aguiar; Alves, Leda Maria Tavares; Nascimento, Weslania Viviane

    2016-01-01

    - After surgical treatment of gastroesophageal reflux disease dysphagia is a symptom in the majority of patients, with decrease in intensity over time. However, some patients may have persistent dysphagia. - The objective of this investigation was to evaluate the dynamics of water ingestion in patients with postfundoplication dysphagia compared with patients with dysphagia caused by achalasia, idiopathic or consequent to Chagas' disease, and controls. - Thirty-three patients with postfundoplication dysphagia, assessed more than one year after surgery, together with 50 patients with Chagas' disease, 27 patients with idiopathic achalasia and 88 controls were all evaluated by the water swallow test. They drunk, in triplicate, 50 mL of water without breaks while being precisely timed and the number of swallows counted. Also measured was: (a) inter-swallows interval - the time to complete the task, divided by the number of swallows during the task; (b) swallowing flow - volume drunk divided by the time taken; (c) volume of each swallow - volume drunk divided by the number of swallows. - Patients with postfundoplication dysphagia, Chagas' disease and idiopathic achalasia took longer to ingest all the volume, had an increased number of swallows, an increase in interval between swallows, a decrease in swallowing flow and a decrease in water volume of each swallow compared with the controls. There was no difference between the three groups of patients. There was no correlation between postfundoplication time and the results. - It was concluded that patients with postfundoplication dysphagia have similar water ingestion dynamics as patients with achalasia.

  1. Effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia.

    Science.gov (United States)

    Sdravou, Katerina; Walshe, Margaret; Dagdilelis, Lukas

    2012-06-01

    Aspiration is common in adults with neurogenic dysphagia and pharyngeal delay. This can lead to dehydration, malnutrition, and aspiration pneumonia. Diet modifications aimed at reducing thin liquid aspiration are partially successful or unpalatable or both. Carbonated liquids show some potential in influencing swallowing behavior. However, there is a paucity of evidence to support this intervention. This study compares the effects of carbonated thin liquids (CTL) with that of noncarbonated thin liquids (NCTL) on oropharyngeal swallowing in adults with neurogenic dysphagia and examines the palatability of the CTL stimulus. Seventeen people with pharyngeal delay attended for videofluoroscopy (VFSS). Outcome measures were oral transit time (OTT), pharyngeal transit time (PTT), stage transition duration (STD), initiation of the pharyngeal swallow (IPS), penetration-aspiration scale (PENASP), and pharyngeal retention (PR). A modification of Quartermaster Hedonic Scale (AQHS) was employed to assess palatability of the CTL. CTL vs. NCTL significantly decreased penetration and aspiration on 5-ml (P = 0.028) and 10-ml (P = 0.037) swallows. CTL had no significant effect on OTT, PTT, IPS, and PR for any volume of bolus. Only one participant disliked the CTL stimulus. These findings support the hypothesis that oropharyngeal swallowing can be modulated in response to sensory stimuli. Implications for research and clinical practice are discussed.

  2. An EMG screening method (dysphagia limit) for evaluation of neurogenic dysphagia in childhood above 5 years old.

    Science.gov (United States)

    Ozdemirkiran, T; Secil, Y; Tarlaci, S; Ertekin, C

    2007-03-01

    Oropharyngeal dysphagia is not rare in older children before the adult age, especially the patients with cerebral palsy. Non-invasive simple tests are needed for the evaluation of children with neurogenic dysphagia including the patients with cerebral palsy. So we aimed to evaluate non-invasive ways to screen for dysphagia in children and the usefulness of this almost new electrophysiologic method for the detection of dysphagia in children with cerebral palsy. Twenty-eight healthy children and 12 patients with cerebral palsy were investigated for the applicability of this method. The movement of the larynx was monitored using a simple piezoelectric wafer sensor and submental surface EMG activity was recorded by bipolar silver-chloride electrodes taped under the chin over the submental muscle complex. The onset and duration of pharyngeal swallowing was recorded from submental-suprahyoid muscles such as the mylohyoid-genitohyoid-anterior digastric complex. By this method, the maximal water volume capacity was measured in single swallows with progressively increasing water volumes, this was called 'dysphagia limit'. The healthy control children revealed to swallow the bolus at once maximally 11.2+/-0.4 and 2.5 ml in average. Dysphagia limit varied from 7 to above 20 ml water volume from age 5-16 years old. Patients with cerebral palsy had the dysphagia limit of 7.7+/-1.8 and 6.4 ml in average. The dysphagia limit was significantly reduced in patients with cerebral palsy (pDysphagia limit seemed to be less sensitive in demonstrating the oropharyngeal swallowing disorders in childhood period (90% in the adult dysphagic patients). But the majority of patients with cerebral palsy (58%) showed abnormality. This electrophysiologic method is completely non-invasive, devoid from any hazard and applicable to children above 5 years. It may be candidate as a screening test before selection of dysphagic children.

  3. Oropharyngeal dysphagia, an underestimated disorder in pediatrics.

    Science.gov (United States)

    Vaquero-Sosa, Esther; Francisco-González, Laura; Bodas-Pinedo, Andrés; Urbasos-Garzón, Cristina; Ruiz-de-León-San-Juan, Antonio

    2015-02-01

    Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate), a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders.It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding may be necessary.

  4. Oropharyngeal dysphagia, an underestimated disorder in pediatrics

    Directory of Open Access Journals (Sweden)

    Esther Vaquero-Sosa

    2015-02-01

    Full Text Available Oropharyngeal dysphagia is a rather frequent clinical entity in patients with neurological problems that can lead to serious complications such as aspiration pneumonia and other disorders like dehydration or malnutrition due to feeding difficulties. It should be suspected in children with splitting of food intake or prolonged feeding, coughing or choking during feeding, continuous drooling or repeated respiratory symptoms. For the diagnosis, apart from the examination of swallowing, additional tests can be run like the water-swallowing test, the viscosity-volume test (which determines what kind of texture and how much volume the patient is able to tolerate, a fiberoptic endoscopy of swallowing or a videofluoroscopic swallow study, which is the gold standard for the study of swallowing disorders. It requires a multidisciplinary approach to guarantee an adequate intake of fluids and nutrients with minimal risk of aspiration. If these two conditions cannot be met, a gastrostomy feeding may be necessary.

  5. Bulbar muscle MRI changes in patients with SMA with reduced mouth opening and dysphagia.

    Science.gov (United States)

    Wadman, Renske I; van Bruggen, H Willemijn; Witkamp, Theo D; Sparreboom-Kalaykova, Stanimira I; Stam, Marloes; van den Berg, Leonard H; Steenks, Michel H; van der Pol, W Ludo

    2014-09-16

    We performed a study in patients with proximal spinal muscular atrophy (SMA) to determine the prevalence of reduced maximal mouth opening (MMO) and its association with dysphagia as a reflection of bulbar dysfunction and visualized the underlying mechanisms using MRI. We performed a cross-sectional study of MMO in 145 patients with SMA types 1-4 and 119 healthy controls and used MRI in 12 patients to visualize mandibular condylar shape and sliding and the anatomy of muscle groups relevant for mouth opening and closing. We analyzed associations of reduced MMO with SMA severity and complaints of dysphagia. Reduced MMO was defined as an interincisal distance ≤ 35 mm and was found in none of the healthy controls and in 100%, 79%, 50%, and 7% of patients with SMA types 1, 2, 3a, and 3b/4, respectively. MRI showed severe fatty degeneration of the lateral pterygoid muscles that mediate mouth opening by allowing mandibular condylar sliding but relatively mild involvement of the mouth closing muscles in patients with reduced MMO. Reduced MMO was associated with SMA type, age, muscle weakness, and dysphagia (p SMA types 1-3a and is mainly caused by fatty degeneration of specific mouth opening muscles. Reduced MMO is a sign of bulbar dysfunction in SMA. © 2014 American Academy of Neurology.

  6. Validity of conducting clinical dysphagia assessments for patients with normal to mild cognitive impairment via telerehabilitation.

    Science.gov (United States)

    Ward, Elizabeth C; Sharma, Shobha; Burns, Clare; Theodoros, Deborah; Russell, Trevor

    2012-12-01

    To assess the validity of conducting clinical dysphagia assessments via telerehabilitation, 40 individuals with dysphagia from various etiologies were assessed simultaneously by a face-to-face speech-language pathologist (FTF-SLP) and a telerehabilitation SLP (T-SLP) via an Internet-based videoconferencing telerehabilitation system. Dysphagia status was assessed using a Clinical Swallowing Examination (CSE) protocol, delivered via a specialized telerehabilitation videoconferencing system and involving the use of an assistant at the patient's end of the consultation to facilitate the assessment. Levels of agreement between the FTF-SLP and T-SLP revealed that the majority of parameters reached set levels of clinically acceptable levels of agreement. Specifically, agreement between the T-SLP and FTF-SLP ratings for the oral, oromotor, and laryngeal function tasks revealed levels of exact agreement ranging from 75 to 100% (kappa = 0.36-1.0), while the parameters relating to food and fluid trials ranged in exact agreement from 79 to 100% (kappa = 0.61-1.0). Across the parameters related to aspiration risk and clinical management, exact agreement ranged between 79 and 100% (kappa = 0.49-1.0). The data show that a CSE conducted via telerehabilitation can provide valid and reliable outcomes comparable to clinical decisions made in the FTF environment.

  7. Surface electromyography as a screening method for evaluation of dysphagia and odynophagia

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    Eviatar Ephraim

    2009-02-01

    Full Text Available Abstract Objective Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition. Data sources Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949–2007 and EMBASE (1975–2007. Methods Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles, the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc. Results According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia. Conclusion With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia.

  8. Surface electromyography as a screening method for evaluation of dysphagia and odynophagia

    Science.gov (United States)

    Vaiman, Michael; Eviatar, Ephraim

    2009-01-01

    Objective Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. The article analyzes various instrumental methods of dysphagia assessment, introduces surface electromyography (sEMG) to carry out rapid assessment of such patients, and debates proposed suggestions for sEMG screening protocol in order to identify abnormal deglutition. Data sources Subject related books and articles from 1813 to 2007 were obtained through library search, MEDLINE (1949–2007) and EMBASE (1975–2007). Methods Specifics steps for establishing the protocol for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. SEMG is compared with other techniques in terms of cost, timing, involvement of radiation, etc. Results According to the published data, SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, time-saving and inexpensive to perform. The major weakness of the method seems to be inability for precise diagnostic of neurologically induced dysphagia. Conclusion With standardization of the technique and an established normative database, sEMG might serve as a reliable screening method for optimal patient management but cannot serve for proper investigation of neurogenic dysphagia. PMID:19232090

  9. Electrophysiological Evaluation of Oropharyngeal Dysphagia in Parkinson’s Disease

    Science.gov (United States)

    Ertekin, Cumhur

    2014-01-01

    Parkinson’s disease (PD) is a chronic, neurodegenerative movement disorder that typically affects elderly patients. Swallowing disorders are highly prevalent in PD and can have grave consequences, including pneumonia, malnutrition, dehydration and mortality. Neurogenic dysphagia in PD can manifest with both overt clinical symptoms or silent dysphagia. Regardless, early diagnosis and objective follow-up of dysphagia in PD is crucial for timely and appropriate care for these patients. In this review, we provide a comprehensive summary of the electrophysiological methods that can be used to objectively evaluate dysphagia in PD. We discuss the electrophysiological abnormalities that can be observed in PD, their clinical correlates and the pathophysiology underlying these findings. PMID:25360228

  10. Electrophysiological Evaluation of Oropharyngeal Dysphagia in Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Cumhur Ertekin

    2014-10-01

    Full Text Available Parkinson’s disease (PD is a chronic, neurodegenerative movement disorder that typically affects elderly patients. Swallowing disorders are highly prevalent in PD and can have grave consequences, including pneumonia, malnutrition, dehydration and mortality. Neurogenic dysphagia in PD can manifest with both overt clinical symptoms or silent dysphagia. Regardless, early diagnosis and objective follow-up of dysphagia in PD is crucial for timely and appropriate care for these patients. In this review, we provide a comprehensive summary of the electrophysiological methods that can be used to objectively evaluate dysphagia in PD. We discuss the electrophysiological abnormalities that can be observed in PD, their clinical correlates and the pathophysiology underlying these findings.

  11. Dysphagia lusorium in elderly:A case report

    Institute of Scientific and Technical Information of China (English)

    Bulent Kantarceken; Ertan Bulbuloglu; Murvet Yuksel; Ali Cetinkaya

    2004-01-01

    AIM: Late unset of dysphagia due to vascular abnormalities is a rare condition. We aimed to present a case of right subclavian artery abnormalities caused dysphagia in the elderly.METHODS: A 68-year-old female was admitted with dysphagia seven months ago. Upper endoscopic procedures and routine examinations could not demonstrate any etiology. Multislice computed thorax tomography was performed for probable extra- esophagial lesions.RESULTS: Multislice computed thorax tomography showed right subclavian artery abnormality and esophagial compression with this aberrant artery.CONCLUSION: Causes of dysphagia in the elderly are commonly malignancies, strictures and/or motility disorders. If routine examinations and endoscopic procedures fail to show any etiology, rare vascular abnormalities can be considered in such patients. Multislice computed tomography is a usefull choice in such conditions.

  12. Validation of the videofluoroscopic dysphagia scale in various etiologies.

    Science.gov (United States)

    Kim, Juyong; Oh, Byung-Mo; Kim, Jung Yoon; Lee, Goo Joo; Lee, Seung Ah; Han, Tai Ryoon

    2014-08-01

    The videofluoroscopic dysphagia scale (VDS) was developed as an objective predictor of the prognosis of dysphagia after stroke. We evaluated the clinical validity of the VDS for various diseases. We reviewed the medical records of 1,995 dysphagic patients (1,222 men and 773 women) who underwent videofluoroscopic studies in Seoul National University Hospital from April 2002 through December 2009. Their American Speech–Language–Hearing Association’s National Outcome Measurement System (ASHA NOMS) swallowing scale, clinical dysphagia scale (CDS), and VDS scores were evaluated on the basis of the clinical and/or videofluoroscopic findings by the consensus of two physiatrists. The correlations between the VDS and the other scales were calculated. The VDS displayed significant correlations with the ASHA NOMS swallowing scale and the CDS in every disease group (p dysphagia

  13. MeCP2 post-translational modifications: a mechanism to control its involvement in synaptic plasticity and homeostasis?

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    Elisa eBellini

    2014-08-01

    Full Text Available Although Rett syndrome (RTT represents one of the most frequent forms of severe intellectual disability in females worldwide, we still have an inadequate knowledge of the many roles played by MeCP2 (whose mutations are responsible for most cases of RTT and their relevance for RTT pathobiology. Several studies support a role of MeCP2 in the regulation of synaptic plasticity and homeostasis. At the molecular level, MeCP2 is described as a repressor capable of inhibiting gene transcription through chromatin compaction. Indeed, it interacts with several chromatin remodeling factors, such as HDAC-containing complexes and ATRX. Other studies have inferred that MeCP2 functions also as an activator; a role in regulating mRNA splicing and in modulating protein synthesis has also been proposed. Further, MeCP2 avidly binds both 5-methyl- and 5-hydroxymethyl-cytosine. Recent evidence suggests that it is the highly disorganized structure of MeCP2, together with its post-translational modifications (PTMs that generate and regulate this functional versatility. Indeed, several reports have demonstrated that differential phosphorylation of MeCP2 is a key mechanism by which the methyl binding protein modulates its affinity for its partners, gene expression and cellular adaptations to stimuli and neuronal plasticity. As logic consequence, generation of phospho-defective Mecp2 knock-in mice has permitted associating alterations in neuronal morphology, circuit formation, and mouse behavioral phenotypes with specific phosphorylation events. MeCP2 undergoes various other PTMs, including acetylation, ubiquitination and sumoylation, whose functional roles remain largely unexplored. These results, together with the genome-wide distribution of MeCP2 and its capability to substitute histone H1, recall the complex regulation of histones and suggest the relevance of quickly gaining a deeper comprehension of MeCP2 PTMs, the respective writers and readers and the consequent

  14. Dysphagia produced by cervical spine osteophyte. A case report

    Directory of Open Access Journals (Sweden)

    Claudio Silveri

    2014-01-01

    Full Text Available We present a case of a 73-year-old male patient with progressive dysphagia, and hoarseness (irritability in the throat. He was studied with the appropriate imaging techniques, and esophagoscopy led to a diagnosis of extrinsic esophageal dysphagia for osteophyte obstruction of the cervical spine due to the arthrosis. A surgical resection was performed, without complications. Some considerations are given on this theme.

  15. Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke.

    Science.gov (United States)

    Joundi, Raed A; Martino, Rosemary; Saposnik, Gustavo; Giannakeas, Vasily; Fang, Jiming; Kapral, Moira K

    2017-04-01

    Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke. © 2017 American Heart Association, Inc.

  16. The challenges of managing dysphagia in brain-injured patients.

    Science.gov (United States)

    Mayer, Victoria

    2004-02-01

    Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury. Assessment of dysphagia is normally undertaken by speech and language therapists in conjunction with the multidisciplinary team. A bedside screening assessment may be augmented by instrumental assessment, such as videofluoroscopy, in cases where silent aspiration of food or liquid into the lungs is suspected. Dysphagia is treated using a variety of strategies, depending on the presenting symptoms. Individuals with dysphagia following traumatic brain injury present with particular difficulties, relating to impairments of cognition, communication and behavioural control. A description of the normal swallow is presented below with a review of dysphagic disorders, assessment methods and management. This is followed by a case account of a young man with dysphagia subsequent to traumatic brain injury to highlight some of the difficulties which can be encountered in the management of dysphagia.

  17. Development of the Arabic Version of Dysphagia Handicap Index (DHI).

    Science.gov (United States)

    Farahat, Mohamed; Malki, Khalid H; Mesallam, Tamer A; Bukhari, Manal; Alharethy, Sami

    2014-08-01

    The Dysphagia Handicap Index (DHI) is a 25-item self-administered questionnaire. It is a noninvasive tool for measuring the handicapping effect of dysphagia on the physical, functional, and emotional aspects of people's lives. The purposes of the present study were to develop an Arabic version of the DHI and to evaluate its validity, consistency, and reliability in the normal Arabic population with oropharyngeal dysphagia. This was a prospective study that was carried out at the Communication and Swallowing Disorders Unit, King Saud University. The generated Arabic DHI was administered to 94 patients with oropharyngeal dysphagia and 98 control subjects. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared. The Arabic DHI showed excellent internal consistency (Cronbach's α = 0.95). Also, good test-retest reliability was found for the total scores of the Arabic DHI (r = 0.9, p = 0.001). There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (p DHI is a valid tool for self-assessment of the handicapping effect of dysphagia on the physical, functional, and emotional aspects of patients and can be used by Arabic language speakers.

  18. Management of acid-related disorders in patients with dysphagia.

    Science.gov (United States)

    Howden, Colin W

    2004-09-06

    Dysphagia affects a large and growing number of individuals in the United States, particularly the elderly and those who are neurologically impaired. Swallowing difficulties may be due to age-related changes in oropharyngeal and esophageal functioning as well as central nervous system diseases such as stroke, Parkinson disease, and dementia. Among institutionalized individuals, dysphagia is associated with increased morbidity and mortality. An appreciation of the physiology of swallowing and the pathophysiology of dysphagia is necessary for proper patient management. Careful history, physical examination, and evaluation of radiologic and endoscopic studies should differentiate oropharyngeal and esophageal etiologies of dysphagia and distinguish mechanical (anatomic) disorders from functional (motor) disorders. A significant percentage of patients with dysphagia have concomitant acid-related disorders that are managed best with proton pump inhibitor (PPI) therapy. Three of the currently available PPIs are manufactured as capsules containing enteric-coated granules that may be mixed with soft foods or fruit juices before oral administration to those with swallowing difficulties. In addition, omeprazole and lansoprazole may be administered via gastrostomy or nasogastric feeding tubes as suspensions in sodium bicarbonate. Novel dosage formulations of lansoprazole that may be appropriate for patients with dysphagia include the commercially manufactured lansoprazole strawberry-flavored enteric-coated granules for suspension and lansoprazole orally disintegrating tablets.

  19. Modification of hydrological properties in a fine textured soil following field application of pelletized biochar: investigation of the mechanism involved.

    Science.gov (United States)

    Costanza Andrenelli, Maria; Mocali, Stefano; Pellegrini, Sergio; Vignozzi, Nadia

    2016-04-01

    The application of pelletized biochar is seldom employed in field, and its effect on soil hydrological behaviour scarcely investigated. Biochar is usually added in powdered or granular form to improve the homogeneity of distribution, meanwhile favouring its interaction with soil matrix. In this study we evaluated the possibility of applying pelletized biochar as soil conditioner to enhance, during a single cropping season, the hydrological behaviour of a silty clay loam soil prone to structure degradation. For that purpose, the water retention curves (WRCs) were determined on undisturbed soil samples (0-15 cm) three months after the addition, at the rate of 14 Mg ha-1, of two differently pyrolyzed biochars (B1 and B2). Starting from the WRCs the pore size distribution was determined. The gravimetric water content at both field capacity (-10 kPa) and wilting point (-1,500 kPa) was also measured on biochar samples to assess their available water capacity (AWC). In both the treatments, soil bulk density (BD) was significantly lower compared to control, apparently as direct consequence of the addition of low density pellets. Actually, excluding the intrinsic biochar porosity from soil bulk density calculation, BD values of the treated soils remain lower of around 10% over control. Such findings suggest that a modification of soil structural characteristics might have been induced by pellet addition. Data of the WRCs indicate a significant increase of transmission (500-50 micron), storage (50-0.5 micron) and AWC pores (30-0.2 micron) in the amended soils. The two biochars affected the AWC by direct pore contribution, but the extent of such effect was related to the biochar type: the tested pelletized biomass seems to have positive effects provided that the pyrolysis temperature does not exceed 800°C, as in the case of B1. The overall hydrological improvement might be correlated to both the inherent biochar retention capacity and a merely mechanical process of

  20. Behavior Modification in Coaching.

    Science.gov (United States)

    Lynch, Annette Rutt; Stillman, Stephen M.

    1979-01-01

    An example of behavior modification used in athletic coaching is presented. The case study involves a member of a women's basketball team and details the use of behavior modification for both weight reduction and skill improvement. (JMF)

  1. Electrophysiological Evaluation of Dysphagia in the Mild or Moderate Patients with Multiple Sclerosis: A Concept of Subclinical Dysphagia.

    Science.gov (United States)

    Beckmann, Yesim; Gürgör, Nevin; Çakır, Ahmet; Arıcı, Şehnaz; İncesu, Tülay Kurt; Seçil, Yaprak; Ertekin, Cumhur

    2015-06-01

    Swallowing mechanism and neurogenic dysphagia in MS have been rarely studied by electromyographical (EMG) methods. This study aims to evaluate the presence of subclinical dysphagia in patients with mild multiple sclerosis (MS) using electrophysiological methods. A prospective study of 51 patients with relapsing remitting multiple sclerosis and 18 age-matched healthy adults was investigated. We used electromyography to measure the activity of the submental muscles during swallowing. Electrophysiological recordings of patients were obtained during relapse, after relapse, and at any time in remission period. Clinical dysphagia was found in 12% of MS patients, while electrophysiological swallowing abnormalities were encountered in 33% of patients. Subclinical dysphagia was determined in 35% of patients during an MS relapse, in 20% of patients after a relapse, and in 25% of all 51 patients in the remission period based on EMG findings. Duration of swallowing signal of submental muscles in all MS patients was found to be longer than in normal subjects (p = 0.001). During swallowing of 50 ml of sequential water, the compensatory respiratory cycles occurred more often in MS patients than normal subjects, especially during a relapse (p = 0.005). This is the first study investigating swallowing abnormalities and subclinical dysphagia from the electrophysiological aspect in MS patients with mild disability. The electrophysiological tests described in this study are useful to uncover subclinical dysphagia since they have the advantage of being rapid, easy to apply, non-invasive, and without risk for the patients.

  2. The value of scintigraphy in the evaluation of oropharyngeal dysphagia.

    Science.gov (United States)

    Argon, Murat; Secil, Yaprak; Duygun, Ulkem; Aydogdu, Ibrahim; Kocacelebi, Kenan; Ozkilic, Hayal; Ertekin, Cumhur

    2004-01-01

    Healthy adults can swallow boluses of 20 ml water in a single swallow. Individuals with impaired swallowing, however, may be unable to do so, instead requiring two or more swallows; this phenomenon is called "piecemeal deglutition". The term "dysphagia limit" refers to the volume at which piecemeal deglutition occurs. The aim of our study was to investigate the potential value of scintigraphic evaluation of piecemeal deglutition and dysphagia limit in patients with dysphagia, based on correlation with the results of submental electromyography (SM-EMG) and laryngeal sensor monitoring (LS). The study population comprised 24 patients with dysphagia secondary to neurological disorders and ten normal adults, who formed a control group. In the scintigraphic evaluation, subjects underwent four separate dynamic studies using 5, 10, 15 and 20 ml of water containing 0.5 mCi technetium-99m labelled sulphur colloid, and time-activity curves (TACs) were created for each study. Static thoracic images were also recorded in order to detect airway aspiration Observation of two or more peaks on TACs within the 10-s acquisition period was considered a sign of piecemeal deglutition. If piecemeal deglutition occurred at or below 20 ml, this volume was regarded as the dysphagia limit. Piecemeal deglutition was not found in any normal subjects; by contrast, it was observed in 14 of the 24 (58%) patients on scintigraphy and in 17 (71%) patients on EMG and LS. In three patients, signs of the airway aspiration were observed on static thoracic images. Scintigraphic and electrophysiological findings were in agreement in 19 patients (79%), and the correlation between scintigraphy and the electrophysiological methods for the evaluation of dysphagia was statistically significant (r=0.57, P=0.003). The novel finding of this study is the demonstration of piecemeal deglutition and dysphagia limit on scintigraphic studies in patients with neurogenic dysphagia. Based on this finding we consider that

  3. The value of scintigraphy in the evaluation of oropharyngeal dysphagia

    Energy Technology Data Exchange (ETDEWEB)

    Argon, Murat; Duygun, Uelkem; Kocacelebi, Kenan; Ozkilic, Hayal [Department of Nuclear Medicine, Ege University Medical School Hospital, 35100, Bornova, Izmir (Turkey); Secil, Yaprak; Aydogdu, Ibrahim; Ertekin, Cumhur [Department of Clinical Neurophysiology, Ege University Medical School Hospital, Izmir (Turkey)

    2004-01-01

    Healthy adults can swallow boluses of 20 ml water in a single swallow. Individuals with impaired swallowing, however, may be unable to do so, instead requiring two or more swallows; this phenomenon is called ''piecemeal deglutition''. The term ''dysphagia limit'' refers to the volume at which piecemeal deglutition occurs. The aim of our study was to investigate the potential value of scintigraphic evaluation of piecemeal deglutition and dysphagia limit in patients with dysphagia, based on correlation with the results of submental electromyography (SM-EMG) and laryngeal sensor monitoring (LS). The study population comprised 24 patients with dysphagia secondary to neurological disorders and ten normal adults, who formed a control group. In the scintigraphic evaluation, subjects underwent four separate dynamic studies using 5, 10, 15 and 20 ml of water containing 0.5 mCi technetium-99m labelled sulphur colloid, and time-activity curves (TACs) were created for each study. Static thoracic images were also recorded in order to detect airway aspiration Observation of two or more peaks on TACs within the 10-s acquisition period was considered a sign of piecemeal deglutition. If piecemeal deglutition occurred at or below 20 ml, this volume was regarded as the dysphagia limit. Piecemeal deglutition was not found in any normal subjects; by contrast, it was observed in 14 of the 24 (58%) patients on scintigraphy and in 17 (71%) patients on EMG and LS. In three patients, signs of the airway aspiration were observed on static thoracic images. Scintigraphic and electrophysiological findings were in agreement in 19 patients (79%), and the correlation between scintigraphy and the electrophysiological methods for the evaluation of dysphagia was statistically significant (r=0.57, P=0.003). The novel finding of this study is the demonstration of piecemeal deglutition and dysphagia limit on scintigraphic studies in patients with neurogenic

  4. Standardization of surface electromyography utilized to evaluate patients with dysphagia.

    Science.gov (United States)

    Vaiman, Michael

    2007-06-06

    Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. We introduce surface electromyography (sEMG) to carry out rapid assessment of such patients and propose suggestions for standardizing sEMGs in order to identify abnormal deglutition. Specifics steps for establishing standards for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. A previously described normative database for single swallowing and drinking and standard approach to analysis was compared to data on the duration and electric activity of muscles involved in deglutition and with sEMG recordings in order to estimate stages of a swallow. SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, timesaving and inexpensive to perform. With standardization of the technique and an established normative database, sEMG can serve as a reliable screening method for optimal patient management.

  5. Standardization of surface electromyography utilized to evaluate patients with dysphagia

    Directory of Open Access Journals (Sweden)

    Vaiman Michael

    2007-06-01

    Full Text Available Abstract Backgorund Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. We introduce surface electromyography (sEMG to carry out rapid assessment of such patients and propose suggestions for standardizing sEMGs in order to identify abnormal deglutition. Methods Specifics steps for establishing standards for applying the technique for screening purposes (e.g., evaluation of specific muscles, the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water are presented in detail. A previously described normative database for single swallowing and drinking and standard approach to analysis was compared to data on the duration and electric activity of muscles involved in deglutition and with sEMG recordings in order to estimate stages of a swallow. Conclusion SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, timesaving and inexpensive to perform. With standardization of the technique and an established normative database, sEMG can serve as a reliable screening method for optimal patient management.

  6. Global identification of multiple OsGH9 family members and their involvement in cellulose crystallinity modification in rice.

    Directory of Open Access Journals (Sweden)

    Guosheng Xie

    Full Text Available Plant glycoside hydrolase family 9 (GH9 comprises typical endo-β-1,4-glucanase (EGases, EC3.2.1.4. Although GH9A (KORRIGAN family genes have been reported to be involved in cellulose biosynthesis in plants, much remains unknown about other GH9 subclasses. In this study, we observed a global gene co-expression profiling and conducted a correlation analysis between OsGH9 and OsCESA among 66 tissues covering most periods of life cycles in 2 rice varieties. Our results showed that OsGH9A3 and B5 possessed an extremely high co-expression with OsCESA1, 3, and 8 typical for cellulose biosynthesis in rice. Using two distinct rice non-GH9 mutants and wild type, we performed integrative analysis of gene expression level by qRT-PCR, cellulase activities in situ and in vitro, and lignocellulose crystallinity index (CrI in four internodes of stem tissues. For the first time, OsGH9B1, 3, and 16 were characterized with the potential role in lignocellulose crystallinity alteration in rice, whereas OsGH9A3 and B5 were suggested for cellulose biosynthesis. In addition, phylogenetic analysis and gene co-expression comparison revealed GH9 function similarity in Arabidopsis and rice. Hence, the data can provide insights into GH9 function in plants and offer the potential strategy for genetic manipulation of plant cell wall using the five aforementioned novel OsGH9 genes.

  7. Oral Burning With Dysphagia and Weight Loss.

    Science.gov (United States)

    Seccia, Teresa Maria; Rossitto, Giacomo; Calò, Lorenzo A; Rossi, Gian Paolo

    2015-08-01

    Fibromyalgia is a disorder characterized by an abnormal pain regulation. Widespread pain, fatigue, and sleep disturbance are the prevalent symptoms. When unusual symptoms are overbearingly predominant at clinical presentation, the diagnosis becomes challenging.We report on the case of a patient with fibromyalgia, who presented with dysphagia, odynophagia, and glossodynia as prevalent symptoms. Difficulty in swallowing gradually developed over a month prior hospitalization, and worsened progressively so that nourishment and fluid intake were impeded.Because anemia with mild iron deficiency was found, esophagogastroduodenoscopy was performed, but no lesions were seen in the upper digestive tract. Levels of zinc and vitamin B12 were normal. Intense pain at pelvis and the inferior limbs, which was at a first glance referred to as osteoarthrosis, associated with oral symptoms and feeling of being in the clouds allowed us to diagnose fibromyalgia. Amitriptyline was used, with relief of symptoms.Although oropharyngeal symptoms were occasionally reported in fibromyalgia, they are often overlooked. The present case, therefore, testifies the need to consider the diagnosis of fibromyalgia when the patient presents with such symptoms that cannot be readily explained on other grounds.

  8. Cryostimulation improves recovery from oropharyngeal dysphagia after stroke.

    Science.gov (United States)

    Zart, Patrícia; Levy, Deborah Salle; Bolzan, Geovana de Paula; Mancopes, Renata; da Silva, Ana Maria Toniolo

    2013-01-01

     Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia.  To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke.  Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue) 3 times a day (for a total of 30 daily applications per structure) for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test.  Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects.  Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

  9. Cryostimulation improves recovery from oropharyngeal dysphagia after stroke

    Directory of Open Access Journals (Sweden)

    Silva, Ana Maria Toniolo da

    2013-01-01

    Full Text Available Introduction: Stroke is considered one of the most frequent neurological causes of oropharyngeal dysphagia. Aim: To determine the effect of cryostimulation on oropharyngeal sensitivity and, subsequently, on the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. Methods: Clinical and experimental study. The study enrolled 7 adult subjects, 6 men and 1 woman ranging from 28 to 64 years of age, with a diagnosis of stroke and current oropharyngeal dysphagia without any other underlying disease. The selected subjects underwent speech-language pathology evaluation and videofluoroscopic assessment of the dysphagia. The subjects were then treated with cryostimulation consisting of 10 applications to each structure (anterior faucial pillar, posterior oropharyngeal wall, soft palate, and back tongue 3 times a day (for a total of 30 daily applications per structure for 4 consecutive days. The patients were then re-evaluated based on the same criteria. The pre- and post-cryostimulation results of the clinical and videofluoroscopic evaluations were analyzed descriptively and statistically using Student's t-test and Fisher's exact test. Results: Cryostimulation had beneficial effects on oropharyngeal sensitivity in 6 of the 7 subjects. There was also a significant improvement in swallowing and in the premature escape in six subjects. Conclusion: Cryostimulation increased sensitivity and subsequently improved the swallowing reaction and premature escape of food in patients with neurogenic dysphagia after stroke. These effects were evident by both speech-language pathology and videofluoroscopic evaluation.

  10. Hard to Swallow: Developmental Biological Insights into Pediatric Dysphagia

    Science.gov (United States)

    LaMantia, Anthony-Samuel; Moody, Sally A.; Maynard, Thomas M.; Karpinski, Beverly A.; Zohn, Irene E.; Mendelowitz, David; Lee, Norman H.; Popratiloff, Anastas

    2015-01-01

    Pediatric dysphagia—feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity—is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties. Altered hindbrain patterning, neural crest migration, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may reflect disrupted hindbrain patterning and its impact on neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia. PMID:26554723

  11. Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation.

    Science.gov (United States)

    Wesling, Michele; Brady, Susan; Jensen, Mary; Nickell, Melissa; Statkus, Donna; Escobar, Nelson

    2003-01-01

    The purpose of this retrospective study was to compare functional dysphagia outcomes following inpatient rehabilitation for patients with brain tumors with that of patients following a stroke. Group 1 (n = 24) consisted of consecutive admissions to the brain injury program with the diagnosis of brain tumor and dysphagia. Group 2 (n = 24) consisted of matched, consecutive admissions, with the diagnosis of acute stroke and dysphagia. Group 2 was matched for age, site of lesion, and initial composite cognitive FIM score. The main outcome measures for this study included the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, length of stay, hospital charges, and medical complications. Results showed that swallowing gains made by both groups as evaluated by the admission and discharge ASHA NOMS levels were considered to be statistically significant. The differences for length of stay, total hospital charges, and speech charges between the two groups were not considered to be statistically significant. Three patients in the brain tumor group (12.5%) demonstrated dysphagia complications of either dehydration or pneumonia during their treatment course as compared to 0% in the stroke group. This study confirms that functional dysphagia gains can be achieved for patients with brain tumors undergoing inpatient rehabilitation and that they should be afforded the same type and intensity of rehabilitation for their swallowing that is provided to patients following a stroke.

  12. Compensatory recombination phenomena of neurological functions in central dysphagia patients

    Institute of Scientific and Technical Information of China (English)

    Xiao-dong Yuan; Li-fu Zhou; Shu-juan Wang; Yan-sheng Zhao; Xiao-jie Wang; Li-li Zhang; Shou-hong Wang; Ya-jie Zhang; Li Chen

    2015-01-01

    We speculate that cortical reactions evoked by swallowing activity may be abnormal in patients with central infarction with dysphagia. The present study aimed to detect functional imaging features of cerebral cortex in central dysphagia patients by using blood oxygen level-depen-dent functional magnetic resonance imaging techniques. The results showed that when normal controls swallowed, primary motor cortex (BA4), insula (BA13), premotor cortex (BA6/8), supramarginal gyrus (BA40), and anterior cingulate cortex (BA24/32) were activated, and that the size of the activated areas were larger in the left hemisphere compared with the right. In re-current cerebral infarction patients with central dysphagia, BA4, BA13, BA40 and BA6/8 areas were activated, while the degree of activation in BA24/32 was decreased. Additionally, more areas were activated, including posterior cingulate cortex (BA23/31), visual association cortex (BA18/19), primary auditory cortex (BA41) and parahippocampal cortex (BA36). Somatosen-sory association cortex (BA7) and left cerebellum in patients with recurrent cerebral infarction with central dysphagia were also activated. Experimental ifndings suggest that the cerebral cortex has obvious hemisphere lateralization in response to swallowing, and patients with recurrent cerebral infarction with central dysphagia show compensatory recombination phenomena of neurological functions. In rehabilitative treatment, using the favorite food of patients can stimu-late swallowing through visual, auditory, and other nerve conduction pathways, thus promoting compensatory recombination of the central cortex functions.

  13. Compensatory recombination phenomena of neurological functions in central dysphagia patients

    Directory of Open Access Journals (Sweden)

    Xiao-dong Yuan

    2015-01-01

    Full Text Available We speculate that cortical reactions evoked by swallowing activity may be abnormal in patients with central infarction with dysphagia. The present study aimed to detect functional imaging features of cerebral cortex in central dysphagia patients by using blood oxygen level-dependent functional magnetic resonance imaging techniques. The results showed that when normal controls swallowed, primary motor cortex (BA4, insula (BA13, premotor cortex (BA6/8, supramarginal gyrus (BA40, and anterior cingulate cortex (BA24/32 were activated, and that the size of the activated areas were larger in the left hemisphere compared with the right. In recurrent cerebral infarction patients with central dysphagia, BA4, BA13, BA40 and BA6/8 areas were activated, while the degree of activation in BA24/32 was decreased. Additionally, more areas were activated, including posterior cingulate cortex (BA23/31, visual association cortex (BA18/19, primary auditory cortex (BA41 and parahippocampal cortex (BA36. Somatosensory association cortex (BA7 and left cerebellum in patients with recurrent cerebral infarction with central dysphagia were also activated. Experimental findings suggest that the cerebral cortex has obvious hemisphere lateralization in response to swallowing, and patients with recurrent cerebral infarction with central dysphagia show compensatory recombination phenomena of neurological functions. In rehabilitative treatment, using the favorite food of patients can stimulate swallowing through visual, auditory, and other nerve conduction pathways, thus promoting compensatory recombination of the central cortex functions.

  14. Oral muscles are progressively affected in Duchenne muscular dystrophy: implications for dysphagia treatment

    NARCIS (Netherlands)

    Engel-Hoek, L. van den; Erasmus, C.E.; Hendriks, J.C.M.; Geurts, A.C.H.; Klein, W.M.; Pillen, S.; Sie, L.T.L.; Swart, B.J.M. de; Groot, I.J.M. de

    2013-01-01

    Dysphagia is reported in advanced stages of Duchenne muscular dystrophy (DMD). The population of DMD is changing due to an increasing survival. We aimed to describe the dysphagia in consecutive stages and to assess the underlying mechanisms of dysphagia in DMD, in order to develop mechanism based

  15. Family Perceptions of Facilitators and Inhibitors of Effective School-Based Dysphagia Management

    Science.gov (United States)

    Angell, Maureen E.; Bailey, Rita L.; Stoner, Julia B.

    2008-01-01

    Purpose: This qualitative study focused on the perceptions of family members of children with dysphagia by asking what the family-identified factors are that facilitate or inhibit effective school-based management of pediatric dysphagia. Method: Semistructured interviews of 7 family members of 6 children with dysphagia, ages 2 through 11 years,…

  16. Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases

    NARCIS (Netherlands)

    Knuijt, Simone; Kalf, Johanna G.; de Swart, Bert J. M.; Drost, Gea; Hendricks, Henk T.; Geurts, Alexander C. H.; van Engelen, Baziel G. M.

    2014-01-01

    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

  17. Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases

    NARCIS (Netherlands)

    Knuijt, S.; Kalf, J.G.; Swart, B.J. de; Drost, G.; Hendricks, H.T.; Geurts, A.C.; Engelen, B.G. van

    2014-01-01

    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

  18. Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases

    NARCIS (Netherlands)

    Knuijt, S.; Kalf, J.G.; Swart, B.J. de; Drost, G.; Hendricks, H.T.; Geurts, A.C.; Engelen, B.G. van

    2014-01-01

    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 p

  19. Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases

    NARCIS (Netherlands)

    Knuijt, Simone; Kalf, Johanna G.; de Swart, Bert J. M.; Drost, Gea; Hendricks, Henk T.; Geurts, Alexander C. H.; van Engelen, Baziel G. M.

    2014-01-01

    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 p

  20. The effect of pneumatic dilation in management of postfundoplication dysphagia.

    Science.gov (United States)

    Sunjaya, D; Podboy, A; Blackmon, S H; Katzka, D; Halland, M

    2017-06-01

    Fundoplication surgery is a commonly performed procedure for gastro-esophageal reflux disease or hiatal hernia repair. Up to 10% of patients develop persistent postoperative dysphagia after surgery. Data on the effectiveness of pneumatic dilation for treatment are limited. The aim of this study was to evaluate clinical outcomes and identify clinical factors associated with successful response to pneumatic dilation among patients with persistent postfundoplication dysphagia (PPFD). We retrospectively evaluated patients who had undergone pneumatic dilation for PPFD between 1999 and 2016. Patients with dysphagia or achalasia prior to fundoplication were excluded. Demographic information, surgical history, severity of dysphagia, and clinical outcomes were collected. Data pertaining to esophagram, manometry, endoscopy, and pneumatic dilation were also collected. We identified 38 patients (82% female, 95% Caucasian, and median age 59 years) with PPFD who completed pneumatic dilation. The median postfundoplication dysphagia score was 2. Eleven patients had abnormal peristalsis on manometry. Seventeen patients reported response (seven complete) with an average decrease of 1 in their dysphagia score. Fifteen patients underwent reoperation due to PPFD. Hiatal hernia repair was the only factor that predicts a higher response rate to pneumatic dilation. Only one patient in our study developed complication (pneumoperitoneum) from pneumatic dilation. We found that pneumatic dilation to be a safe treatment option for PPFD with moderate efficacy. Patients who developed PPFD after a hiatal hernia repair may gain the greatest benefit after pneumatic dilation. We were not able to identify additional clinical, radiological, endoscopic, or manometric parameters that were predictive of response. © 2017 John Wiley & Sons Ltd.

  1. Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: a cross-sectional study.

    Science.gov (United States)

    van den Berg, Manon G A; Rütten, Heidi; Rasmussen-Conrad, Ellen L; Knuijt, Simone; Takes, Robert P; van Herpen, Carla M L; Wanten, Geert J A; Kaanders, Johannes H A M; Merkx, Matthias A W

    2014-01-01

    The aim of this study was to evaluate nutritional status, food intake, and dysphagia in long-term head and neck cancer survivors. Thirty-two patients with stage III-IV head and neck cancer treated by chemoradiotherapy were invited to evaluate nutritional status (malnutrition, relative weight loss), food intake (food modification; quality), and dysphagia. At a median follow up of 44 months, 6 of 32 patients were at risk for malnutrition. Women (p = .049) and patients with high body mass index before treatment (p = .024) showed more weight loss. None of the 32 patients could eat a "full diet." Six patients used nutritional supplements/tube feeding. Low dysphagia-related quality of life scores were significantly correlated to increased food modification (r = 0.405; p = .024). Nutritional advice in patients with head and neck cancer is still necessary years after chemoradiation and should focus on nutritional status, food modification, and quality, in accord with recommended food groups. Copyright © 2013 Wiley Periodicals, Inc.

  2. Pulmonary hyalinizing granuloma presenting with dysphagia: a rare presentation.

    Science.gov (United States)

    Khan, Fazal; Hamid, Arsalan; Fatima, Benish; Hashmi, Shiraz; Fatimi, Saulat

    2017-01-01

    A 25-year-old man presented with a 2-month history of dysphagia and past history of pulmonary and intestinal tuberculosis. A barium swallow showed a point of constriction 42 mm above the gastroesophageal junction. Computed tomography revealed large opacities in bilateral lung fields, encroaching more on the esophagus. The lesion progressively compressed the esophagus as it moved inferiorly. A right posterolateral thoracotomy was performed for sub-anatomical resection of the mass. A biopsy revealed homogenous whirling hyalinized collagen fibers, highly suggestive of pulmonary hyalinizing granuloma, with no evidence of malignancy. Pulmonary hyalinizing granuloma should be considered in the differential diagnosis of longstanding dysphagia.

  3. Dysphagia after radiotherapy: state of the art and prevention.

    Science.gov (United States)

    Servagi-Vernat, S; Ali, D; Roubieu, C; Durdux, C; Laccourreye, O; Giraud, P

    2015-02-01

    Adjuvant radiotherapy after surgery or exclusive radiotherapy, with or without concurrent chemotherapy is a valuable treatment option in the great majority of patients with head and neck cancer. Recent technical progress in radiotherapy has resulted in a decreased incidence of xerostomia. Another common toxicity of radiotherapy is dysphagia, which alters the nutritional status and quality of life of patients in remission. The objective of this review is to describe the physiology of swallowing function, the pathophysiology of radiation-induced dysphagia and the various strategies currently available to prevent this complication.

  4. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke

    DEFF Research Database (Denmark)

    Sørensen, Rikke Terp; Rasmussen, Rune Skovgaard; Overgaard, Karsten

    2013-01-01

    pneumonia could be reduced in such patients by an early screening for dysphagia and intensified oral hygiene. MATERIAL AND METHODS: In this controlled trial, 146 hospitalized acute stroke patients with moderate or severe dysphagia were included in three groups: an intervention group (n = 58), one internal...... oral hygiene. RESULTS: The incidence of x-ray verified pneumonia was 4 of 58 (7%) in the intervention group compared with 16 of 58 (28%) in the internal control group (p ... by the Gugging Swallowing Screen method and intensified oral hygiene reduced the incidence of x-ray verified pneumonia....

  5. Causes of dysphagia among different age groups: a systematic review of the literature.

    Science.gov (United States)

    Roden, Dylan F; Altman, Kenneth W

    2013-12-01

    Dysphagia is a common problem that has the potential to result in severe complications such as malnutrition and aspiration pneumonia. Based on the complexity of swallowing, there may be many different causes. This article presents a systematic literature review to assess different comorbid disease associations with dysphagia based on age. The causes of dysphagia are different depending on age, affecting between 1.7% and 11.3% of the general population. Dysphagia can be a symptom representing disorders pertinent to any specialty of medicine. This review can be used to aid in the diagnosis of patients presenting with the complaint of dysphagia. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Orosensory contributions to dysphagia: a link between perception of sweet and sour taste and pharyngeal delay time.

    Science.gov (United States)

    Pauloski, Barbara R; Nasir, Sazzad M

    2016-06-01

    Pharyngeal delay is a significant swallowing disorder often resulting in aspiration. It is suspected that pharyngeal delay originates from sensory impairment, but a direct demonstration of a link between oral sensation and pharyngeal delay is lacking. In this study involving six patients with complaints of dysphagia, taste sensation of the oral tongue was measured and subsequently related to swallowing kinematics. It was found that a response bias for sour taste was significantly correlated with pharyngeal delay time on paste, highlighting oral sensory contributions to swallow motor dysfunctions. Investigating the precise nature of such a link between oral sensation and dysphagia would constitute a basis for understanding the disorder. The results of this study highlight oral sensory contributions to pharyngeal swallow events and provide impetus to examine this link in larger samples of dysphagic patients.

  7. A collection of cytochrome P450 monooxygenase genes involved in modification and detoxification of herbicide atrazine in rice (Oryza sativa) plants.

    Science.gov (United States)

    Rong Tan, Li; Chen Lu, Yi; Jing Zhang, Jing; Luo, Fang; Yang, Hong

    2015-09-01

    Plant cytochrome P450 monooxygenases constitute one of the largest families of protein genes involved in plant growth, development and acclimation to biotic and abiotic stresses. However, whether these genes respond to organic toxic compounds and their biological functions for detoxifying toxic compounds such as herbicides in rice are poorly understood. The present study identified 201 genes encoding cytochrome P450s from an atrazine-exposed rice transcriptome through high-throughput sequencing. Of these, 69 cytochrome P450 genes were validated by microarray and some of them were confirmed by real time PCR. Activities of NADPH-cytochrome P450 reductase (CPR) and p-nitroanisole O-demethylase (PNOD) related to toxicity were determined and significantly induced by atrazine exposure. To dissect the mechanism underlying atrazine modification and detoxification by P450, metabolites (or derivatives) of atrazine in plants were analyzed by ultra performance liquid chromatography mass spectrometry (UPLC/MS). Major metabolites comprised desmethylatrazine (DMA), desethylatrazine (DEA), desisopropylatrazine (DIA), hydroxyatrazine (HA), hydroxyethylatrazine (HEA) and hydroxyisopropylatrazine (HIA). All of them were chemically modified by P450s. Furthermore, two specific inhibitors of piperonyl butoxide (PBO) and malathion (MAL) were used to assess the correlation between the P450s activity and rice responses including accumulation of atrazine in tissues, shoot and root growth and detoxification. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Evolution of chronic dysphagia following treatment for head and neck cancer.

    Science.gov (United States)

    Nguyen, Nam P; Moltz, Candace C; Frank, Cheryl; Vos, Paul; Smith, Herbert J; Karlsson, Ulf; Nguyen, Ly M; Rose, Sue; Dutta, Suresh; Sallah, Sabah

    2006-04-01

    We would like to assess the evolution of chronic dysphagia (1 year or more) following treatment for head and neck cancer. Modified barium swallow (MBS) examinations were performed in cancer-free patients who complained of dysphagia following treatment for head and neck cancer. The severity of the dysphagia was graded on a scale of 1-7. Each patient had at least 2 MBS. Severity of dysphagia was compared between the first and last MBS study to determine whether the swallowing dysfunction had returned to normal. Patients with complaint of dysphagia and normal MBS also underwent a regular barium swallow to assess the structural integrity of the pharynx and esophagus. Between 1996 and 2001, 25 patients with dysphagia underwent repeat MBS following treatment. Swallowing dysfunction did not return to normal in the majority of the patients. At a median time of 26 months following treatment (range 15-82 months), only two patient (8%) had normalization of the swallowing. The severity of dysphagia decreased in eight patients (32%), remained unchanged in 12 patients (48%), and worsened in five patients (20%). Eight patients (32%) still had aspiration problems at 12-83 months following treatment. Six patients (24%) required dilation because of pharyngeal stenosis. Three patients who required dilation had improvement of the dysphagia severity. Chronic dysphagia is a relentless process possibly due to excessive scarring. Patients with chronic dysphagia are at risk of malnutrition, and aspiration. Management of chronic dysphagia requires a team approach with nutritional support, psychological counseling, dilation, and tube feedings when indicated.

  9. Carers' experiences of dysphagia in people treated for head and neck cancer: a qualitative study.

    Science.gov (United States)

    Nund, Rebecca L; Ward, Elizabeth C; Scarinci, Nerina A; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V

    2014-08-01

    The implication of dysphagia for people treated nonsurgically for head and neck cancer (HNC) and its detrimental effects on functioning and quality of life has been well documented. To date, however, there has been a paucity of research on the effects of dysphagia following HNC on carers, independent of the consequences of a gastrostomy. The objective of this qualitative study was to report on the experiences of carers of people with dysphagia (non-gastrostomy dependent) following nonsurgical treatment for HNC and to identify the support needs of this group. A purposive, maximum-variation sampling technique was adopted to recruit 12 carers of people treated curatively for HNC since 2007. Each participated in an in-depth interview, detailing their experience of caring for someone with dysphagia and the associated impact on their life. Thematic analysis was adopted to search the transcripts for key phases and themes that emerged from the discussions. Analysis of the transcripts revealed four themes: (1) dysphagia disrupts daily life, (2) carers make adjustments to adapt to their partner's dysphagia, (3) the disconnect between carers' expectations and the reality of dysphagia, and (4) experiences of dysphagia-related services and informal supports. Carers generally felt ill-prepared for their role in dysphagia management. The qualitative methodology successfully described the impact of dysphagia on the everyday lives of carers, particularly in regard to meal preparation, social events, and family lifestyle. Clinicians should provide adequate and timely training and support to carers and view carers as copartners in dysphagia management.

  10. Evaluation of neurogenic dysphagia in Iraqi patients with acute stroke.

    Science.gov (United States)

    Hasan, Zeki N; Al-Shimmery, Ehsan K; Taha, Mufeed A

    2010-04-01

    To clinically assess neurogenic dysphagia, and to correlate its presence with demographic features, different stroke risk factors, anatomical arterial territorial stroke types, and pathological stroke types. Seventy-two stroke inpatients were studied between July 2007 and February 2008, at the Departments of Medicine and Neurology at Al-Yarmouk Teaching Hospital, Baghdad, and Rizgary Teaching Hospital, Erbil, Iraq. All patients were assessed using the Mann Assessment of Swallowing Ability score (MASA), Modified Rankin Scale, and the Stroke Risk Scorecard. All patients were reassessed after one month. There were 40 males and 32 females. Sixty-eight patients had ischemic stroke, and 4 had primary intracerebral hemorrhage (ICH). According to the MASA score, 55% of anterior circulation stroke (ACS) cases were associated with dysphasia, and 91% of lateral medullary syndrome cases were associated with dysphagia. Fifty-six percent of ACS dysphagic cases improved within the first month. Forty percent of dysphagic patients died in the one month follow up period, and in most, death was caused by aspiration pneumonia. We observed no significant differences regarding demographic features of dysphagia. Dysphagia can be an indicator of the severity of stroke causing higher mortality and morbidity in affected patients. It was not related to the stroke risk factors and the type of stroke. It is essential from a prognostic point of view to assess swallowing, and to treat its complications early.

  11. Oral vs. pharyngeal dysphagia: surface electromyography randomized study.

    Science.gov (United States)

    Vaiman, Michael; Nahlieli, Oded

    2009-05-21

    A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG) studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis. Parameters evaluated during swallowing for patients after dental surgery (1: n = 62), oral infections (2: n = 49), acute tonsillitis (3: n = 66) and healthy controls (4: n = 50) included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles. The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high. Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.

  12. Oral vs. pharyngeal dysphagia: surface electromyography randomized study

    Directory of Open Access Journals (Sweden)

    Nahlieli Oded

    2009-05-01

    Full Text Available Abstract Background A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis. Methods Parameters evaluated during swallowing for patients after dental surgery (1: n = 62, oral infections (2: n = 49, acute tonsillitis (3: n = 66 and healthy controls (4: n = 50 included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles. Results The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high. Conclusion Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.

  13. Managing dysphagia. Special problems in patients with neurologic disease.

    Science.gov (United States)

    Horner, J; Massey, E W

    1991-04-01

    Swallowing is a brief but intricate process. When this process is interrupted, as in patients with neurologic disorders, problems such as aspiration and risk of malnutrition can occur. The authors of this article discuss an individualized approach to evaluation and management of neurogenic oropharyngeal dysphagia. Three cases illustrate the diversity of causes, signs and symptoms, and clinical course.

  14. Dysphagia: A Short Review of the Current State

    Science.gov (United States)

    Koidou, Irene; Kollias, Nikolaos; Sdravou, Katerina; Grouios, George

    2013-01-01

    Dysphagia is the clinical expression of disruption of the synchronized activity surrounding the normal swallowing mechanism. It results from a large number of causes including neurologic, myopathic, metabolic, inflammatory/autoimmune, infectious, structural, iatrogenic, and psychiatric diseases. It can have a significant impact on social and…

  15. A Non-Frequently Considered Diagnosis of Dysphagia; Eosinophilic Esophagitis

    Directory of Open Access Journals (Sweden)

    Mehmet Ağın

    2015-08-01

    Full Text Available Eosinophilic Esophagitis is infiltration of esophagus mucosa by eosinophil leucocyte. It is rarely observed in children and the symptoms are similar to gastroesophageal reflux. This case, which was applied esophagus balloon dilatation in the pediatric surgery due to dysphagia and diagnosed eosinophilic esophagitis, was presented in order to attract attention to the approach to the child with dysphagia. Total IgE=834 IU/mL and specific IgE (-, Fx5 (- was found negative. In the upper GIS endoscopy, it was observed that esophagus mucosa was pale, its structure was hard and its motility was disordered and a couple milimetric white lesions were observed as well. In the esophagus biopsy materials, it was observed that the eosinophil infiltration in the mucosa was 60%. With the diagnosis of Eosinophilic Esophagitis, the case was started on oral prednisolone 1 mg/kg/day. In the polyclinic control of the case after a week, it was observed that there was a significant decrease in the complaints about dysphagia and in the one-month control the complaints were all gone. In the symptoms similar to dysphagia and reflux, especially if the case is not responding to gastroesophageal reflux treatment, the diagnosis of Eosinophilic Esophagitis should absolutely be considered

  16. Plummer-Vinson syndrome: an unusual cause of dysphagia.

    Science.gov (United States)

    Ganesh, R; Janakiraman, L; Sathiyasekaran, M

    2008-06-01

    Plummer-Vinson syndrome, comprising a triad of dysphagia, iron deficiency anaemia and cricoid webs, is rarely reported in children. It is important to identify this condition not only to provide relief of symptoms by iron supplementation but also to include these children in surveillance programmes for oesophageal squamous cell carcinoma.

  17. A Descriptive Investigation of Dysphagia in Adults with Intellectual Disabilities

    Science.gov (United States)

    Chadwick, Darren D.; Jolliffe, J.

    2009-01-01

    Background: Dysphagia has rarely been investigated in adults with intellectual disabilities (ID) despite being a serious condition affecting health and quality of life. Method: This study collected information about 101 adults with ID, living in community settings, referred for an assessment of their eating and drinking. Ninety-nine people were…

  18. Esophageal peristaltic defects in adults with functional dysphagia.

    Science.gov (United States)

    Ratuapli, Shiva K; Hansel, Stephanie L; Umar, Sarah B; Burdick, George E; Ramirez, Francisco C; Fleischer, David E; Harris, Lucinda A; Lacy, Brian E; DiBaise, John K; Crowell, Michael D

    2014-08-01

    Functional dysphagia (FD) is characterized by the presence of dysphagia without evidence of mechanical esophageal obstruction, GERD, and histopathology-based esophageal motor disorders. Dysphagia is common in older patients; however, there is a paucity of information regarding the type and frequency of peristaltic abnormalities compared to younger patients. Based on recently validated criteria for classification of weak peristalsis using high-resolution manometry (HRM), we hypothesized that older patients with FD would have more peristaltic defects detected by HRM compared to younger FD patients. A retrospective review of our motility database yielded 65 patients that met inclusion criteria. Patients were divided into two groups based on age (younger: dysphagia, or quality of life. Dyspeptic symptoms, including nausea (p 5 cm) (p < 0.001). The mean contraction amplitude was also lower in the older group (p < 0.05). These data support the hypothesis that older patients with FD have a higher frequency of peristaltic abnormalities on HRM compared to younger patients. Older age was associated with increased frequency of weak peristalsis with small and large peristaltic defects.

  19. Effectiveness of Dysphagia Training for Adult Learning Disabilities Support Workers

    Science.gov (United States)

    Tredinnick, Gerlind; Cocks, Naomi

    2014-01-01

    This study investigated the effectiveness of a 1-day dysphagia training package delivered to support workers who work with adults with a learning disability. Thirty-eight support staff took part in this study. Twenty-five support staff received training, and 13 did not receive training and therefore acted as a control group. Three questionnaires…

  20. Dysphagia is present but mild in myotonic dystrophy type 2

    NARCIS (Netherlands)

    R. Ensink; S. Knuijt; Baziel van Engelen; J. van Vliet; A. Tieleman; Bert de Swart

    2009-01-01

    The phenotype of myotonic dystrophy type 2 (DM2) shows similarities as well as differences to that of myotonic dystrophy type 1 (DM1). Dysphagia, a predominant feature in DM1, has not yet been examined in DM2. In a recent nationwide questionnaire survey of gastrointestinal symptoms in DM2, 12 out of

  1. Eosinophilic esophagitis: A newly established cause of dysphagia

    OpenAIRE

    Yan, Brian M; Shaffer, Eldon A.

    2006-01-01

    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also atta...

  2. Dysphagia is present but mild in myotonic dystrophy type 2.

    NARCIS (Netherlands)

    Tieleman, A.A.; Knuijt, S.; Vliet, J. van; Swart, B.J.M. de; Ensink, R.J.H.; Engelen, B.G.M. van

    2009-01-01

    The phenotype of myotonic dystrophy type 2 (DM2) shows similarities as well as differences to that of myotonic dystrophy type 1 (DM1). Dysphagia, a predominant feature in DM1, has not yet been examined in DM2. In a recent nationwide questionnaire survey of gastrointestinal symptoms in DM2, 12 out of

  3. Dysphagia is present but mild in myotonic dystrophy type 2

    NARCIS (Netherlands)

    Swart, Bert de; Tieleman, A.; Knuijt, S.; Vliet, J. van; Ensink, R.; Engelen, Baziel van

    2009-01-01

    The phenotype of myotonic dystrophy type 2 (DM2) shows similarities as well as differences to that of myotonic dystrophy type 1 (DM1). Dysphagia, a predominant feature in DM1, has not yet been examined in DM2. In a recent nationwide questionnaire survey of gastrointestinal symptoms in DM2, 12 out of

  4. Effects of expiratory muscle strength training on oropharyngeal dysphagia in subacute stroke patients: a randomised controlled trial.

    Science.gov (United States)

    Park, J S; Oh, D H; Chang, M Y; Kim, K M

    2016-05-01

    Expiratory muscle strength training (EMST) involves forcible blowing as a means of generating high expiratory pressure, against adjustable resistance. EMST has recently been introduced as a potential treatment for dysphagia. This study was performed to investigate the effects of EMST on the activity of suprahyoid muscles, aspiration and dietary stages in stroke patients with dysphagia. Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group performed EMST with a 70% threshold value of maximal expiratory pressure, using an EMST device, 5 days a week for 4 weeks. The placebo group trained with a sham device. The EMST regime involved 5 sets of 5 breaths through the EMST device for a total of 25 breaths per day. Activity in the suprahyoid muscle group was measured using surface electromyography (sEMG). Further, the penetration-aspiration scale (PAS) was used to assess the results of the videofluoroscopic swallowing study (VFSS). In addition, dietary stages were evaluated using the Functional Oral Intake Scale (FOIS). The experimental group exhibited improved suprahyoid muscle group activity and PAS results, when compared to the placebo group. Following intervention, statistical analysis indicated significant differences in measured suprahyoid muscle activity (P = 0·01), liquid PAS outcomes (P = 0·03) and FOIS results (P = 0·06), but not semisolid type PAS outcomes (P = 0·32), between the groups. This study confirms EMST as an effective treatment for the development of suprahyoid muscle activity in stroke patients with dysphagia. Additionally, improvements in aspiration and penetration outcomes were observed. © 2016 John Wiley & Sons Ltd.

  5. Postoperative dysphagia correlates with increased morbidity, mortality, and costs in anterior cervical fusion.

    Science.gov (United States)

    Joseph, Jacob R; Smith, Brandon W; Mummaneni, Praveen V; La Marca, Frank; Park, Paul

    2016-09-01

    Anterior cervical fusion (ACF) after discectomy and/or corpectomy is a common procedure with traditionally good patient outcomes. Though typically mild, postoperative dysphagia can result in significant patient morbidity. In this study, we examine the relationship between postoperative dysphagia and in-hospital outcomes, readmissions, and overall costs. The University HealthSystem Consortium (UHC) database was utilized to perform a retrospective cohort study of all adults who underwent a principal procedure of ACF of the anterior column (International Classification of Diseases, Ninth Revision [ICD-9] procedure code 81.02) between 2013 and 2015. Patients with a diagnosis of dysphagia (ICD-9 78720-78729) were compared to those without. Patient demographics, length of stay, in-hospital mortality, 30-day readmissions, and direct costs were recorded. A total of 49,300 patients who underwent ACF were identified. Mean age was 54.5years and 50.2% were male. Dysphagia was documented in 3,137 patients (6.4%) during their hospital stay. Patients with dysphagia had an average 2.1 comorbidities, while patients without dysphagia had 1.5 (p<0.01). Mean length of stay was 6.38days in patients with dysphagia, and 2.13days in those without (p<0.01). In-hospital mortality was 0.10% in patients without dysphagia, and 0.61% in those with dysphagia (p<0.01). Direct costs were $13,099 in patients without dysphagia, and $21,245 in those with dysphagia (p<0.01). Thirty-day readmission rate was 2.9% in patients without dysphagia, and 5.3% in those with dysphagia (p=0.01). In summary, dysphagia in patients who undergo ACF correlates with significantly increased length of stay, 30-day readmissions, and in-hospital mortality. Direct costs are similarly increased as a result.

  6. Exploring factors that influence the spread and sustainability of a dysphagia innovation: an instrumental case study.

    Science.gov (United States)

    Ilott, Irene; Gerrish, Kate; Eltringham, Sabrina A; Taylor, Carolyn; Pownall, Sue

    2016-08-18

    Swallowing difficulties challenge patient safety due to the increased risk of malnutrition, dehydration and aspiration pneumonia. A theoretically driven study was undertaken to examine the spread and sustainability of a locally developed innovation that involved using the Inter-Professional Dysphagia Framework to structure education for the workforce. A conceptual framework with 3 spread strategies (hierarchical control, participatory adaptation and facilitated evolution) was blended with a processual approach to sustaining organisational change. The aim was to understand the processes, mechanism and outcomes associated with the spread and sustainability of this safety initiative. An instrumental case study, prospectively tracked a dysphagia innovation for 34 months (April 2011 to January 2014) in a large health care organisation in England. A train-the-trainer intervention (as participatory adaptation) was deployed on care pathways for stroke and fractured neck of femur. Data were collected at the organisational and clinical level through interviews (n = 30) and document review. The coding frame combined the processual approach with the spread mechanisms. Pre-determined outcomes included the number of staff trained about dysphagia and impact related to changes in practice. The features and processes associated with hierarchical control and participatory adaptation were identified. Leadership, critical junctures, temporality and making the innovation routine were aspects of hierarchical control. Participatory adaptation was evident on the care pathways through stakeholder responses, workload and resource pressures. Six of the 25 ward based trainers cascaded the dysphagia training. The expected outcomes were achieved when the top-down mandate (hierarchical control) was supplemented by local engagement and support (participatory adaptation). Frameworks for spread and sustainability were combined to create a 'small theory' that described the interventions, the

  7. Modification of beta-2-microglobulin in sera from patients with small cell lung cancer: evidence for involvement of a serine protease

    DEFF Research Database (Denmark)

    Nissen, Mogens Holst; Bjerrum, Ole Jannik; Plesner, T

    1987-01-01

    Modification of beta-2-microglobulin has been shown to occur in vitro in serum of patients suffering of small cell lung cancer, where it clearly correlated to the clinical course of disease. The cause of serum beta-2-microglobulin modification occurring in these patients is investigated in the pr...

  8. Omission of Dysphagia Therapies in Hospital Discharge Communications

    Science.gov (United States)

    Kind, Amy; Anderson, Paul; Hind, Jacqueline; Robbins, JoAnne; Smith, Maureen

    2009-01-01

    Background Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. Objective To examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk sub-acute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. Design Retrospective cohort study Subjects All stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to sub-acute care in 2003-2005 from a single large academic medical center (N=187). Measurements Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included: dietary (food and liquid), postural/compensatory techniques (e.g., chin-tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Results 45% of discharge summaries omitted all SLP dysphagia recommendations. 47%(88/186) of patients with SLP dietary recommendations, 82%(93/114) with postural, 100%(16/16) with rehabilitation, 90%(69/77) with meal pacing, 95%(21/22) with medication, and 79%(96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Conclusions Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to sub-acute care. PMID:20098999

  9. Gore-Tex medialization laryngoplasty for treatment of dysphagia.

    Science.gov (United States)

    Hendricker, Ryan M; deSilva, Brad W; Forrest, L Arick

    2010-04-01

    Gore-Tex medialization laryngoplasty is a well described procedure for the management of glottal incompetence with associated phonatory disturbance. Limited literature exists describing the use of this procedure in the management of dysphagia. We describe our experience with Gore-Tex medialization laryngoplasty and the treatment of dysphagia. Case series with chart review. Tertiary referral center. Between April 2000 and September 2008, 189 Gore-Tex medialization laryngoplasties were performed on 180 patients by the senior author. Complete records and analysis were available for and performed on 121 procedures for 113 patients. The main outcome measures were discontinuation of gastrostomy tube (g-tube) use or avoidance of g-tube, as well as clinical subjective improvement in swallowing function. Fifty-seven of 113 (50%) patients had complaints of dysphagia at presentation, with 47 of 57 (82%) having an objective swallowing evaluation. Thirty-two of 47 (68%) had documented penetration and/or aspiration. Twenty of 57 (35%) patients with dysphagia required g-tubes for alimentation. Eleven of 20 (55%) patients were able to discontinue g-tube use after Gore-Tex medialization laryngoplasty, and an additional five patients with aspiration were able to avoid need for g-tubes with Gore-Tex medialization laryngoplasty and swallowing therapy. Gore-Tex medialization laryngoplasty is a well tolerated and well described treatment for the management of glottal incompetence. The procedure is an appropriate adjunct in dysphagia management for the appropriate patient population. Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

  10. A case of dysphagia induced by irradiation to the neck

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Hiroyuki [Kanagawa Rehabilitation Hospital, Atsugi (Japan); Kubota, Akira; Moriyama, Hiroshi

    1995-12-31

    This report deals with a case of dysphagia induced by the irradiation of a malignant lymphoma of the neck. The patient was a 55-year-old male with dysphagia who had undergone irradiation to the neck for a malignant lymphoma ten years previously. The dysphagia that had gradually worsened in ten years made him enable to eat and drink orally. He often contracted by pneumonia. On first examination, atrophic changes were observed in the soft palates, and the epiglottis, and the improvement of the tongue was bilaterally impaired. These findings were diagnosed as the causes of the dysphagia. A barium study showed that the movement of the tongue and the pharynx were impaired. The barium was aspirated. A plain X-ray film of the mandible showed ostitis. The impairment of the tongue movement was due to bilateral hypopharyngeal nerve palsies induced by the irradiation. Laryngeal suspension and cricopharyngeal myotomy were not suitable because they could have aggravated the radiation necrosis of the thyroid cartilage which will be expected in the future. A total laryngectomy, which sacrifies the phonation, was out of the question, because the patient`s dysarthria was not so hard to understand. He was instructed in the self-insertion of a feeding tube to get enough nutrition, the physical therapy of the lung with the aid of his wife to prevent aspiration pneumonia. The loss of phonation lowers the QOL of such patients. In the cases with dysphagia which do not recover with surgical treatments, rehabilitation should mainly stress the conservation of phonation and the prevention of pneumonia to maintain the higher QOL of patients. (author).

  11. DYSPHAGIA AND SIALORRHEA: the relationship to Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Denise Hack NICARETTA

    2013-03-01

    Full Text Available Context Dysphagia and sialorrhea in patients with Parkinson's disease are both automatically accepted as dependent on this neurological disease. Objective The aim were to establish if these two complaints are a consequence or associated manifestations of Parkinson's disease. Method Two Parkinson's diseases groups from the same outpatients' population were studied. Patients in the first group, with dysphagia, were studied by videofluoroscopy. The second, with sialorrhea, were studied by the scintigraphic method, Results Videofluoroscopic examination of the oral, pharyngeal and esophageal phases of swallowing showed that 94% of Parkinson's diseases patients present, structural causes, not related to Parkinson's diseases, able to produce or intensify the observed disphagia. The scintigraphic examination of Parkinson's diseases patients with sialorrhea showed that there is no increase of serous saliva production. Nevertheless, showed a significantly higher velocity of saliva excretion in the Parkinson's diseases patients. Conclusions Dysphagia can be due to the muscular rigidity often present in the Parkinson's diseases patient, or more usually by non Parkinson's disease associated causes. In Parkinson's diseases patients, sialorrhea is produced by saliva retention. Nevertheless, sialorrhea can produce discomfort in swallowing, although without a formal complaint of dysphagia. In this case, subclinical dysphagia must be considered. Sialorrhea is indicative of dysphagia or at least of subclinical dysphagia. As final conclusion, Parkinson's diseases can be an isolated cause of dysphagia and/or sialorrhea, but frequently, a factor unrelated to Parkinson's diseases is the main cause of or at least aggravates the dysphagia. Contexto Disfagia e sialorreia em pacientes com doença de Parkinson são automaticamente entendidos como decorrentes do comprometimento neurológico produzido pela doença de Parkinson. Objetivo Estabelecer se estas duas queixas s

  12. Spontaneous swallowing frequency has potential to identify dysphagia in acute stroke.

    Science.gov (United States)

    Crary, Michael A; Carnaby, Giselle D; Sia, Isaac; Khanna, Anna; Waters, Michael F

    2013-12-01

    Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke. In a cohort of 63 acute stroke cases, swallow frequency rates (swallows per minute [SPM]) were compared with stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with versus without clinically significant dysphagia. Receiver operating characteristic curve analysis was used to identify the optimal threshold in SPM, which was compared with a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was used to identify the minimally adequate time period to complete spontaneous swallow frequency analysis. SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. Receiver operating characteristic curve analysis yielded a threshold of SPM≤0.40 that identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5- to 10-minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke. Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel.

  13. Spontaneous Swallowing Frequency [Has Potential to] Identify Dysphagia in Acute Stroke

    Science.gov (United States)

    Carnaby, Giselle D; Sia, Isaac; Khanna, Anna; Waters, Michael

    2014-01-01

    Background and Purpose Spontaneous swallowing frequency has been described as an index of dysphagia in various health conditions. This study evaluated the potential of spontaneous swallow frequency analysis as a screening protocol for dysphagia in acute stroke. Methods In a cohort of 63 acute stroke cases swallow frequency rates (swallows per minute: SPM) were compared to stroke and swallow severity indices, age, time from stroke to assessment, and consciousness level. Mean differences in SPM were compared between patients with vs. without clinically significant dysphagia. ROC analysis was used to identify the optimal threshold in SPM which was compared to a validated clinical dysphagia examination for identification of dysphagia cases. Time series analysis was employed to identify the minimally adequate time period to complete spontaneous swallow frequency analysis. Results SPM correlated significantly with stroke and swallow severity indices but not with age, time from stroke onset, or consciousness level. Patients with dysphagia demonstrated significantly lower SPM rates. SPM differed by dysphagia severity. ROC analysis yielded a threshold of SPM ≤ 0.40 which identified dysphagia (per the criterion referent) with 0.96 sensitivity, 0.68 specificity, and 0.96 negative predictive value. Time series analysis indicated that a 5 to 10 minute sampling window was sufficient to calculate spontaneous swallow frequency to identify dysphagia cases in acute stroke. Conclusions Spontaneous swallowing frequency presents high potential to screen for dysphagia in acute stroke without the need for trained, available personnel. PMID:24149008

  14. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome

    Science.gov (United States)

    Broeg-Morvay, Anne; Meisterernst, Julia; Schlager, Markus; Mono, Marie-Luise; El-Koussy, Marwan; Kägi, Georg; Jung, Simon; Sarikaya, Hakan

    2016-01-01

    Background Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. Methods We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of favourable clinical outcome and mortality at 3 months between dysphagic patients and those without dysphagia. Results Dysphagia was diagnosed in 118 of 570 (20.7%) patients and persisted in 60 (50.9%) at hospital discharge. Thirty-six (30.5%) patients needed nasogastric tube because of severe dysphagia. Stroke severity rather than infarct location was associated with dysphagia. Dysphagic patients suffered more frequently from pneumonia (23.1% vs. 1.1%, pdysphagia. At 3 months, dysphagic patients less often had a favourable outcome (35.7% vs. 69.7%; pdysphagia to be an independent predictor of discharge destination and institutionalization at 3 months, while severe dysphagia requiring tube placement was strongly associated with mortality. Conclusion Dysphagia still affects a substantial portion of stroke patients and may have a large impact on clinical outcome, mortality and institutionalization. PMID:26863627

  15. Possible involvement of GABAergic mechanism in protective effect of melatonin against sleep deprivation-induced behaviour modification and oxidative damage in mice.

    Science.gov (United States)

    Kumar, Anil; Singh, Anant

    2009-08-01

    Sleep is an important physiological process responsible for the maintenance of physical, mental and emotional health of a living being. Sleep deprivation is considered risky for several pathological diseases such as anxiety and motor and cognitive dysfunctions. Sleep deprivation has recently been reported to cause oxidative damage. This study has been designed to explore the possible involvement of the GABAergic mechanism in protective effects of melatonin against 72-h sleep deprivation-induced behaviour modification and oxidative damage in mice. Mice were sleep-deprived for a period of 72 h using the grid over water suspended method. Animals were divided into groups of 6-8 animals each. Melatonin (5 and 10 mg/kg), flumazenil (0.5 mg/kg), picrotoxin (0.5 mg/kg) and muscimol (0.05 mg/kg) were administered for 5 days starting 2 days before 72-h sleep deprivation. Various behavioural tests (plus maze, zero maze, mirror chamber, actophotometer) and body weight assessment followed by oxidative stress parameters (malondialdehyde level, glutathione, catalase, nitrite and protein) were carried out. The 72-h sleep deprivation caused significant anxiety-like behaviour, weight loss, impaired locomotor activity and oxidative damage as compared with naïve (without sleep deprivation). Treatment with melatonin (5 mg/kg and 10 mg/kg, ip) significantly improved locomotor activity, weight loss and antianxiety effect as compared with control (sleep-deprived). Biochemically, melatonin treatment significantly restored reduced glutathione, catalase activity, attenuated lipid peroxidation and nitrite level as compared with control animals (72-h sleep-deprived). Flumazenil (0.5 mg/kg) and picrotoxin (0.5 mg/kg) pretreatments with a lower dose of melatonin (5 mg/kg) significantly antagonized the protective effect of melatonin. However, muscimol (0.05 mg/kg) pretreatment with melatonin (5 mg/kg, ip) potentiated the protective effect of melatonin which was significant as compared with their

  16. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery.

    Science.gov (United States)

    Starmer, Heather M; Riley, Lee H; Hillel, Alexander T; Akst, Lee M; Best, Simon R A; Gourin, Christine G

    2014-02-01

    Dysphonia and dysphagia are common complications of anterior cervical discectomy (ACD). We sought to determine the relationship between dysphagia and in-hospital mortality, complications, speech therapy/dysphagia training, length of hospitalization, and costs associated with ACD. Discharge data from the Nationwide Inpatient Sample for 1,649,871 patients who underwent ACD of fewer than four vertebrae for benign acquired disease between 2001 and 2010 were analyzed using cross-tabulations and multivariate regression modeling. Dysphagia was reported in 32,922 cases (2.0 %). Speech therapy/dysphagia training was reported in less than 0.1 % of all cases and in only 0.2 % of patients with dysphagia. Dysphagia was significantly associated with age ≥65 years (OR = 1.5 [95 % CI 1.4-1.7], P Dysphagia was a significant predictor of aspiration pneumonia (OR = 8.6 [6.7-10.9], P dysphagia training (OR = 32.0 [15.4-66.4], P Dysphagia, vocal cord paralysis, and aspiration pneumonia were significant predictors of increased length of hospitalization and hospital-related costs, with aspiration pneumonia having the single largest impact on length of hospitalization and costs. Dysphagia is significantly associated with increased morbidity, length of hospitalization, and hospital-related costs in ACD patients. Despite the known risk of dysphagia in ACD patients and an established role for the speech-language pathologist in dysphagia management, speech-language pathology intervention appears underutilized in this population.

  17. Treatment for dysphagia (swallowing difficulties) in hereditary ataxia.

    Science.gov (United States)

    Vogel, Adam P; Keage, Megan J; Johansson, Kerstin; Schalling, Ellika

    2015-11-13

    Hereditary ataxias are a heterogeneous group of disorders resulting in progressive inco-ordination. Swallowing impairment, also known as dysphagia, is a common and potentially life threatening sequel of disease progression. The incidence and nature of dysphagia in these conditions is largely unknown. The loss of an effective and safe swallow can dramatically affect the health and well-being of an individual. Remediation of difficulties of eating and drinking is an important goal in the clinical care of people with hereditary ataxia. To assess the effects of interventions for swallowing impairment (dysphagia) in people with hereditary ataxias. We searched the Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, PsycINFO, and the Education Resources Information Center (ERIC) on 14 September 2015. We also searched Linguistics and Language Behavior Abstracts (LLBA), Dissertation Abstracts, and Trials Registries on 24 September 2015. We considered all randomised controlled trials (RCTs) and quasi-RCTs that compared treatments for hereditary ataxia with placebo or no treatment. We only included studies measuring dysphagia. Three review authors (ES, KJ, MK) independently screened all titles and abstracts. In the event of any disagreement or uncertainty over the inclusion of a particular paper, the review authors planned to meet and reach consensus. We identified no RCTs from the 519 titles and abstracts screened. We excluded papers primarily for not including participants with a hereditary ataxia (that is, being focused on other neurological conditions), being theoretical reviews rather than intervention studies, or being neither randomised nor quasi-randomised trials.We identified five papers of various design that described treatment for dysphagia, or improvement to swallow as a by-product of treatment, in people with hereditary ataxia. None of these studies were RCTs or

  18. Pathway analysis of whole exome sequence data provides further support for the involvement of histone modification in the aetiology of schizophrenia.

    Science.gov (United States)

    Curtis, David

    2016-10-01

    Weighted burden pathway analysis was applied to whole exome sequence data for 2045 schizophrenic patients and 2045 controls. Overall, there was a statistically significant excess of pathways with more rare, functional variants in cases than in controls. Among the highest ranked were pathways relating to histone modification, as well as neuron differentiation and membrane and vesicle function. This bolsters the evidence from previous studies that histone modification pathways may be important in the aetiology of schizophrenia.

  19. The physiology of deglutition and the pathophysiology and complications of oropharyngeal dysphagia.

    Science.gov (United States)

    Steele, Catriona M

    2012-01-01

    The opening session of the 2nd International Conference on Oropharyngeal Dysphagia featured a series of invited talks reviewing the definition of dysphagia, its prevalence and its pathophysiology. The discussion arising from these talks focused heavily on the current underrecognition of dysphagia as a significant concern for older adults, particularly those over 75. The burdens associated with dysphagia in this sector of the population were recognized to be substantial, both in social/psychological terms and in terms of economic consequences for the healthcare system. The importance of developing swallow screening protocols as a routine method for the early identification of dysphagia and aspiration was explored. The idea of launching political initiatives aimed at increasing awareness and the utilization of appropriate dysphagia healthcare codes was also discussed. Copyright © 2012 S. Karger AG, Basel.

  20. Nutrition assessment and intervention in the patient with dysphagia: challenges for quality improvement.

    Science.gov (United States)

    Ochoa, Juan B

    2012-01-01

    Dysphagia, a symptom characterized by difficulty swallowing, is an independent predictor of poor outcome, worsening morbidity, increasing the risk for hospital readmissions, health care costs and mortality. Dysphagia is a result of a number of illnesses including neurological diseases, after surgery for head and neck pathology, observed in the intensive care unit after prolonged endotracheal intubation among others, and is particularly frequent in the elderly. Dysphagia increases the incidence of malnutrition, which in turn delays patient recovery. Treatment of dysphagia can be successful, but requires the use of multidisciplinary teams. A focus on the management of malnutrition including prevention and treatment is essential. Perhaps the biggest challenge is the lack of awareness of the presence of dysphagia and malnutrition, so that only a minority of patients are identified and successfully treated. We propose that better identification and treatment of dysphagia could occur with the systematic implementation of clinical practice improvement processes with a consequent decrease in morbidity, mortality and cost.

  1. [Importance of the detection of dysphagia in geriatric patients].

    Science.gov (United States)

    Zamora Mur, A; Palacín Ariño, C; Guardia Contreras, A I; Zamora Catevilla, A; Clemente Roldán, E; Santaliestra Grau, J

    2017-04-27

    Oropharyngeal dysphagia is one of the lesser known geriatric syndromes, despite its enormous impact on functional capacity, quality of life, and health of those affected. A descriptive and prospective study was conducted by the Geriatric Department of Barbastro Hospital (Huesca), from March 2012 to October 2014, as biannual and annual reviews in October 2015. This study included all patients on whom a volume-viscosity clinical examination (MECV-V test) was performed to suspecting dysphagia. The study included 266 patients with a mean age of 82.35±12.3 years, and with a mean Barthel index score of 20.5±25.4, and mean Charlson index of 1.77±1.6. The test was performed in 105 cases after stroke (40%), 53 in dementia (20%), 24 in Parkinsonism (9%), and for other different reasons in 80 (31%). Dysphagia was diagnosed in 228 (86%) cases. Enteral nutrition was given in 25 (10.9%) cases. The test results were shown in the discharge report in 45% of the tests with positive result. The mean survival obtained after test in the patients who died was 230.8±256.5 days. Differences in survival at 12 months were found in patients with positive test, without finding a clear relationship with functional status and comorbidity. Dysphagia has a significant mortality, and the use of thickeners after its detection should be properly reported. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Chest pain following oesophageal stenting for malignant dysphagia

    Energy Technology Data Exchange (ETDEWEB)

    Golder, Mark; Tekkis, Paris P.; Kennedy, Colette; Lath, Sadaf; Toye, Rosemary; Steger, Adrian C

    2001-03-01

    AIM: The palliative use of self-expanding metallic stents has been widely reported to relieve dysphagia in cases of oesophageal carcinoma. Little has been documented on the severity of chest pain following oesophageal stenting. The aim of this study was to investigate the association of pain with oesophageal stenting for malignant dysphagia. METHODS: Fifty-two patients with inoperable oesophageal carcinoma underwent stent placement between 1995-1999. Daily opioid analgesic requirements (mg of morphine equivalent doses) were monitored for 3 days before and 7 days after stenting. The degree of palliation was expressed as a dysphagia score (0-3). Hospital stay, readmission days, stent complications and patient survival time were also recorded. RESULTS: Twenty-six patients (50%) required opioid analgesia for chest pain (median dose: 80 mg morphine/day) within 48 h of the procedure compared to 11 (21.2%) patients before stenting (P = 0.0041). A significant increase was evident in the analgesic consumption following stent deployment (P < 0.001). The dysphagia score improved by a median value of 1 (CI 0.25)P < 0.001, with a re-intervention rate of 11.5%. The median survival time was 40 days post stenting (range 1-120). CONCLUSION: A significant proportion of patients developed chest pain after oesophageal stenting, requiring high dose opioid analgesia. As the origin of the pain is still unknown, pre-emptive analgesia may a play role in reducing stent-related morbidity and possibly in-hospital stay. Golder, M. et al. (2001)

  3. Barium Swallow Findings in the Evaluation of Patients with Dysphagia

    Directory of Open Access Journals (Sweden)

    Amirhosein Hashemi Attar

    2011-05-01

    Full Text Available Background/Objective: Dysphagia is a subjective"nsensation of difficulty in swallowing that has a wide"nrange of etiologies from psychosomatic disorders"nto high grade neoplasms. In this study we evaluated"nbarium swallow findings of patients with dysphagia."nPatients and Methods: We evaluated 200 patients"n(117 men, 83 women; mean age, 49.6 years with"ncomplaint of dysphagia. Fluoroscopic barium"nswallow was done for all the patients and they were"nreviewed for primary peristalsis (presence or absence,"nAbstracts"nS62 Iran J Radiol 2011, 8 (Supp.1"nAbstracts"nimpaired lower esophageal sphincter, esophageal dilatation, delayed emptying of barium, nonperistaltic contractions, stricture and filling defects. Clinical and in some cases endoscopic or manometric follow up was done for all patients."nResults: We had 134 (67% normal barium swallow"nexams with uncomplicated clinical courses. Sixty"nsix patients (33% had abnormal imaging findings"nincluding stricture in 24 patients (12%, filling defect"nin 12 patients (6% and mucosal abnormality in 14"n(7% patients (six cases of mucosal irregularity, three"ncases of mucosal ulceration and five cases of mucosal"nherniation, Bird's beak sign in three patients (1.5%,"ntertiary spasm in six patients (3% and hiatal hernia in"nseven patients (3.5%."nConclusion: In the majority of patients with dysphagia,"nbarium swallow is the only paraclinical study needed"nto plan proper treatment. If radiographic findings are"nequivocal, endoscopy or manometry may be required"nfor more certain diagnosis.

  4. Pooling score: an endoscopic model for evaluating severity of dysphagia

    OpenAIRE

    FARNETI, D.

    2008-01-01

    The finding of secretions and bolus pooling is of great diagnostic interest in the evaluation of subjects with swallowing disorders. Bedside evaluation alone, in subjects at risk for aspiration, can underestimate this parameter. The usefulness of endoscopic investigation for the evaluation of subjects with swallowing disorders is stressed, in order to plan treatment and follow-up. Based on endoscopic evaluation of material pooling we devised a score expressing the severity of dysphagia. This ...

  5. Analysis of carbonated thin liquids in pediatric neurogenic dysphagia.

    Science.gov (United States)

    Lundine, Jennifer P; Bates, D Gregory; Bates, David G; Yin, Han

    2015-08-01

    Aspiration of liquids is a serious complication of neurological impairments such as traumatic brain injury or stroke. Carbonated liquids have been examined as a possible alternative to thickened liquids to help reduce aspiration in cases of dysphagia in adults, but no published literature to the best of our knowledge has evaluated this technique in children. If carbonated liquids result in safer swallowing in children, they could provide a preferred alternative to thickened liquids. This pilot study examined whether carbonated thin liquids (CARB) improved swallowing compared to non-carbonated thin liquids (NOCARB) for children with neurogenic dysphagia. Twenty-four children admitted to a level I trauma center for acute neurological injury/disease were evaluated via videofluoroscopic swallow studies. Four descriptive outcome measures were contrasted. CARB significantly decreased pooling (P = 0.0006), laryngeal penetration/aspiration (P = 0.0044) and Penetration-Aspiration Scale scores (P = 0.0127) when compared to NOCARB. On average, CARB improved scores on the Penetration-Aspiration Scale by 3.7 points for participants who aspirated NOCARB. There was no significant difference in pharyngeal residue noted between CARB and NOCARB (P = 0.0625). These findings support the hypothesis that carbonated thin liquids may provide an alternative to thickened liquids for children with neurogenic dysphagia. Implications for future research and clinical practice are discussed.

  6. [TECHNICAL CHARACTERISTICS OF SPECIFIC FOOD PRODUCTS FOR PATIENTS WITH DYSPHAGIA].

    Science.gov (United States)

    Calleja Fernández, Alicia; Pintor de la Maza, Begoña; Vidal Casariego, Alfonso; Villar Taibo, Rocío; Urioste Fondo, Ana; Cano Rodríguez, Isidoro; Ballesteros Pomar, María D

    2015-10-01

    Dysphagia is a common problem among elderly and also in some pathological conditions such as neurodegenerative diseases or tumors. Making an adequate diet for this disease may present some difficulties. The aim of this document is to make a detailed technical report about the characteristics of the products that are available in Spain to hydrate and to feed patients with dysphagia. Food and pharmaceutical industries have developed a range of products designed to ensure homogeneous texture and a suitable viscosity to guaranty an adequate hydration. An adequate nutritional status is also achieved with these products for patients with dysphagia, without compromising their safety. The ingredients used to achieve a suitable viscosity are different types of starches, gums and other substances. It has been developed thickeners and gellified water for hydratation, and in case of food there are purees (dehydrated, lyophilized, pasteurized and sterilized), fruit purees, fruit pudding, and dehydrated cereal. Patients who do not meet their nutritional needs have also oral supplements with different viscosities. The industry offers extensive information about the technical characteristics of the products, except for viscosity. It would be recommended for the manufacturers to include in detail the technical specifications of the used methodology and the measurement and the results obtained in the analysis of viscosity that can be consulted by professionals of the Clinical Nutrition and Dietetics Units who treat these patients.

  7. Eosinophilic esophagitis: A newly established cause of dysphagia

    Institute of Scientific and Technical Information of China (English)

    Brian M Yan; Eldon A Shaffer

    2006-01-01

    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment,and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/105 in children and 2.5/105 in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline"or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimai contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (>20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors,or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign,albeit inconvenient, course. With increasing recognition,this entity is taking its place as an established cause of solid food dysphagia.

  8. Eosinophilic esophagitis: a newly established cause of dysphagia.

    Science.gov (United States)

    Yan, Brian-M; Shaffer, Eldon-A

    2006-04-21

    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/10(5) in children and 2.5/10(5) in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline" or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimal contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (>20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors, or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign, albeit inconvenient, course. With increasing recognition, this entity is taking its place as an established cause of solid food dysphagia.

  9. Pill in the blister pack: a rare cause of dysphagia in an elderly adult

    OpenAIRE

    Laeeq, Syed Mudassir; Rai, Ayesha Aslam; Tasneem, Abbas Ali; Luck, Nasir Hassan; Majid, Zain

    2015-01-01

    Foreign body impaction in the esophagus amongst adults is not a common cause of dysphagia. Fish bone, food bolus, dentures may cause symptoms of dysphagia, odynophagia, chest pain or respiratory distress. It needs prompt evaluation along with removal of the substance either surgically or endoscopically to avoid the development of life threatening complications. Here we are reporting a case of an elderly male, who presented to us with a history of absolute dysphagia for one week, as a conseque...

  10. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care.

    Science.gov (United States)

    Crary, Michael A; Humphrey, Jamie L; Carnaby-Mann, Giselle; Sambandam, Raam; Miller, Leslie; Silliman, Scott

    2013-03-01

    Dysphagia may predispose stroke patients toward undernutrition and hydration. These comorbidities increase patient risks for reduced functional outcome and short-term mortality. Despite this impact, available information on relationships among dysphagia, nutrition, and hydration status in acute stroke is limited and conflicted. This study evaluated nutrition and hydration status in ischemic stroke patients with versus without clinically significant dysphagia at admission and at discharge from acute care. Sixty-seven patients admitted to the stroke unit in a tertiary-care hospital provided data for this study. On the day of hospital admission and upon discharge or at 7 days post admission, serum biochemical measures were obtained for nutrition (prealbumin) and hydration status (BUN/Cr). Clinical evaluation for dysphagia, nutrition status, and stroke severity were completed an average of 1.4 days following hospital admission. Dysphagia was identified in 37 % of the cohort. At admission 32 % of patients demonstrated malnutrition based on prealbumin levels and 53 % demonstrated evidence of dehydration based on BUN/Cr levels. No differences in nutrition status were attributed to dysphagia. Patients with dysphagia demonstrated significantly higher BUN/Cr levels (greater dehydration) than patients without dysphagia at admission and at discharge. Dehydration at both admission and discharge was associated with dysphagia, clinical nutrition status, and stroke severity. Results of this study support prior results indicating that dysphagia is not associated with poor nutrition status during the first week post stroke. Dehydration status is associated with dysphagia during this period. The results have implications for future confirmatory research and for clinical management of dysphagia in the acute stroke period.

  11. Dysphagia Rehabilitation and Prevention of Aspiration Pneumonia : The trial of Integrative Medicine -

    OpenAIRE

    植田, 耕一郎; Ueda, Koichiro

    2003-01-01

    Dysphagia rehabilitation has made rapid progress for ten years. It has been come into wide use across fields of medical care, health and welfare. Contacting with rehabilitation medicine, it was thought that training was possible for a mouth obstacle. However we have come to the time to reflect about dysphagia rehabilitation. Chronic diseases are increasing in aging society. And integrative medicine is new possibility of dysphagia rehabilitation and prevention of aspiration pneumonia in the si...

  12. Epidermolysis bullosa acquisita with moderately severe dysphagia due to esophageal strictures

    Directory of Open Access Journals (Sweden)

    Jenny Tu

    2011-01-01

    Full Text Available Epidermolysis bullosa acquisita (EBA is a chronic, autoimmune condition involving the skin and mucous membranes. Symptomatic mucosal involvement is rare, but can impact on quality of life, due to esophageal strictures and dysphagia. We report a case involving a 60-year-old male presenting with bullous skin lesions on areas of friction on his hands, feet and mouth. Milia were visible on some healed areas. Biopsy showed a subepidermal vesicle. Direct immunofluorescence showed intense linear junctional IgG and C3 at the dermo-epidermal junction. Serological tests also supported the diagnosis of EBA. Screening tests for underlying malignancies were negative. Despite treatment with systemic steroids, the patient developed increasing dysphagia, requiring further investigation with esophagoscopy and a barium swallow. Confirmation of extensive esophageal stricturing prompted adjustment of medications including an increase in systemic steroids and addition of azathioprine. Currently, the patient′s disease remains under control, with improvement in all his symptoms and return of anti-basement membrane antibody levels to normal, whilst he remains on azathioprine 150 mg daily and prednisolone 5 mg daily. This case highlights the fact that the treatment of a given patient with EBA depends on severity of disease and co-morbid symptoms. Newer immunoglobulin and biological therapies have shown promise in treatment resistant disease. Considering that long-term immunosuppressants or biologicals will be required, potential side effects of the drugs should be considered. If further deterioration occurs in this patient, cyclosporin A or intravenous immunoglobulin (IV Ig will be considered. Vigilance for associated co-morbidities, especially malignancies, should always be maintained.

  13. Higher risk of complications in odynophagia-associated dysphagia in amyotrophic lateral sclerosis

    Directory of Open Access Journals (Sweden)

    Karen Fontes Luchesi

    2014-03-01

    Full Text Available Objective This investigation aimed to identify associated factors with dysphagia severity in amyotrophic lateral sclerosis (ALS. Method We performed a cross-sectional study of 49 patients with ALS. All patients underwent fiberoptic endoscopy evaluation of swallowing and answered a verbal questionnaire about swallowing complaints. The patients were divided into groups according to dysphagia severity. Results Among the factors analyzed, only odynophagia was associated with moderate or severe dysphagia. Conclusion Odynophagia was associated with moderate and severe dysphagia in ALS and suggests a high risk of pulmonary and nutritional complications.

  14. McNeill dysphagia therapy program: a case-control study.

    Science.gov (United States)

    Carnaby-Mann, Giselle D; Crary, Michael A

    2010-05-01

    To compare the effectiveness of the McNeill Dysphagia Therapy Program, a systematic exercise-based rehabilitation framework for swallowing remediation, with traditional swallowing therapy techniques paired with surface electromyography (sEMG) biofeedback. Matched case-control study. University medical center. Dysphagic patients referred to an outpatient swallowing therapy service. Cases were individually matched to 2 separate controls for age, sex, and primary medical diagnosis (N=24). Cases were patients with dysphagia who entered the McNeill Dysphagia Therapy Program from September 2006 to October 2008. Controls entered a traditional swallowing therapy program augmented with sEMG biofeedback (traditional therapy with biofeedback group) from February 1994 to June 1999. The primary outcome was the proportion of patients who improved clinical swallowing ability and functional oral intake. The secondary outcomes were the presence (or not) of tube feeding, physiologic change on instrumental swallowing studies, and occurrence of aspiration on posttreatment assessment. Case patients were more likely to demonstrate dysphagia recovery at posttreatment re-evaluation (adjusted odds ratio for dysphagia recovery=13.0 [95% CI, 1.27-63.89]; Mantel-Haenszel chi(2)=6.7; P=.009; relative risk reduction=.69). Dysphagia was reduced by 69% in the McNeill Dysphagia Therapy Program treatment group compared with the traditional therapy with biofeedback group. Both approaches facilitated improved swallowing function. The McNeill Dysphagia Therapy Program resulted in superior outcomes compared with traditional dysphagia therapy supplemented with sEMG biofeedback.

  15. Formatting an experiential learning education module to encourage dysphagia assessment in apheresis patients.

    Science.gov (United States)

    West, James; Stutzman, Sonja E; Atem, Folefac; Olson, DaiWai M

    2017-08-02

    Dysphagia screening is oftentimes a focus of hospitalized patients, but dysphagia can also occur in outpatient settings. Dysphagia can be overlooked by nurses and clinicians, and it is therefore important to educate nurses on the importance of dysphagia screenings. This was a randomized prospective pilot study to compare the effect of experiential learning versus traditional PowerPoint learning regarding nurses' attitudes towards performing dysphagia screening in an outpatient setting. Twelve pre and post-test surveys were collected from nurses working in outpatient apheresis about their attitudes towards dysphagia screening. Additionally, 128 electronic medical records (EMR) were reviewed to determine if education increased the occurrence of dysphagia screening. There was a statistically significant difference in the pre vs. post-test group scores (P < .001), but due to small sample size, there was insufficient evidence to reject the null hypothesis that nurses had changed their attitudes towards dysphagia screening. Comparing documentation of dysphagia assessment in the EMR, there was not a significant difference in practice before or after the educational intervention (P = 0.18). The study results showed that the both types of teaching strategies are possible with nurses and they were receptive to both. Although the results of this study did not show a significant difference in practice, more research is needed to determine how to raise awareness and put this into practice. © 2017 Wiley Periodicals, Inc.

  16. O-METHYL PHOSPHORAMIDATE MODIFICATIONS ON THE CAPSULAR POLYSACCHARIDE OF CAMPYLOBACTER JEJUNI ARE INVOLVED IN SERUM RESISTANCE, INFECTION, AND INSECTICIDAL ACTIVITY

    Science.gov (United States)

    Campylobacter jejuni is the most commonly reported cause of bacterial foodborne illness in North America. C. jejuni decorates its surface polysaccharides with a variety of variable phosphorylated structures, including O-methyl phosphoramidate (MeOPN) modifications on the capsular polysaccharide. Alt...

  17. Development of a Multimedia Dysphagia Assessment Learning System Using Responsive Web Design: From e-Learning to m-Learning.

    Science.gov (United States)

    Huang, Hui-Chi; Guo, Sophie Huey-Ming

    2016-01-01

    Swallowing problems have significant affect the health outcome of some residents in long-term care facilities. Nursing staff who care these residents should have the ability of assessing dysphagia. However, nursing continued education to improve the performance of dysphagia assessment is still challenged. To enhance nurses' capability of dysphagia assessment, a Multimedia Dysphagia Assessment learning System was developed for nursing staff in long-term care institutions. This system was evaluated by performing a user usability test.

  18. Dysphagia in spinal muscular atrophy type II: more than a bulbar problem?

    NARCIS (Netherlands)

    Engel-Hoek, L. van den; Erasmus, C.E.; Bruggen, H.W. van; Swart, B.J.M. de; Sie, L.T.L.; Steenks, M.H.; Groot, I.J.M. de

    2009-01-01

    OBJECTIVE: In patients with spinal muscular atrophy (SMA) type II, feeding problems and dysphagia are common, but the underlying mechanisms of these problems are not well defined. This case control study was designed to determine the underlying mechanisms of dysphagia in SMA type II. METHODS: Six

  19. Dysphagia due to oesophageal obstruction: A case report of unusual occupational aetiology

    Directory of Open Access Journals (Sweden)

    Navnit Makaram

    2015-12-01

    Conclusion: A structured and thorough history and examination in dysphagia is emphasized. It is important to enquire about ‘red-flag’ symptoms, suggestive of head and neck or upper gastrointestinal malignancy. Barium swallow is a critical investigation in dysphagia-it can also demonstrate large bony abnormalities, which is a rare causative factor.

  20. Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's

    Science.gov (United States)

    Goes, Vanessa Fernanda; Mello-Carpes, Pâmela Billig; de Oliveira, Lilian Oliveira; Hack, Jaqueline; Magro, Marcela; Bonini, Juliana Sartori

    2014-01-01

    Objective to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease. Methods the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed. Results it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients. Conclusion an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease. PMID:26107841

  1. Dysphagia Therapy in Stroke: A Survey of Speech and Language Ttherapists

    Science.gov (United States)

    Archer, S. K.; Wellwood, I.; Smith, C. H.; Newham, D. J.

    2013-01-01

    Background: Dysphagia is common after stroke, leading to adverse outcome. There is a paucity of high-quality evidence for dysphagia therapy, thus making it difficult to determine the best approaches to treatment. Clinical decisions are often based on usual practice, however no formal method of monitoring practice patterns exists. Aims: To…

  2. Dysphagia Management: A Survey of School-Based Speech-Language Pathologists in Vermont

    Science.gov (United States)

    Hutchins, Tiffany L.; Gerety, Katherine W.; Mulligan, Moira

    2011-01-01

    Purpose: This study (a) gathered information about the kinds of dysphagia management services school-based speech-language pathologists (SLPs) provide, (b) examined the attitudes of SLPs related to dysphagia management, (c) compared the responses of SLPs on the basis of their experience working in a medical setting, and (d) investigated the…

  3. Establishing a Public School Dysphagia Program: A Model for Administration and Service Provision

    Science.gov (United States)

    Homer, Emily M.

    2008-01-01

    Purpose: Many school-based speech-language pathologists (SLPs) are hampered in participating in managing children with dysphagia by their school systems' lack of supportive policies and procedures. A need exists to better define the dysphagia-trained SLP's role and clarify the district's responsibility. The purpose of this article is to address…

  4. Current Evaluation of Upper Oesophageal Sphincter Opening in Dysphagia Practice: An International SLT Survey

    Science.gov (United States)

    Regan, Julie; Walshe, Margaret; McMahon, Barry P.

    2012-01-01

    Background: The assessment of adequate upper oesophageal sphincter (UOS) opening during swallowing is an integral component of dysphagia evaluation. Aims: To ascertain speech and language therapists' (SLTs) satisfaction with current methods for assessing UOS function in people with dysphagia and to identify challenges encountered by SLTs with UOS…

  5. School-Based Speech-Language Pathologists' Perspectives on Dysphagia Management in the Schools

    Science.gov (United States)

    Bailey, Rita L.; Stoner, Julia B.; Angell, Maureen E.; Fetzer, Alycia

    2008-01-01

    Purpose: Although provision of dysphagia services is within the scope of practice of speech-language pathologists (SLPs), little is known about the perspectives of school-based SLPs in relation to these services. The purpose of this study was to examine SLPs' perspectives related to school-based management of students with dysphagia. Method: Focus…

  6. Late Morbidity (Dysphagia) in Head and Neck Cancer after Radiotherapy using various Treatment Techniques

    NARCIS (Netherlands)

    D.N. Teguh (David)

    2010-01-01

    textabstractOropharyngeal Cancer (Chapter 2) Good tumor control but late-side effects occur e.g. dysphagia. Quality of Life: Dysphagia (Chapters 3-6) Dose-effects relationships in base of tongue, tonsillar fossa and nasopharyngeal cancer are found for swallowing problems. Quality of

  7. Tele-Dysphagia Management: An Opportunity for Prevention, Cost-Savings and Advanced Training

    Directory of Open Access Journals (Sweden)

    James Coyle

    2012-06-01

    Full Text Available Many patients survive severe stroke because of aggressive management in intensive care units.  However, acquiring pneumonia during the post-onset phase significantly reduces both the quality and likelihood of survival. Aspiration pneumonia (AP, a relatively recent addition to the list of the pneumonias, is associated with dysphagia, a swallowing disorder that may cause aspiration of swallowed food or liquids mixed with bacterial pathogens common to saliva, or by aspiration of gastric contents due to emesis or gastroesophageal reflux. While it is within the purview of speech-language pathologists to provide evaluation, treatment, and management of dysphagia, the number of patients with dysphagia is growing faster than the number of qualified dysphagia clinicians.  Because dysphagia consultations via telepractice are feasible and relatively accessible from a technological standpoint, they offer a promising strategy to bring the expertise of distant dysphagia experts to patients in underserved areas.  Tele-dysphagia management has the potential to increase patients’ survival, enhance the expertise of primary, local clinicians, and reduce healthcare costs. Even a modest reduction in either hospital admissions for aspiration pneumonia, or in the length of stay for AP, could save the US health care system hundreds of millions of dollars each year.  Wide spread tele-dysphagia management offers significant opportunities for prevention, cost-savings and advanced training, and is therefore worthy of consideration by stakeholders in the health care system and university training programs.

  8. Evaluation of dysphagia risk, nutritional status and caloric intake in elderly patients with Alzheimer's

    Directory of Open Access Journals (Sweden)

    Vanessa Fernanda Goes

    2014-04-01

    Full Text Available OBJECTIVE: to evaluate the risk of dysphagia and its relationship with the stage of Alzheimer's Disease, as well as the relationship between the risk of dysphagia and nutritional status and caloric intake in elderly people with Alzheimer's disease.METHODS: the sample consisted of 30 subjects of both genders with probable Alzheimer's disease. The stage of the disease, nutritional status, energy intake, and risk of dysphagia were assessed.RESULTS: it was found that increased risk of dysphagia is associated with the advance in the stages of Alzheimer's disease and that even patients in the early stages of disease have a slight risk of developing dysphagia. No association was found between nutritional status and the risk of dysphagia. High levels of inadequate intake of micronutrients were also verified in the patients.CONCLUSION: an association between dysphagia and the development of Alzheimer's disease was found. The results indicate the need to monitor the presence of dysphagia and the micronutrient intake in patients with Alzheimer's disease.

  9. A novel animal model of dysphagia following stroke.

    Science.gov (United States)

    Sugiyama, Naoto; Nishiyama, Eiji; Nishikawa, Yukitoshi; Sasamura, Takashi; Nakade, Shinji; Okawa, Katsumasa; Nagasawa, Tadashi; Yuki, Akane

    2014-02-01

    Patients who have an ischemic stroke are at high risk of swallowing disorders. Aspiration due to swallowing disorders, specifically delayed trigger of the pharyngeal stage of swallowing, predisposes such patients to pneumonia. In the present study, we evaluated swallowing reflex in a rat model of transient middle cerebral artery occlusion (tMCAO), which is one of the most common experimental animal models of cerebral ischemia, in order to develop a novel animal model of dysphagia following ischemic stroke. A swallowing reflex was elicited by a 10-s infusion of distilled water (DW) to the pharyngolaryngeal region in the tMCAO rat model. Swallowing reflex was estimated using the electromyographic activity of the mylohyoid muscle from 1 to 3 weeks after surgery. Two weeks after tMCAO, the number of swallows significantly decreased and the onset latency of the first swallow was prolonged compared with that of the sham group. The number of swallows in rats significantly increased by infusions of 10 mM citric acid and 0.6 μM capsaicin to the pharyngolaryngeal region compared with the number from infusion of DW. It has been reported that sensory stimulation of the pharyngolaryngeal region with citric acid, capsaicin, and L-menthol ameliorates hypofunction of pharyngeal-stage swallowing in dysphagia patients. Therefore, the tMCAO rat model may show some of the symptoms of pharyngeal-stage swallowing disorders, similar to those in patients with ischemic stroke. This rat tMCAO model has the potential to become a novel animal model of dysphagia following stroke that is useful for development of therapeutic methods and drugs.

  10. VIDEOFLUOROSCOPIC SWALLOWING STUDY: esophageal alterations in patients with dysphagia

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    Betina SCHEEREN

    2014-09-01

    Full Text Available Context Videofluoroscopic swallowing study is a dynamic exam and allows the evaluation of the complete swallowing process. However, most published studies have only reported alterations in the oropharynx and pharyngoesophageal transition, leaving the analysis of the esophagus as a secondary goal. Objectives The goal of this study was to investigate the prevalence of alterations in the esophageal phase thorough videofluoroscopic swallowing study in patients with dysphagia. Methods Consecutive patients with dysphagia who underwent videofluoroscopic swallowing study including esophageal analysis between May 2010 and May 2012 had their exams retrospectively reviewed. Patients were classified into two groups: Group I - without a pre-established etiological diagnosis and Group II - with neurological disease. During the exam, the patients ingested three different consistencies of food (liquid, pasty and solid contrasted with barium sulfate and 19 items were analyzed according to a protocol. The esophageal phase was considered abnormal when one of the evaluated items was compromised. Results Three hundred and thirty-three (n = 333 consecutive patients were studied - 213 (64% in Group I and 120 (36% in Group II. Esophageal alterations were found in 104 (31% patients, with a higher prevalence in Group I (36.2%, especially on the items esophageal clearance (16.9% and tertiary contractions (16.4%. It was observed that 12% of individuals in Group I only presented alterations on the esophageal phase. Conclusion Evaluation of the esophageal phase of swallowing during videofluoroscopic swallowing study detects abnormalities in patients with cervical dysphagia, especially in the group without pre-established etiological diagnosis.

  11. Dysphagia in stroke, neurodegenerative disease, and advanced dementia.

    Science.gov (United States)

    Altman, Kenneth W; Richards, Amanda; Goldberg, Leanne; Frucht, Steven; McCabe, Daniel J

    2013-12-01

    Aspiration risk from dysphagia increases with central and peripheral neurologic disease. Stroke, microvascular ischemic disease, a spectrum of neurodegenerative diseases, and advancing dementia all have unique aspects. However, there are distinct commonalities in this population. Increasing nutritional requirements to stave off oropharyngeal muscular atrophy and a sedentary lifestyle further tax the patient's abilities to safely swallow. This article reviews stroke, muscular dystrophy, myasthenia gravis, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, and advanced dementia. Approaches to screening and evaluation, recognizing sentinel indicators of decline that increase aspiration risk, and options for managing global laryngeal dysfunction are also presented.

  12. Dysphagia and dyspnea by lingual thyroid mass: An appropriate approach

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    Samad Ghiasi

    2015-03-01

    Full Text Available Lingual thyroid is a rare embryological anomaly originated from the thyroid gland failure that descends from the foramen cecum to its normal eutopic pre-laryngeal site. The case in this study was a 39 year old female, presenting with the sensation of a foreign body, progressive dysphagia and dyspnea. Indirect laryngoscopy revealed a large well-defined mass in the tongue base. Imaging studies confirmed the diagnosis of large ectopic lingual thyroid. The surgery was performed via an external cervical approach due to the mass size. The decision on the best treatment looks into the mass position, size, symptoms, airway emergency and medical facilities.

  13. Ultrasound in dysphagia rehabilitation: a novel approach following partial glossectomy.

    Science.gov (United States)

    Blyth, Katrina M; McCabe, Patricia; Madill, Catherine; Ballard, Kirrie J

    2017-10-01

    While the presence of dysphagia following partial glossectomy has been widely reported, there is insufficient quality evidence to guide clinical decision making about the treatment of this disorder. This study investigated a novel dysphagia rehabilitation approach using ultrasound tongue imaging for patient training. Initially, a pilot study was conducted to investigate the feasibility of ultrasound visual feedback during swallow tasks. The protocol was then replicated using a single-case experimental designed study to investigate therapeutic effect. Swallow, speech, and oromotor functions were measured across multiple baselines using an A-B-A intervention study design. During intervention, both participants were able to interpret ultrasound tongue images during swallow tasks. Following intervention, positive therapeutic effect was achieved with reduced frequency of aspiration and self-initiated swallow strategies. Generalization of intervention was evidenced by reduced bolus transit duration on videofluoroscopy and improved functional oral intake scores. Speech and oromotor functions remained stable throughout the study demonstrating experimental control. This study establishes that ultrasound visual feedback is feasible in dysphagia rehabilitation following partial glossectomy. In addition, the predicted therapeutic effect specifically to swallow but not speech or oromotor functions were demonstrated. Implications for Rehabilitation Partial glossectomy results in altered tongue shape, movement, and function which negatively impact on speech and swallowing There is limited research evidence to support previously used speech pathology interventions (in particular, tongue range of movement exercises) to rehabilitate dysphagia following tongue cancer surgery The tongue, and hence oral phase of swallowing, can be viewed by placing an ultrasound probe under the chin Ultrasound scanning of the tongue is not invasive, can be repeated without dosage side effect. It's also

  14. Effectiveness of Chin-tuck Maneuver to Facilitate Swallowing in Neurologic Dysphagia.

    Science.gov (United States)

    Saconato, Mariana; Chiari, Brasilia Maria; Lederman, Henrique Manoel; Gonçalves, Maria Inês Rebelo

    2016-01-01

    Introduction The chin-tuck maneuver is the most frequently employed postural maneuver in the treatment of neurogenic oropharyngeal dysphagia caused by encephalic vascular strokes and degenerative diseases. Objective The purpose of this study was to investigate the effectiveness of this maneuver in patients with neurogenic dysphagia and factors that could interfere in it. Methods In this retrospective cohort, we analyzed the medical files and videofluoroscopy exams of 35 patients (19 male - 54% and 16 female - 46%; age range between 20 and 89 years old; mean = 69 years). Results The results suggest that the effectiveness of chin-tuck maneuver is related to the overall degree of dysphagia: the more severe the dysphagia, the less effective the maneuver. Conclusion Chin-tuck maneuver should benefit dysphagic patients with delay in the swallowing trigger, reduced laryngeal elevation, and difficulties to swallow liquids, but is not the best compensatory strategy for patients with severe dysphagia.

  15. Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention

    DEFF Research Database (Denmark)

    Wirth, Rainer; Beck, Anne Marie; Dziewas, Rainer

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why...... the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition......, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation...

  16. Oropharyngeal dysphagia in older persons – from pathophysiology to adequate intervention

    DEFF Research Database (Denmark)

    Wirth, Rainer; Beck, Anne Marie; Dziewas, Rainer

    2016-01-01

    Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why...... the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related changes increase the risk of dysphagia. Physicians in charge of older patients should be aware that malnutrition......, dehydration, and pneumonia are frequently caused by (unrecognized) dysphagia. The diagnosis is particularly difficult in the case of silent aspiration. In addition to numerous screening tools, videofluoroscopy was the traditional gold standard of diagnosing OD. Recently, the fiberoptic endoscopic evaluation...

  17. Altered Cortical Swallowing Processing in Patients with Functional Dysphagia: A Preliminary Study

    Science.gov (United States)

    Wollbrink, Andreas; Warnecke, Tobias; Winkels, Martin; Pantev, Christo; Dziewas, Rainer

    2014-01-01

    Objective Current neuroimaging research on functional disturbances provides growing evidence for objective neuronal correlates of allegedly psychogenic symptoms, thereby shifting the disease concept from a psychological towards a neurobiological model. Functional dysphagia is such a rare condition, whose pathogenetic mechanism is largely unknown. In the absence of any organic reason for a patient's persistent swallowing complaints, sensorimotor processing abnormalities involving central neural pathways constitute a potential etiology. Methods In this pilot study we measured cortical swallow-related activation in 5 patients diagnosed with functional dysphagia and a matched group of healthy subjects applying magnetoencephalography. Source localization of cortical activation was done with synthetic aperture magnetometry. To test for significant differences in cortical swallowing processing between groups, a non-parametric permutation test was afterwards performed on individual source localization maps. Results Swallowing task performance was comparable between groups. In relation to control subjects, in whom activation was symmetrically distributed in rostro-medial parts of the sensorimotor cortices of both hemispheres, patients showed prominent activation of the right insula, dorsolateral prefrontal cortex and lateral premotor, motor as well as inferolateral parietal cortex. Furthermore, activation was markedly reduced in the left medial primary sensory cortex as well as right medial sensorimotor cortex and adjacent supplementary motor area (pdysphagia - a condition with assumed normal brain function - seems to be associated with distinctive changes of the swallow-related cortical activation pattern. Alterations may reflect exaggerated activation of a widely distributed vigilance, self-monitoring and salience rating network that interferes with down-stream deglutition sensorimotor control. PMID:24586948

  18. Endoscopic palliation of malignant dysphagia: a challenging task in inoperable oesophageal cancer

    Directory of Open Access Journals (Sweden)

    Mylvaganam S

    2006-07-01

    Full Text Available Abstract Background The main goal when managing patients with inoperable oesophageal cancer is to restore and maintain their oral nutrition. The aim of the present study was to assess the value of endoscopic palliation of dysphagia in patients with oesophageal cancer, who either due to advanced stage of the disease or co-morbidity are not suitable for surgery. Patients and methods All the endoscopic palliative procedures performed over a 5-year period in our unit were retrospectively reviewed. Dilatation and insertion of self-expandable metal stents (SEMS were mainly used for tight circumferential strictures whilst ablation with Nd-YAG laser was used for exophytic lesions. All procedures were performed under sedation. Results Overall 249 palliative procedures were performed in 59 men and 40 women, with a median age of 73 years (range 35 – 93. The median number of sessions per patient was 2 (range 1 – 13 sessions. Palliation involved laser ablation alone in 24%, stent insertion alone in 22% and dilatation alone in 13% of the patients. In 41% of the patients, a combination of the above palliative techniques was applied. A total of 45 SEMS were inserted. One third of the patients did not receive any other palliative treatment, whilst the rest received chemotherapy, radiotherapy or chemoradiotherapy. Swallowing was maintained in all patients up to death. Four oesophageal perforations were encountered; two were fatal whilst the other two were successfully treated with covered stent insertion and conservative treatment. The median survival from diagnosis was 10.5 months (range 0.5–83 months and the median survival from 1st palliation was 5 months (range 0.5–68.5 months. Conclusion Endoscopic interventions are effective and relatively safe palliative modalities for patients with oesophageal cancer. It is possible to adequately palliate almost all cases of malignant dysphagia. This is achieved by expertise in combination treatment.

  19. Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures

    NARCIS (Netherlands)

    van der Molen, L.; Heemsbergen, W.D.; de Jong, R.; van Rossum, M.A.; Smeele, L.E.; Rasch, C.R.N.; Hilgers, F.J.M.

    2013-01-01

    Background and purpose: Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Material and methods: Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment

  20. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders.

    Science.gov (United States)

    Ertekin, C; Aydoğdu, I; Yüceyar, N

    1996-11-01

    Before the advanced evaluation of deglutition and selection of a treatment method, objective screening methods are necessary for patients with dysphagia. In this study a new electroclinical test was established to evaluate patients with dysphagia. This test is based on determining piecemeal deglutition; which is a physiological phenomenon occurring when a bolus of a large volume is divided into two or more parts which are swallowed successively. The combined electrophysiological and mechanical method used to record laryngeal movements detected by a piezoelectric transducer, and activities of the related submental integrated EMG (SM-EMG)-and sometimes the cricopharyngeal muscle of the upper oesophageal sphincter (CP-EMG)-were performed during swallowing. Thirty normal subjects and 66 patients with overt dysphagia of neurogenic origin were investigated after detailed clinical evaluation. Twenty patients with a potential risk of dysphagia, but who were normal clinically at the time of investigation, were also evaluated to determine the specificity of the test. All subjects were instructed to swallow doses of water, gradually increasing in quantity from 1 ml to 20 ml, and any recurrence of the signals related to swallowing within the eight seconds was accepted as a sign of dysphagia limit. In normal subjects as well as in the patients without dysphagia, piecemeal deglutition was never seen with less than 20 ml water. This volume was therefore accepted as the lower limit of piecemeal deglutition. In patients with dysphagia, dysphagia limits were significantly lower than those of normal subjects. The method is a highly specific and sensitive test for the objective evaluation of oropharyngeal dysphagia even in patients with suspected dysphagia of neurogenic origin. It can also be safely and simply applied in any EMG laboratory.

  1. The One-Year Attributable Cost of Post-Stroke Dysphagia

    Science.gov (United States)

    Bonilha, Heather Shaw; Simpson, Annie N.; Ellis, Charles; Mauldin, Patrick; Martin-Harris, Bonnie; Simpson, Kit

    2014-01-01

    With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies. PMID:24948438

  2. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Nam P. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States)]. E-mail: NamPhong.Nguyen@med.va.gov; Moltz, Candace C. [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Frank, Cheryl [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Karlsson, Ulf [Department of Radiation Oncology, East Carolina University, Greenville, NC 27858 (United States); Nguyen, Phuc D. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States); Vos, Paul [Department of Biostatistics, East Carolina University, Greenville, NC 27858 (United States); Smith, Herbert J. [Radiology Service, VA North Texas Health Care System, Dallas, TX 75216 (United States); Dutta, Suresh [Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033 (United States); Nguyen, Ly M. [Public Health School, University of Michigan, Ann Arbor, MI 48109 (United States); Lemanski, Claire [Department of Radiation Oncology, Val D' Aurelle, Montpellier (France); Chan, Wayne [Radiation Oncology Service, VAMC, Jackson, MS 39216 (United States); Sallah, Sabah [Division of Hematology/Oncology Research, Novo Nordisk, Athens (Greece)

    2006-09-15

    Objective: The purpose of the study is to evaluate dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer, and particularly the aspiration risk because of its potential life-threatening consequence. Materials and methods: We reviewed retrospectively the modified barium swallow (MBS) results in 110 patients who complained of dysphagia following chemoradiation (57) and postoperative radiation (53) of their head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: mild (grades 2-3), moderate (grades 4-5), and severe (grades 6-7). Results: Mean and median dysphagia grades were 4.84/5 and 4.12/4 for chemoradiation and postoperative radiation respectively. The mean difference between the two groups is statistically significant (p = 0.02). Mild dysphagia occurred in 13 patients (22%) of the chemoradiation group and 17 (32%) of the postoperative group. Corresponding number for the moderate group was 25 (43%) and 25 (48%), respectively. Severe dysphagia was significant in the chemoradiation group (34%) compared to the postoperative group (19%). However, the difference was not statistically significant (p = 0.29). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group who developed severe dysphagia. Conclusion: Dysphagia remained a significant morbidity of chemoradiation and postoperative radiation for head and neck cancer. Dysphagia may be more severe in the chemoradiation group because of the higher proportion of patients with large tumor, the high radiation dose, and a high number of oropharyngeal tumors. Aspiration occurred in both groups. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, as it may be silent.

  3. [The Determinants of Dysphagia in Patients With Stroke During Hospitalized Rehabilitation].

    Science.gov (United States)

    Szu, Li-Yun; Hsieh, Suh-Ing; Tseng, Su-Mei; Huang, Tzu-Hsin

    2017-06-01

    Stroke was the third leading cause of death in Taiwan in 2014. A study found that 53.61% of stroke patients suffered from dysphagia disorder during the rehabilitation phase, which may result in lung aspiration and death. The determinants of dysphagia among nationally hospitalized-rehabilitation stroke patients have not been explored comprehensively. To explore the incidence of dysphagia among hospitalized-rehabilitation stroke patients and the related determinants of dysphagia. This descriptive and correlational research design employed a convenience sample of 130 hospitalized stroke patients from rehabilitation wards at a northern regional hospital in Taiwan. A questionnaire and functional assessment were used to collect data. Instruments used included personal and clinical characteristics data questionnaire, the National Institute of Health Stroke Scale (NIHSS), Barthel Index, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Standardization Swallowing Assessment (SSA), and Acute Stroke Dysphagia Screening (ASDS). Data analyses contained descriptive statistics and logistic regression. The incidence of stroke dysphagia was 63.8% (SSA) and 64.6% (ASDS), respectively. Age, marital status, stroke site, stroke severity (NIHSS), and cognitive status (MMSE) were identified as significant determinants of dysphagia in bivariate logistic regression, whereas stroke severity and cognitive status were identified as significant independent determinants of dysphagia in multivariate logistic regression. Two-thirds of the participant sample were affected by dysphagia, for which NIHSS and cognitive status were identified as significant determinants. Thus, nurses may conduct early screening for high risk populations based on patients' clinical characteristics in order to reduce aspiration pneumonia problems and to improve the quality of clinical care for dysphagia patients.

  4. Rare case of dysphagia, skin blistering, missing nails in a young boy.

    Science.gov (United States)

    Makker, Jasbir; Bajantri, Bharat; Remy, Prospere

    2015-02-16

    Epidermolysis bullosa is a group of genetic disorders with an autosomal dominant or an autosomal recessive mode of inheritance and more than 300 mutations. The disorder is characterized by blistering mucocutaneous lesions and has several varying phenotypes due to anchoring defect between the epidermis and dermis. The variation in phenotypic expression depends on the involved structural protein that mediates cell adherence between different layers of the skin. Epidermolysis bullosa can also involve extra-cutaneous sites including eye, nose, ear, upper airway, genitourinary tract and gastrointestinal tract. The most prominent feature of the gastrointestinal tract involvement is development of esophageal stricture. The stricture results from recurrent esophageal mucosal blistering with consequent scarring and most commonly involves the upper esophagus. Here we present a case of a young boy with dominant subtype of dystrophic epidermolysis bullosa who presented with dysphagia, extensive skin blistering and missing nails. Management of an esophageal stricture eventually requires dilatation of the stricture or placement of a gastrostomy tube to keep up with the nutritional requirements. Gastrostomy tube also provides access for esophageal stricture dilatation in cases where antegrade approach through the mouth has failed.

  5. Posttranslational protein modification in Archaea.

    Science.gov (United States)

    Eichler, Jerry; Adams, Michael W W

    2005-09-01

    One of the first hurdles to be negotiated in the postgenomic era involves the description of the entire protein content of the cell, the proteome. Such efforts are presently complicated by the various posttranslational modifications that proteins can experience, including glycosylation, lipid attachment, phosphorylation, methylation, disulfide bond formation, and proteolytic cleavage. Whereas these and other posttranslational protein modifications have been well characterized in Eucarya and Bacteria, posttranslational modification in Archaea has received far less attention. Although archaeal proteins can undergo posttranslational modifications reminiscent of what their eucaryal and bacterial counterparts experience, examination of archaeal posttranslational modification often reveals aspects not previously observed in the other two domains of life. In some cases, posttranslational modification allows a protein to survive the extreme conditions often encountered by Archaea. The various posttranslational modifications experienced by archaeal proteins, the molecular steps leading to these modifications, and the role played by posttranslational modification in Archaea form the focus of this review.

  6. Dysphagia Due to Anterior Cervical Spine Osteophyte: A Case Report

    Directory of Open Access Journals (Sweden)

    Hossein Mashhadinezhad

    2010-07-01

    Full Text Available Introduction: Degenerative changes of the cervical spine are more common in elderly, but anterior cervical osteophytes that cause problems in swallowing are rare. The most common cause of this problem is DISH disease (diffuse idiopathic skeletal hyperostosis. Trauma is also suggested as a potential cause in osteophyte formation. Case Report: We report a rare case of anterior cervical osteophyte with problems in swallowing that was caused by cervical spine trauma in a car accident 4 years ago, treated with a cervical collar. Dysphagia was the initial symptom of the disease. Barium swallowing showed a large cervical osteophyte at the C3-C4 level with compression effect on the esophagus. X-ray, CT scan and MRI of the cervical spine confirmed the osteophyte and its correlation with the esophagus. Endoscopic study of esophagus and stomach also ruled out other disorders. Surgical osteophytectomy was performed. Conclusion: Up to now, only two cases of post-traumatic anterior cervical osteophyte have been cited in the literature. In this report, we introduce an unusual case of dysphagia caused by cervical spine trauma.

  7. [Sarcomatoid pleural mesothelioma presenting as posterior mediastinal tumor with dysphagia].

    Science.gov (United States)

    Togashi, K; Hosaka, Y; Sato, K

    2007-01-01

    Case 1: A 46-year-old man with dysphagia, chest pain and cough admitted to our department. Radiological studies demonstrated a solid mass with a maximal diameter of 5cm at the posterior mediastinum. The tumor was resected, then postoperative radiotherapy (60Gy) and chemotherapy were performed. Results of histological and immunohistochemical study showed that the tumor consisted of sarcomatoid mesothelioma. The patient died of recurrence with bone metastasis 6 months after surgery. Case 2: A 76-year-old man with dysphagia, chest pain and cough admitted to our department Radiological studies demonstrated a solid mass with a maximal diameter of 12cm in the posterior mediastinum. accompanied by abundant effusion in the bilateral pleural cavities. The patient underwent open biopsy and histological and immunohistochemical study showed that the tumor consisted of sarcomatoid mesothelioma. The patient died of multiple organ failure on the 1st postoperative day. We report extremely rare cases of sarcomatoid mesothelioma that appeared to be posterior mediastinal tumor before surgery, and discuss the difficulty of diagnosing sarcomatoid mesothelioma with atypical clinical manifestations.

  8. Do nasogastric tubes worsen dysphagia in patients with acute stroke?

    Directory of Open Access Journals (Sweden)

    Ringelstein Erich B

    2008-07-01

    Full Text Available Abstract Background Early feeding via a nasogastric tube (NGT is recommended as safe way of supplying nutrition in patients with acute dysphagic stroke. However, preliminary evidence suggests that NGTs themselves may interfere with swallowing physiology. In the present study we therefore investigated the impact of NGTs on swallowing function in acute stroke patients. Methods In the first part of the study the incidence and consequences of pharyngeal misplacement of NGTs were examined in 100 stroke patients by fiberoptic endoscopic evaluation of swallowing (FEES. In the second part, the effect of correctly placed NGTs on swallowing function was evaluated by serially examining 25 individual patients with and without a NGT in place. Results A correctly placed NGT did not cause a worsening of stroke-related dysphagia. Except for two cases, in which swallowing material got stuck to the NGT and penetrated into the laryngeal vestibule after the swallow, no changes of the amount of penetration and aspiration were noted with the NGT in place as compared to the no-tube condition. Pharyngeal misplacement of the NGT was identified in 5 of 100 patients. All these patients showed worsening of dysphagia caused by the malpositioned NGT with an increase of pre-, intra-, and postdeglutitive penetration. Conclusion Based on these findings, there are no principle obstacles to start limited and supervised oral feeding in stroke patients with a NGT in place.

  9. Older people with dysphagia: transitioning to texture-modified food.

    Science.gov (United States)

    Ullrich, Sandra; Crichton, Jonathan

    Older people with dysphagia are at high risk of malnutrition. To maintain safe oral and nutritional intake, solid food may be texture-modified. Little is known about the transition experiences of older people who move from normal to texture-modified foods. The aim of this study was to describe residents' experiences as they transitioned from normal food to texture-modified food. The study used a qualitative descriptive design and individual interviews were conducted with a study group of 28 participants (residents, family members, nursing and care staff, and speech and language therapists). The interviews were thematically analysed. The findings suggest that transition creates the risk of distress, reducing eating to a matter of necessity and hunger, and that the process is perceived as abrupt, and characterised by lack of communication and awareness of the need for change. A key finding is that the language used during transition can be adversely affected by the management of risk. This language promotes a culture of care that emphasises the limitations of residents, reduces their motivation to eat and hinders the delivery of person-centred care. The findings suggest that care facilities for older people need to revisit their dysphagia management protocols to ensure that they support a person-centred approach for recipients of texture-modified food.

  10. Investigation of compensatory postures with videofluoromanometry in dysphagia patients

    Institute of Scientific and Technical Information of China (English)

    Antonio Solazzo; Luigi Monaco; Lucia Del Vecchio; Stefania Tamburrini; Francesca Iacobellis; Daniela Berritto; Nunzia Luisa Pizza

    2012-01-01

    AIM:To investigate the effectiveness of head compensatory postures to ensure safe oropharyngeal transit.METHODS:A total of 321 dysphagia patients were enrolled and assessed with videofluoromanometry (VFM).The dysphagia patients were classified as follows:safe transit; penetration without aspiration; aspiration before,during or after swallowing; multiple aspirations and no transit.The patients with aspiration or no transit were tested with VFM to determine whether compensatory postures could correct their swallowing disorder.RESULTS:VFM revealed penetration without aspiration in 71 patients (22.1%); aspiration before swallowing in 17 patients (5.3%); aspiration during swallowing in 32 patients (10%); aspiration after swallowing in 21 patients (6.5%); multiple aspirations in six patients (1.9%); no transit in five patients (1.6%); and safe transit in 169 patients (52.6%).Compensatory postures guaranteed a safe transit in 66/75 (88%) patients with aspiration or no transit.A chin-down posture achieved a safe swallow in 42/75 (56%) patients,a head-turned posture in 19/75 (25.3%) and a hyperextended head posture in 5/75 (6.7%).The compensatory postures were not effective in 9/75 (12%) cases.CONCLUSION:VFM allows the speech-language therapist to choose the most effective compensatory posture without a trial-and-error process and check the effectiveness of the posture.

  11. 植物萜类生物合成中的后修饰酶%Post-modification Enzymes Involved in the Biosynthesis of Plant Terpenoids

    Institute of Scientific and Technical Information of China (English)

    李军玲; 罗晓东; 赵沛基; 曾英

    2009-01-01

    萜类化合物由于其结构类型丰富多样而被称为"terpenome".除了参与植物生长发育、环境应答等生理过程,萜类化合物还应用于医药、有机化工等领域.萜类的生物合成大致可分为前体形成、骨架构建以及后修饰三部分,基本骨架通常由萜类合酶催化形成,进一步在后修饰酶的作用下产生数以万计的萜类化合物.结合我们对香茶菜二萜生物合成的初步研究结果,本文主要针对近年来植物萜类生物合成中的一些有代表性的后修饰酶包括P450单氧酶、双键还原酶、酰基转移酶和糖基转移酶,进行研究现状分析与展望.%Terpenoids are called "terpenome" for their structural diversities. Besides their important roles in plant growth, development and environmental responses, terpenoids have been widely used in medicine and organic chemicals. The biosynthesis of terpenoids in plants can be conceptually divided into three discrete processes: the formation of terpene precursors, the construction of terpene skeletons, followed by the complex post-modifications. After the skeleton construction by terpene synthases (TPS), diverse reactions catalyzed by the responsible post-modification enzymes result in tens of thousands of terpenoids. In this paper, with our preliminary studies on the biosynthesis of Isodon diterpenes, a number of representative post-modification enzymes of plant terpenoids formation reported in recent years are reviewed, which include P450 monooxidases, double-bond reductases, acylrransferases and glycosyltransferases.

  12. Heterologous expression of the isopimaric acid pathway in Nicotiana benthamiana and the effect of N-terminal modifications of the involved cytochrome P450 enzyme

    DEFF Research Database (Denmark)

    Gnanasekaran, Thiyagarajan; Vavitsas, Konstantinos; Andersen-Ranberg, Johan;

    2015-01-01

    in the chloroplast and subsequently oxidized by a cytochrome P450, CYP720B4. RESULTS: We transiently expressed the isopimaric acid pathway in Nicotiana benthamiana leaves and enhanced its productivity by the expression of two rate-limiting steps in the pathway (providing the general precursor of diterpenes). This co...... enzymes. CONCLUSIONS: It is possible to localize a diterpenoid pathway from spruce fully within the chloroplast of N. benthamiana and a few modifications of the N-terminal sequences of the CYP720B4 can facilitate the expression of plant P450s in the plastids. The coupling of terpene biosynthesis closer......BACKGROUND: Plant terpenoids are known for their diversity, stereochemical complexity, and their commercial interest as pharmaceuticals, food additives, and cosmetics. Developing biotechnology approaches for the production of these compounds in heterologous hosts can increase their market...

  13. Heterologous expression of the isopimaric acid pathway in Nicotiana benthamiana and the effect of N-terminal modifications of the involved cytochrome P450 enzyme

    DEFF Research Database (Denmark)

    Gnanasekaran, Thiyagarajan; Vavitsas, Konstantinos; Andersen-Ranberg, Johan

    2015-01-01

    in the chloroplast and subsequently oxidized by a cytochrome P450, CYP720B4. RESULTS: We transiently expressed the isopimaric acid pathway in Nicotiana benthamiana leaves and enhanced its productivity by the expression of two rate-limiting steps in the pathway (providing the general precursor of diterpenes). This co...... enzymes. CONCLUSIONS: It is possible to localize a diterpenoid pathway from spruce fully within the chloroplast of N. benthamiana and a few modifications of the N-terminal sequences of the CYP720B4 can facilitate the expression of plant P450s in the plastids. The coupling of terpene biosynthesis closer......BACKGROUND: Plant terpenoids are known for their diversity, stereochemical complexity, and their commercial interest as pharmaceuticals, food additives, and cosmetics. Developing biotechnology approaches for the production of these compounds in heterologous hosts can increase their market...

  14. The use of pulse oximetry as a screening assessment for paediatric neurogenic dysphagia.

    Science.gov (United States)

    Morgan, A T; Omahoney, R; Francis, H

    2008-01-01

    Early screening and intervention for dysphagia is crucial to offset potential outcomes such as compromised nutrition or reduced respiratory function. Current paediatric dysphagia screening tests are subjective with poor sensitivity and specificity. The present study examined whether an objective method, pulse oximetry (measuring oxygen saturation (SpO2) levels), could differentiate between children with and without dysphagia, in relation to (1) Average pre-feeding baseline SpO2 levels; (2) Average feeding SpO2 levels; (3) Average post-feeding SpO2 levels; and (4) The number of events of oxygen desaturation pre-, during and after feeding. Nine participants with chronic neurological disability (CND) (7 F, 2 M) (9; 7-15; 11 years) and nine control participants matched for age (9; 5-16; 0 years) and sex were assessed using a clinical bedside evaluation (CBE) and pulse oximetry. A statistically significant difference was found in SpO2 levels between the two groups (p dysphagia experienced 'events' of SpO2 desaturation during feeding. Pulse oximetry may provide a useful adjunct to the CBE for dysphagia screening, with average SpO2 levels during feeding predicting those with and without dysphagia with moderate levels of sensitivity and specificity. The finding of individual variation in desaturation 'events', however, warrants the provision of further data on large homogenous populations to provide definitive criterion for pathological SpO2 levels associated with dysphagia during oral feeding.

  15. [Evaluation and treatment of dysphagia in amyotrophic lateral sclerosis and Parkinson's disease].

    Science.gov (United States)

    Yamamoto, Toshiyuki

    2011-11-01

    As both amyotrophic lateral sclerosis (ALS) and Parkinson's disease (PD) exhibit a variety of patterns of dysphagia, appropriate symptomatic treatment is provided after evaluation of swallowing function through videofluoroscopic examination of swallowing. In ALS, disease progression is rapid, therefore, respiratory function, swallowing function and nutritional status should be evaluated regularly. When the oral or pharyngeal stage of swallowing are affected early in dysphagia, adjusting swallowing volume and varying consistency can be beneficial in ALS. When all stages of swallowing are impaired in ALS, such complications as pneumonia, dehydration and malnutrition, are observed. In such patients, it is necessary to consider an alternative to oral dietary intake. In PD, dysphagia is not necessarily associated with severity of parkinsonism and can appear at any time during the course of the disease. Dysphagia in PD can occur at any stage of swallowing and frequently accompanies multiple abnormalities. In particular, aspiration is an important risk factor for pneumonia in PD. The effect of L-dopa treatment for dysphagia is often insufficient; however, this treatment remains the first choice because dysphagia is exacerbated during off state. Rehabilitation for dysphagia in PD has also some effect.

  16. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting

    Directory of Open Access Journals (Sweden)

    Jaishika Seedat

    2016-02-01

    Full Text Available Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23 was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23 was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

  17. Knowledge of nurses regarding dysphagia in patients post stroke in Namibia

    Directory of Open Access Journals (Sweden)

    Anthea Rhoda

    2015-07-01

    Full Text Available Background: Stroke patients commonly experience dysphagia post stroke. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, dehydration, and a subsequent increased risk of death. Its early diagnosis and management is an important prerequisite for recovery from stroke during the rehabilitation phase. As nurses are the first health personnel that interact with a patient post stroke, it is important that they are knowledgeable and skilled in the screening of these patients for dysphagia.Objective: The aim of the study was to determine the knowledge and factors associated with knowledge of nurses regarding dysphagia in stroke patients.Methods: The study used a quantitative survey to determine the knowledge of the nurses employed at an intermediate hospital in Namibia. A convenient sample of 182 participants completed a self-administered questionnaire with closed-ended questions, which was developed by the researcher. The data was analysed using descriptive and inferential statistics.Results: The findings of the study confirmed that nurses have a moderate knowledge of the signs, symptoms, and complications of dysphagia, but poor knowledge about its management.Training and experience in the care of dysphagia patients was a stronger predictor of knowledge than the initial qualification or years of experience as a nurse.Conclusion: Post basic training in dysphagia would better equip nurses to manage stroke patients in the acute phase.

  18. Diagnosis and Management of Oropharyngeal Dysphagia and Its Nutritional and Respiratory Complications in the Elderly

    Directory of Open Access Journals (Sweden)

    Laia Rofes

    2011-01-01

    Full Text Available 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.

  19. [Dysphagia management of acute and long-term critically ill intensive care patients].

    Science.gov (United States)

    Zielske, J; Bohne, S; Axer, H; Brunkhorst, F M; Guntinas-Lichius, O

    2014-10-01

    Dysphagia is a severe complication in critically ill patients and affects more than half the patients in an intensive care unit. Dysphagia also has a strong impact on morbidity and mortality. Risk factors for the development of dysphagia are neurological diseases, age >55-70 years, intubation >7 days and sepsis. With increasing numbers of long-term survivors chronic dysphagia is becoming an increasing problem. There is not much knowledge on the influence of specific diseases, including the direct impact of sepsis on the development of dysphagia. Fiberoptic evaluation of swallowing is a standardized tool for bedside evaluation, helping to plan swallowing training during the acute phase and to decrease the rate of chronic dysphagia. For evaluation of chronic dysphagia even more extensive diagnostic tools as well as several options of stepwise rehabilitation using restitution, compensation and adaption strategies for swallowing exist. Currently it seems that these options are not being sufficiently utilized. In general, there is a need for controlled clinical trials analyzing specific swallowing rehabilitation concepts for former critically ill patients and long-term survivors.

  20. The lived experience of dysphagia following non-surgical treatment for head and neck cancer.

    Science.gov (United States)

    Nund, Rebecca L; Ward, Elizabeth C; Scarinci, Nerina A; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V

    2014-06-01

    The prevalence and severity of dysphagia in people treated non-surgically for primary head and neck cancer (HNC) is well documented. However, few studies have looked beyond the physiological impairment to explore the lived experience of dysphagia in the post-treatment period of HNC. The current study adopted a person-centred, qualitative approach to describe the experiences of people living with dysphagia in the months and years following non-surgical treatment for HNC. Using maximum variation sampling, 24 participants who had undergone radiotherapy treatment for HNC were recruited. Individual interviews were conducted to explore the impact of dysphagia on participants' everyday lives. The themes identified included: (1) physical changes related to swallowing; (2) emotions evoked by living with dysphagia; (3) altered perceptions and changes in appreciation of food; and (4) personal and lifestyle impacts. The data revealed the breadth and significance of the impact of dysphagia on the lives of people treated curatively for HNC. Assessment and management in the post-treatment period must be sufficiently holistic to address both the changing physical states and the psychosocial needs of people with dysphagia following HNC. Rehabilitation services which focus only on impairment-based management will fail to fully meet the support needs of this clinical population.

  1. Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson's disease.

    Science.gov (United States)

    Walker, Richard W; Dunn, Janet R; Gray, William K

    2011-03-01

    Many people with Parkinson's disease (PD) experience dysphagia; however, the prevalence of dysphagia in people with PD is unknown. We studied a prevalent population of PD cases. All of those who consented to participate were assessed for anxiety, depression, cognitive function, and quality of life using standard rating scales. Anyone who answered "yes" to either one of the two questions: Do you have difficulty swallowing food/liquid or tablets? and Do you cough after eating/drinking? was considered to have dysphagia. Question 7 of the Unified Parkinson's Disease Rating Scale (UPDRS) was also used to identify dysphagia. Of 106 prevalent PD cases, 75 (38 males) patients consented to examination and assessment. The prevalence of dysphagia was 32.0% (n=24; 11 males). Using the response to UPDRS Question 7 as an indicator of the impact of swallowing problems on the patient, there were significant correlations with cognitive function, anxiety, depression, quality of life, and UPDRS-reported gait disturbance, postural instability and problems with falling. There was no correlation with disease duration, age, or gender. Almost one third of the participants reported dysphagia. There was a strong correlation between dysphagia and gross motor skills; patients reporting such problems should be screened for swallowing problems. © Springer Science+Business Media, LLC 2010

  2. Evaluation of dysphagia in early stroke patients by bedside, endoscopic, and electrophysiological methods.

    Science.gov (United States)

    Umay, Ebru Karaca; Unlu, Ece; Saylam, Guleser Kılıc; Cakci, Aytul; Korkmaz, Hakan

    2013-09-01

    We aimed in this study to evaluate dysphagia in early stroke patients using a bedside screening test and flexible fiberoptic endoscopic evaluation of swallowing (FFEES) and electrophysiological evaluation (EE) methods and to compare the effectiveness of these methods. Twenty-four patients who were hospitalized in our clinic within the first 3 months after stroke were included in this study. Patients were evaluated using a bedside screening test [including bedside dysphagia score (BDS), neurological examination dysphagia score (NEDS), and total dysphagia score (TDS)] and FFEES and EE methods. Patients were divided into normal-swallowing and dysphagia groups according to the results of the evaluation methods. Patients with dysphagia as determined by any of these methods were compared to the patients with normal swallowing based on the results of the other two methods. Based on the results of our study, a high BDS was positively correlated with dysphagia identified by FFEES and EE methods. Moreover, the FFEES and EE methods were positively correlated. There was no significant correlation between NEDS and TDS levels and either EE or FFEES method. Bedside screening tests should be used mainly as an initial screening test; then FFEES and EE methods should be combined in patients who show risks. This diagnostic algorithm may provide a practical and fast solution for selected stroke patients.

  3. Dysphagia is a common and serious problem for adults with mental illness: a systematic review.

    Science.gov (United States)

    Aldridge, Kristy J; Taylor, Nicholas F

    2012-03-01

    Adults with mental illness may experience a higher incidence of dysphagia and choking due to factors such as medication side effects and behavioural abnormalities. The aim of this study was to determine the frequency of dysphagia and the most effective interventions for this population. Studies published up to August 2010 were sought via a comprehensive electronic database search (CINAHL, PsycINFO, MEDLINE, PubMed, Cochrane, and Embase). Studies reporting dysphagia frequency or dysphagia intervention outcomes in adults with mental illness were included. Two reviewers independently assessed study eligibility and quality, and the results were synthesised descriptively. Ten studies were identified, each describing dysphagia frequency or death due to choking asphyxiation. No studies evaluating intervention effectiveness were identified. Study quality was limited by subjective assessment of outcomes. Six studies presented dysphagia frequencies ranging from 9 to 42% in varying subgroups. Four studies presented the frequency of choking asphyxiation death, including a large survey that concluded that adults with organic mental illness were 43 times more likely to die of this cause than the general population. Dysphagia is a common and significant cause of morbidity and mortality in adults with mental illness and our review found that there is a lack of studies evaluating the effectiveness of intervention techniques.

  4. Spontaneous swallow frequency compared with clinical screening in the identification of dysphagia in acute stroke.

    Science.gov (United States)

    Crary, Michael A; Carnaby, Giselle D; Sia, Isaac

    2014-09-01

    The aim of this study was to compare spontaneous swallow frequency analysis (SFA) with clinical screening protocols for identification of dysphagia in acute stroke. In all, 62 patients with acute stroke were evaluated for spontaneous swallow frequency rates using a validated acoustic analysis technique. Independent of SFA, these same patients received a routine nurse-administered clinical dysphagia screening as part of standard stroke care. Both screening tools were compared against a validated clinical assessment of dysphagia for acute stroke. In addition, psychometric properties of SFA were compared against published, validated clinical screening protocols. Spontaneous SFA differentiates patients with versus without dysphagia after acute stroke. Using a previously identified cut point based on swallows per minute, spontaneous SFA demonstrated superior ability to identify dysphagia cases compared with a nurse-administered clinical screening tool. In addition, spontaneous SFA demonstrated equal or superior psychometric properties to 4 validated, published clinical dysphagia screening tools. Spontaneous SFA has high potential to identify dysphagia in acute stroke with psychometric properties equal or superior to clinical screening protocols. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. [Seamless community coordination of rehabilitation nutrition care management in patients with Dysphagia].

    Science.gov (United States)

    Wakabayashi, Hidetaka

    2010-12-01

    Community coordination is necessary in nutrition care management and dysphagia rehabilitation, because they are not completed in one hospital or facility. For seamless community coordination of rehabilitation nutrition care management in patients with dysphagia, it is useful to define why, who, when, where, what, and how. Common communication materials of nutrition support team and dysphagia rehabilitation made by Kanagawa society of dysphagia rehabilitation is effective in promoting community coordination. In qualitative research for participants in community nutrition support team at Yokohama south area, two issues were emerged: strengthening collaboration of the community nutrition support team including visiting medical staffs and offering opportunity to learn clinical nutrition and dysphagia rehabilitation. Concept of rehabilitation nutrition is also useful for community coordination. Rehabilitation nutrition is to assess with the International Classification of Functioning, Disability and Health including nutrition status and to practice rehabilitation nutrition care plan under adequate prognosis prediction. It is not enough for patients with dysphagia to coordinate only clinical nutrition or rehabilitation. Seamless community coordination of rehabilitation nutrition care management is important for patients with dysphagia to improve their activities of daily living and quality of life.

  6. Malnutrition and Dysphagia in long-term care: a systematic review.

    Science.gov (United States)

    Namasivayam, Ashwini M; Steele, Catriona M

    2015-01-01

    Determining the co-occurrence of malnutrition and dysphagia is important to understand the extent to which swallowing impairment contributes to poor food intake in long-term care (LTC). This review investigated the impact of dysphagia on malnutrition in LTC by synthesizing the results of published literature. Seven electronic databases were used to search for English-language publications reporting malnutrition and dysphagia in LTC facilities from 1946 to 2013. Fourteen studies were eligible for inclusion. Overall, the literature on the co-occurrence of malnutrition and dysphagia in LTC shows a paucity of high-quality evidence. Articles reviewed lacked consistent definitions for both conditions. Methods used to confirm each diagnosis also differed and were of questionable validity. Based on a review of the literature, evidence of the existence of concurrent concerns with respect to malnutrition and dysphagia emerges. The reported frequency of participants in LTC with dysphagia ranges from 7% to 40%, while the percentage of those who were malnourished ranges from 12% to 54%. Due to discrepancies used to describe and measure these conditions, it is difficult to determine the exact prevalence of either condition separately, or in combination. Consequently, the impact of dysphagia on malnutrition must be considered and studied using valid definitions and measures.

  7. Rare case of dysphagia, skin blistering, missing nails in ayoung boy

    Institute of Scientific and Technical Information of China (English)

    Jasbir Makker; Bharat Bajantri; Prospere Remy

    2015-01-01

    Epidermolysis bullosa is a group of genetic disorderswith an autosomal dominant or an autosomal recessivemode of inheritance and more than 300 mutations. Thedisorder is characterized by blistering mucocutaneouslesions and has several varying phenotypes due toanchoring defect between the epidermis and dermis.The variation in phenotypic expression depends on theinvolved structural protein that mediates cell adherencebetween different layers of the skin. Epidermolysisbullosa can also involve extra-cutaneous sites includingeye, nose, ear, upper airway, genitourinary tract andgastrointestinal tract. The most prominent feature ofthe gastrointestinal tract involvement is developmentof esophageal stricture. The stricture results fromrecurrent esophageal mucosal blistering with consequentscarring and most commonly involves theupper esophagus. Here we present a case of a youngboy with dominant subtype of dystrophic epidermolysisbullosa who presented with dysphagia, extensiveskin blistering and missing nails. Management of anesophageal stricture eventually requires dilatation ofthe stricture or placement of a gastrostomy tube tokeep up with the nutritional requirements. Gastrostomytube also provides access for esophageal stricturedilatation in cases where antegrade approach throughthe mouth has failed.

  8. Clinical characteristics of neurogenic dysphagia in adult patients with Chiari malformation type I.

    Science.gov (United States)

    Yu, T; Li, J; Wang, K; Ge, Y; Jiang, A C; Duan, L P; Wang, Z Y

    2017-04-18

    To investigate changes of swallowing function and associated symptoms in Chiari malformation typeI (CMI) patients with and without dysphagia by the analysis of their clinical and high-resolution manometry (HRM) parameters. A total of 42 patients diagnosed with symptomatic CMI without atlantoaxial dislocations which were confirmed by clinical manifestations and magnetic resonance imaging (MRI) findings between January 2010 and July 2015 at Peking University Third Hospital were included in this study. Twenty patients had a history of various dysphagia symptoms, or reported symptoms of choking, coughing after eating or drinking, while the other 22 patients denied symptoms of dysphagia. The data collected from the medical records of these patients included the patient's age, sex, date of diagnosis, duration of illness, symptoms, results of MRI and HRM, and date of surgery. (1) Dysphagia group had 14 female patients, and no-dysphagia group had 8 female patients. Dysphagia usually occurred in female patients, and in addition to dysphagia, we recorded other symptoms and signs in the CMI patients, including numbness, hypoesthesia, limb weakness, neck pain, muscle atrophy, ataxia, hoarseness, symptoms caused by posterior cranial nerve damage, pharyngeal reflex, uvula deviation, and pyramidal signs. A higher percentage of the CMI patients with dysphagia (15/20) had symptoms of posterior cranial nerve damage compared with the control group (5/22; P=0.01). (2)HRM showed a significant difference in upper esophageal sphincter (UES) relax ratio measurement (75.3% vs. 63.1%, P=0.023) and UES proximal margin (17.2 cm vs. 15.7 cm, P=0.005) between the two groups. (3) The percentage of syringomyelia affecting the bulbar or upper cervical region on MRI was significantly higher in the dysphagia group (17/20 vs. 7/22, P=0.001). CMI was usually accompanied by symptoms caused by posterior cranial nerve damage, ataxia, and positive pyramidal signs. Location of the syringomyelia affecting

  9. [Neurogenic oropharyngeal dysphagia is a frequent condition in patients admitted to the ICU].

    Science.gov (United States)

    Pedersen, Anette Barbre; Kjærsgaard, Annette; Larsen, Jens Kjærgaard Rolighed; Nielsen, Lars Hedemann

    2015-03-02

    Neurogenic oropharyngeal dysphagia (NOD) is a frequent condition in neurological patients admitted to the ICU, particularly in patients with brainstem lesions. The CNS damage itself can predispose to dysphagia, but also the treatment and preventive measures may predispose to and exacerbate the condition. Frequent pneumonia in a neurological patient is a warning signal that should cause screening for dysphagia. Complications are serious and can be fatal. Neurological patients should be examined for NOD before decannulation. Treatment is difficult, so prevention and multidisciplinary neurological rehabilitation is important.

  10. A Rare Cause of Dysphagia to Remember: Calcific Tendinitis of the Longus Colli Muscle

    Directory of Open Access Journals (Sweden)

    Dominic M. Colella

    2016-12-01

    Full Text Available Longus colli tendinitis (LCT is an acute inflammatory condition with symptoms typically consisting of acute neck pain and stiffness with or without dysphagia. Once more severe etiologies for these symptoms are ruled out, this self-limiting condition usually resolves spontaneously with nonsteroidal anti-inflammatory drugs and corticosteroids. We present a case of LCT that presented as acute neck pain, dysphagia, and odynophagia that rapidly resolved once diagnosed and treated with anti-inflammatory agents. Though exceedingly rare, LCT must be considered in the differential diagnosis of acute neck pain, dysphagia, and odynophagia when more common etiologies do not correlate with the clinical presentation.

  11. Pill in the blister pack: a rare cause of dysphagia in an elderly adult.

    Science.gov (United States)

    Laeeq, Syed Mudassir; Rai, Ayesha Aslam; Tasneem, Abbas Ali; Luck, Nasir Hassan; Majid, Zain

    2015-01-01

    Foreign body impaction in the esophagus amongst adults is not a common cause of dysphagia. Fish bone, food bolus, dentures may cause symptoms of dysphagia, odynophagia, chest pain or respiratory distress. It needs prompt evaluation along with removal of the substance either surgically or endoscopically to avoid the development of life threatening complications. Here we are reporting a case of an elderly male, who presented to us with a history of absolute dysphagia for one week, as a consequence of ingestion of a pill in blister pack.

  12. Progressive dysphagia in limb-girdle muscular dystrophy type 2B.

    LENUS (Irish Health Repository)

    Walsh, Richard

    2012-02-01

    Dysphagia has not been reported in genetically confirmed limb-girdle muscular dystrophy type 2B (LGMD2B). A 40-year-old woman reported exercise-induced calf pain at age 34, followed by progressive lower and upper limb weakness. At age 38, progressive dysphagia for solids, and subsequently liquids, ensued. Endoscopic and videofluoroscopic-radiological findings indicated a myopathic swallowing disorder. Molecular genetic analysis confirmed two dysferlin gene mutations consistent with a compound heterozygote state. Progressive dysphagia should be considered as part of the expanding dysferlinopathy phenotype.

  13. Nutrition and gastrointestinal tract assessment and management of children with dysphagia.

    Science.gov (United States)

    Kirby, Midge; Noel, Richard J

    2007-08-01

    Limited ability to take in nutrients places young patients with dysphagia at risk for malnutrition and failure to gain weight. These children require careful evaluation and ongoing monitoring of growth and nutritional status. Gastroesophageal reflux and recurrent vomiting may contribute to dysphagia when the refluxate causes laryngopharyngeal irritation and can increase the morbidity in patients prone to aspiration. A paucity of evidence-based literature on relevant topics demands both clinical judgment and an interdisciplinary approach for management decisions for these issues. Advances in nutrition and management of aerodigestive conditions related to dysphagia will be reviewed.

  14. A Rare Cause of Dysphagia to Remember: Calcific Tendinitis of the Longus Colli Muscle

    Science.gov (United States)

    Colella, Dominic M.; Calderón Sandoval, Fiorela; Powers, David W.; Patel, Nimal; Sobrado, Javier

    2016-01-01

    Longus colli tendinitis (LCT) is an acute inflammatory condition with symptoms typically consisting of acute neck pain and stiffness with or without dysphagia. Once more severe etiologies for these symptoms are ruled out, this self-limiting condition usually resolves spontaneously with nonsteroidal anti-inflammatory drugs and corticosteroids. We present a case of LCT that presented as acute neck pain, dysphagia, and odynophagia that rapidly resolved once diagnosed and treated with anti-inflammatory agents. Though exceedingly rare, LCT must be considered in the differential diagnosis of acute neck pain, dysphagia, and odynophagia when more common etiologies do not correlate with the clinical presentation. PMID:28100997

  15. Food Habits, Lifestyle Factors, and Risk of Prostate Cancer in Central Argentina: A Case Control Study Involving Self-Motivated Health Behavior Modifications after Diagnosis

    Directory of Open Access Journals (Sweden)

    Sandaly O. S. Pacheco

    2016-07-01

    Full Text Available Cancer is the second most important non-communicable disease worldwide and disproportionately impacts low- to middle-income countries. Diet in combination with other lifestyle habits seems to modify the risk for some cancers but little is known about South Americans. Food habits of Argentinean men pre- and post-diagnosis of prostate cancer (n = 326 were assessed along with other lifestyle factors. We studied whether any of the behaviors and risk factors for prostate cancer were found in men with other cancers (n = 394, compared with control subjects (n = 629. Before diagnosis, both cases reported a greater mean consumption of meats and fats and lower intakes of fruits, green vegetables, cruciferous vegetables, legumes, nuts, seeds, and whole grains than the controls (all p < 0.001. After diagnosis, cases significantly reduced the intake of meats and fats, and reported other dietary modifications with increased consumption of fish, fruits (including red fruits in prostate cancer, cruciferous vegetables, legumes, nuts, and black tea (all p < 0.001. Additional lifestyle aspects significantly predominant in cases included a reduced quality of sleep, emotional stress, low physical activity, tobacco smoking, alcohol consumption, living in rural areas, and being exposed to environmental contaminants. Argentinian men were predisposed to modify their unhealthy dietary habits and other lifestyle factors after cancer diagnosis.

  16. Food Habits, Lifestyle Factors, and Risk of Prostate Cancer in Central Argentina: A Case Control Study Involving Self-Motivated Health Behavior Modifications after Diagnosis

    Science.gov (United States)

    Pacheco, Sandaly O. S.; Pacheco, Fabio J.; Zapata, Gimena M. J.; Garcia, Julieta M. E.; Previale, Carlos A.; Cura, Héctor E.; Craig, Winston J.

    2016-01-01

    Cancer is the second most important non-communicable disease worldwide and disproportionately impacts low- to middle-income countries. Diet in combination with other lifestyle habits seems to modify the risk for some cancers but little is known about South Americans. Food habits of Argentinean men pre- and post-diagnosis of prostate cancer (n = 326) were assessed along with other lifestyle factors. We studied whether any of the behaviors and risk factors for prostate cancer were found in men with other cancers (n = 394), compared with control subjects (n = 629). Before diagnosis, both cases reported a greater mean consumption of meats and fats and lower intakes of fruits, green vegetables, cruciferous vegetables, legumes, nuts, seeds, and whole grains than the controls (all p < 0.001). After diagnosis, cases significantly reduced the intake of meats and fats, and reported other dietary modifications with increased consumption of fish, fruits (including red fruits in prostate cancer), cruciferous vegetables, legumes, nuts, and black tea (all p < 0.001). Additional lifestyle aspects significantly predominant in cases included a reduced quality of sleep, emotional stress, low physical activity, tobacco smoking, alcohol consumption, living in rural areas, and being exposed to environmental contaminants. Argentinian men were predisposed to modify their unhealthy dietary habits and other lifestyle factors after cancer diagnosis. PMID:27409631

  17. Congenital Esophageal Duplication Cyst: A Rare Cause of Dysphagia in an Adult.

    Science.gov (United States)

    Sonthalia, Nikhil; Jain, Samit S; Surude, Ravindra G; Mohite, Ashok R; Rathi, Pravin M

    2016-10-01

    Esophageal duplication cyst is a rare congenital embryonal gastrointestinal (GI) malformation which is diagnosed most commonly in childhood. In adults, they can present with a variety of symptoms ranging from dysphagia, chest pain, epigastric discomfort, and vomiting to more serious complications including infections, hemorrhage, and ulcerations. A 30-year-old male presented with gradually progressive dysphagia to solids for 4 months without significant weight loss. Clinical examination and routine laboratory examination were unrevealing. Upper GI endoscopy revealed a well-defined submucosal lesion bulging into the esophageal lumen involving the right antero-lateral wall of the distal esophagus. The overlying mucosa was normal with mild luminal narrowing but gastroscope could be negotiated across this narrowing. Differential diagnosis included lipoma, leiomyoma or GI stromal tumors. Contrast-enhanced computed tomography of thorax revealed a 3.5 × 2.3 × 3 cm well-defined homogenous hypodense lesion involving the right antero-lateral wall of the distal thoracic esophagus with likely possibility of submucosal or intramural lesion. Subsequently, endoscopic ultrasonography (EUS) revealed a 3.3 × 2.8 cm homogenous hypoechoic lesion without any vascularity involving the distal esophagus wall suggestive of duplication cyst. The lesion was intramural in location as muscularis propria was seen to go around the lesion. Bronchogenic cyst was excluded due to absence of cartilage and close proximity of the cyst to lumen. Fine-needle aspiration was not attempted in view of high risk of introducing infection. Being symptomatic, the patient underwent complete surgical excision of the cyst with exteriorization of the base which on histopathology confirmed duplication cyst. Esophageal duplication cysts are exceedingly rare congenital embryonal malformations with estimated prevalence of 0.0122% arising from aberration of posterior division of embryonic foregut at 3 - 4 weeks of

  18. Infected bronchogenic cyst causing dysphagia and retrosternal pain

    DEFF Research Database (Denmark)

    Søndergaard, Eva Bjerre; Pedersen, Jesper Holst; Kleive, Dyre Berg

    2013-01-01

    Bronchogenic cysts are congenital. They are typically discovered in infancy or early childhood. Secondary infection of the cyst is uncommon. We present the case of a 17-year-old female who presented to the emergency department with intermediate onset of upper abdominal, and retrosternal chest pain...... and fever. Subsequent X-ray and computerised tomography scan showed a bronchogenic cyst. The patient underwent subacute thoracotomy where a bronchogenic cyst filled with pus was located and excised. Bronchogenic cysts can be a rare cause of retrosternal pain. Please cite this paper as: Søndergaard EB......, Pedersen JH and Kleive D. Infected bronchogenic cyst causing dysphagia and retrosternal pain. Clin Respir J 2012; DOI:10.1111/j.1752-699X.2012.00296.x....

  19. Electrical bioimpedance measurement as a tool for dysphagia visualisation.

    Science.gov (United States)

    Chester, Chris J; Gaynor, Paul T; Jones, Richard D; Huckabee, Maggie-Lee

    2014-09-01

    A non-invasive and portable bioimpedance method and a device for detecting superior to inferior closure of the pharynx during swallowing have been developed. The 2-channel device measures electric impedance across the neck at two levels of the pharynx via injected currents at 40 and 70 kHz. The device has been trialled on both healthy and dysphagic subjects. Results from these trials revealed a relationship (r = 0.59) between the temporal separation of the second peaks in the bioimpedance waveforms and descending pressure sequence in the pharynx as measured by pharyngeal manometry. However, these features were only clearly visible in the bioimpedance waveforms for 64% of swallows. Further research is underway to improve the bioimpedance measurement reliability and validate waveform feature correlation to swallowing to maximise the device's efficacy in dysphagia rehabilitation.

  20. Clinical signs of dysphagia in infants with acute viral bronchiolitis☆

    Science.gov (United States)

    Barbosa, Lisiane De Rosa; Gomes, Erissandra; Fischer, Gilberto Bueno

    2014-01-01

    Objective: To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis, to compare the respiratory parameters during deglutition, and to ensure the intra- and inter- examiners agreement, as well as to accomplish intra and interexaminators concordance of the clinical evaluation of the deglutition. Methods: This was a cross-sectional study of 42 infants aged 0-12 months. The clinical evaluation was accompanied by measurements of respiratory rate and pulse oximetry. A score of swallowing disorders was designed to establish associations with other studied variables and to ensure the intra- and interrater agreement of clinical feeding assessments. Caregivers also completed a questionnaire about feeding difficulties. Significance was set at pdysphagia. PMID:25479843

  1. [Clinical signs of dysphagia in infants with acute viral bronchiolitis].

    Science.gov (United States)

    Barbosa, Lisiane De Rosa; Gomes, Erissandra; Fischer, Gilberto Bueno

    2014-09-01

    To determine the occurrence of clinical signs of dysphagia in infants with acute viral bronchiolitis, to compare the respiratory parameters during deglutition, and to ensure the intra- and inter- examiners agreement, as well as to accomplish intra and interexaminators concordance of the clinical evaluation of the deglutition. This was a cross-sectional study of 42 infants aged 0-12 months. The clinical evaluation was accompanied by measurements of respiratory rate and pulse oximetry. A score of swallowing disorders was designed to establish associations with other studied variables and to ensure the intra- and interrater agreement of clinical feeding assessments. Caregivers also completed a questionnaire about feeding difficulties. Significance was set at pdysphagia. Copyright © 2014 Sociedade de Pediatria de São Paulo. Publicado por Elsevier Editora Ltda. All rights reserved.

  2. Oropharyngeal dysphagia in myotonic dystrophy type 1: a systematic review.

    Science.gov (United States)

    Pilz, Walmari; Baijens, Laura W J; Kremer, Bernd

    2014-06-01

    A systematic review was conducted to investigate the pathophysiology of and diagnostic procedures for oropharyngeal dysphagia in myotonic dystrophy (MD). The electronic databases Embase, PubMed, and The Cochrane Library were used. The search was limited to English, Dutch, French, German, Spanish, and Portuguese publications. Sixteen studies met the inclusion criteria. Two independent reviewers assessed the methodological quality of the included articles. Swallowing assessment tools, the corresponding protocols, the studies' outcome measurements, and main findings are summarized and presented. The body of literature on pathophysiology of swallowing in dysphagic patients with MD type 1 remains scant. The included studies are heterogeneous with respect to design and outcome measures and hence are not directly comparable. More importantly, most studies had methodological problems. These are discussed in detail and recommendations for further research on diagnostic examinations for swallowing disorders in patients with MD type 1 are provided.

  3. Dysphagia and anorexia as presentations of leptomeningeal carcinomatosis.

    Science.gov (United States)

    Aiyer, Rohit; Engelman, Ester; Xue, Wei; Yu, Edward

    2016-04-12

    A 61-year-old woman presented to the emergency department, with a 4-day history of isolated oropharyngeal dysphagia associated with anorexia and weight loss over the previous 4 weeks. She had no other focal neurological symptoms and no deficits on examination. She had been in a 4-year remission of breast cancer postmastectomy and chemoradiation. Neuroimaging showed enhancement of cranial nerves VII, VIII, cisternal segment of cranial V, dorsal and ventral surfaces of the cervical and thoracic cord as well as enhancement of the cauda equina. Cerebrospinal fluid analysis revealed carcinomatous cells. The patient was diagnosed as having leptomeningeal carcinomatosis secondary to lobular breast cancer and was started on radiation therapy, antihormonal treatments and intrathecal methotrexate.

  4. A rare cause of dysphagia: Herpes simplex esophagitis

    Institute of Scientific and Technical Information of China (English)

    Bee Lee; Grant Caddy

    2007-01-01

    Herpes simplex esophagitis (HSE) is well documented in immunosuppressed patients. However, it is rare in the immunocompetent host. We present a case of HSE in a 21 year-old healthy lady who was admitted to our unit with dysphagia, odynophagia and chest pAln. Clinical examination revealed mild epigastric tenderness and admission bloods including full blood picture, electrolytes and inflammatory markers were normal. She underwent an esophagogastroduodenoscopy (EGD) which revealed severe exudative, well-circumscribed ulcerations in her distal esophagus. Biopsies confirmed severe esophagitis with acute ulceration and subsequent polymerase chAln reaction (PCR) confirmed herpes simplex virus (HSV) type 1. Subsequent assessment fAlled to identify an immune disorder. HSE should be suspected when faced with characteristic endoscopic findings, even if the patient is immunocompetent. When the diagnosis of HSE is confirmed, an immune deficiency should be sought.

  5. [Validity of schintigraphy in the study of neurogenic dysphagia].

    Science.gov (United States)

    Galli, J; Valenza, V; D'Alatri, L; Gajate Samanes, A M; Reale, F; La Mura, F

    2000-08-01

    The purpose of the present study was to verify the validity and potential application of oropharyngealesophageal scintigraphy in the analysis of neurogenic dysphagia. Scintigraphy was used on 36 patients divided into 2 groups: Group 1 (control) comprised 17 healthy volunteers; Group 2 included 19 patients suffering from various neurological and neuromuscular pathologies (myasthenia gravis, Parkinson's disease, polymyositis, stroke, paralysis of the last cranial nerves). In group 1 scintigraphy provided normal results both for mode of swallowing and transit, and for the values of the various parameters studied. On the other hand, scintigraphy showed that in group 2 all oral, pharyngeal and esophageal phases of swallowing were altered vs the controls with a statistically significant increase in the average values for the oral transit time (OTT) (1.45 sec., p = 0.0005), pharyngeal transit time (OTT) (3.23 sec., p = 0.044), esophageal transit time (ETT) e19.87 sec., p = 0.005) as well as in the corresponding bolus retention indexes ORU (12.95%, p = 0.0003), FIR (15.05%, p = 0.0003) and ERI (28.63%, p = 0.002). Moreover, the quality and means of swallowing also proved altered while tracheobronchial aspiration was only seen in 6 of the 19 patients (maximum value: 90%, average value; 7.66%) with a marked prevalence in the stroke subgroup (4/8). In light of these results and considering the low dose of radiation (0.00043 Gy), the lack of invasiveness and excellent tolerability, scintigraphy has confirmed its clinical validity in the functional, objective and quali-quantitative study of deglutition, even in patients suffering from neurogenic dysphagia.

  6. The influence of tracheotomy tubes on the swallowing frequency in neurogenic dysphagia.

    Science.gov (United States)

    Seidl, Rainer O; Nusser-Müller-Busch, Ricki; Ernst, Arne

    2005-03-01

    To compare the swallowing frequency in patients with neurogenic dysphagia with or without tracheotomy tubes (TT) to assess the underlying mechanisms of dysphagia to improve rehabilitation strategies. Prospective study, 10 patients (64 +/- 7 years) with neurogenic dysphagia. Glasgow Coma Scale (GCS) less than 8 points, tracheotomy due to the dysphagia 2 weeks before the examination. The swallowing frequency (1 or less over 5 min) was assessed over 5 consecutive days with or without TT. The swallowing frequency increased after removal of the TT. These findings did not influence the GCS or the Coma Remission Scale. Over a 5-day period, the frequency of swallowing was increased. TTs decisively influence the swallowing behavior of vegetative patients. This phenomenon could be based on an improved sensitivity under re-established physiological expiration. We strongly favor removing the TT or deflating the cuff of the TT under therapeutic conditions in a rehabilitation therapy setting.

  7. The challenges of dysphagia management and rehabilitation after extensive thermal burn injury: a complex case.

    Science.gov (United States)

    Rumbach, Anna F; Ward, Elizabeth C; Cornwell, Petrea L; Bassett, Lynell V; Muller, Michael J

    2009-01-01

    The role of the speech pathologist in the burns population is still emerging, with detailed discussion of the assessment and management of dysphagia limited to date. This report describes the case of a 60-year-old man who developed severe contractures of the head and neck and oropharyngeal dysphagia after sustaining 53.5% deep partial- and full-thickness burns. Although some aspects of rehabilitation were confounded by a preexisting mild intellectual disability, the patient was able to participate in an intensive regimen of active and passive exercise to rehabilitate his oropharyngeal dysphagia. Significant oral contractures remained; however, the patient was discharged without tracheostomy and consuming a texture-modified diet with no signs of aspiration. To our knowledge, this is one of a small handful of reports that document speech pathology management of the burns population, and a first that identifies and outlines specific characteristics of, and rehabilitation strategies for, dysphagia in a burned individual.

  8. Dysphagia after an L-shaped reconstruction technique of the free jejunum graft.

    NARCIS (Netherlands)

    Keereweer, S.; Sewnaik, A.; Kerrebijn, J.D.; Meeuwis, C.A.; Tilanus, H.W.; Wilt, J.H.W. de

    2010-01-01

    BACKGROUND: The free jejunum graft is a well-established reconstruction technique after total laryngopharyngectomy. However, besides necrosis of the jejunum graft, the two most important complications are pharyngocutaneous fistula formation and dysphagia due to stricture formation. OBJECTIVES: This

  9. Dysphagia training after head and neck cancer fails to follow legislation and national recommendations

    DEFF Research Database (Denmark)

    Fredslund, Sara Vinther; Høgdal, Nina; Christensen, Malene Bæk

    2015-01-01

    INTRODUCTION: Dysphagia is a known sequela after head and neck cancer (HNC) and causes malnutrition, aspiration pneumonia and a reduced quality of life. Due to improved survival rates, the number of patients with sequelae is increasing. Evidence on the ideal HNC-specific rehabilitation of dysphagia...... is lacking, but several studies indicate that early initiation is crucial. The aim of this study was to map the existing dysphagia rehabilitation programmes for HNC patients in Denmark. METHODS: Occupational therapists (OTs), oncologists and surgeons from five hospitals participated in a nationwide...... a fraction of HNC patients are offered rehabilitation and often long after completing treatment. Municipal rehabilitation services vary considerably in terms of type, duration, intensity and expertise. Dysphagia-related rehabilitation requires an improved monitoration, possibly with an increase in the uptake...

  10. Acute onset of trigeminal neuralgia, facial paresis and dysphagia after mild head injury.

    Science.gov (United States)

    Gkekas, Nikolaos; Primikiris, Panagiotis; Georgakoulias, Nikolaos

    2014-01-01

    The authors report the rare and first documented case of concomitant microvascular decompression of trigeminal, facial and glossopharyngeal nerves for the management of intractable to medical therapy acute onset of trigeminal neuralgia, facial paresis and dysphagia after mild head injury.

  11. 75 FR 76020 - Prospective Grant of Exclusive License: Devices for Treating Dysphagia and Dysphonia

    Science.gov (United States)

    2010-12-07

    ... cover a system, device and method for rehabilitating dysphagia due to stroke, ex-tubation or coronary..., olfactory stimulation, taste stimulation, or a combination of these. Upon activation a vibrator moves...

  12. Application of noninvasive brain stimulation for post-stroke dysphagia rehabilitation

    National Research Council Canada - National Science Library

    Wang, Zhuo; Song, Wei-Qun; Wang, Liang

    2017-01-01

    ...), transcranial direct-current stimulation (tDCS), as well as paired associative stimulation (PAS), has attracted increased interest and been applied experimentally in the treatment of post-stroke dysphagia...

  13. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders.

    OpenAIRE

    1996-01-01

    OBJECTIVE: Before the advanced evaluation of deglutition and selection of a treatment method, objective screening methods are necessary for patients with dysphagia. In this study a new electroclinical test was established to evaluate patients with dysphagia. METHODS: This test is based on determining piecemeal deglutition; which is a physiological phenomenon occurring when a bolus of a large volume is divided into two or more parts which are swallowed successively. The combined electrophysiol...

  14. Sarcopenia is an independent risk factor of dysphagia in hospitalized older people.

    Science.gov (United States)

    Maeda, Keisuke; Akagi, Junji

    2016-04-01

    Sarcopenia can cause varying physical function disorders, including dysphagia. Malnutrition, a potential result of dysphagia, can also cause sarcopenia. However, the association between sarcopenia and dysphagia is not fully understood, despite evidence suggesting correlations between deglutition disorders and degenerative loss of muscle mass. The present study investigated the prevalence of dysphagia among patients with sarcopenia, and the association between the two conditions. We included 224 older adults (mean age 82.5 ± 8.4 years; 37.9% men). Individuals who had a stroke or other diseases that could directly cause dysphagia were excluded. Logistic regression analyses were carried out after adjusting for potential causes of sarcopenia, including malnutrition, a low activity of daily living levels and aging, to investigate the relationship between the skeletal muscle index (SMI), prevalence of sarcopenia diagnosed based on a low SMI and grip strength, and swallowing functions. The Mini-Nutritional Assessment short form was used to assess their nutritional status, and the Barthel Index was used to evaluate their activities of daily living. The prevalences of sarcopenia and dysphagia were 76.8% and 30.0%, respectively. Multivariate analysis showed that Barthel Index, SMI and presence of sarcopenia were significant independent factors for the prevalence of dysphagia, after adjusting for sex, age and nutritional status. Furthermore, subgroup analysis showed that SMI in males, and both hand-grip strength and SMI in females were lower in dysphagic subjects than in non-dysphagic subjects (P ≤ 0.01). Sarcopenia was an independent risk factor for dysphagia among older individuals. However, further studies are required to define causality. © 2015 Japan Geriatrics Society.

  15. Dysphagia in Lewy body dementia - a clinical observational study of swallowing function by videofluoroscopic examination

    OpenAIRE

    Londos, Elisabet; Hansson, Oskar; Hirsch, Ingrid Alm; Janneskog, Anna; Bülow, Margareta; Palmqvist, Sebastian

    2013-01-01

    Background: Dysphagia, which can result in aspiration pneumonia and death, is a well-known problem in patients with dementia and Parkinson's disease. There are few studies on dysphagia in patients with dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), especially studies objectively documenting the type of swallowing dysfunction. The aim of this study was therefore to investigate the prevalence, and define the actual swallowing dysfunction according to a videofluo...

  16. Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: an exploratory cohort study.

    Science.gov (United States)

    Gandolfi, Marialuisa; Smania, Nicola; Bisoffi, Giulia; Squaquara, Teresa; Zuccher, Paola; Mazzucco, Sara

    2014-12-01

    Stroke is a major cause of dysphagia. Few studies to date have reported on standardized multidisciplinary protocolized approaches to the management of post-stroke dysphagia. The aim of this retrospective cohort study was to evaluate the impact of a standardized multidisciplinary protocol on clinical outcomes in patients with post-stroke dysphagia. We performed retrospective chart reviews of patients with post-stroke dysphagia admitted to the neurological ward of Verona University Hospital from 2004 to 2008. Outcomes after usual treatment for dysphagia (T- group) were compared versus outcomes after treatment under a standardized diagnostic and rehabilitative multidisciplinary protocol (T+ group). Outcome measures were death, pneumonia on X-ray, need for respiratory support, and proportion of patients on tube feeding at discharge. Of the 378 patients admitted with stroke, 84 had dysphagia and were enrolled in the study. A significantly lower risk of in-hospital death (odds ratio [OR] 0.20 [0.53-0.78]), pneumonia (OR 0.33 [0.10-1.03]), need for respiratory support (OR 0.48 [0.14-1.66]), and tube feeding at discharge (OR 0.30 [0.09-0.91]) was recorded for the T+ group (N = 39) as compared to the T- group (N = 45). The adjusted OR showed no difference between the two groups for in-hospital death and tube feeding at discharge. Use of a standardized multidisciplinary protocolized approach to the management of post-stroke dysphagia may significantly reduce rates of aspiration pneumonia, in-hospital mortality, and tube feeding in dysphagic stroke survivors. Consistent with the study's exploratory purposes, our findings suggest that the multidisciplinary protocol applied in this study offers an effective model of management of post-stroke dysphagia.

  17. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

    Directory of Open Access Journals (Sweden)

    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  18. Thickening agents used for dysphagia management: effect on bioavailability of water, medication and feelings of satiety

    OpenAIRE

    Cichero, Julie AY

    2013-01-01

    Dysphagia is the medical term for difficulty swallowing. Thickened liquids are often used in the management of dysphagia to improve bolus control and to help prevent aspiration. A range of starches and gums has historically been used to thicken liquids. Although thickened liquids improve swallow safety, they appear to have a great potential for unintended physiological consequences. Initial concerns were raised about the impact of thickeners on water binding due to the high prevalence of dehy...

  19. Dysphagia and disrupted cranial nerve development in a mouse model of DiGeorge (22q11 deletion syndrome

    Directory of Open Access Journals (Sweden)

    Beverly A. Karpinski

    2014-02-01

    Full Text Available We assessed feeding-related developmental anomalies in the LgDel mouse model of chromosome 22q11 deletion syndrome (22q11DS, a common developmental disorder that frequently includes perinatal dysphagia – debilitating feeding, swallowing and nutrition difficulties from birth onward – within its phenotypic spectrum. LgDel pups gain significantly less weight during the first postnatal weeks, and have several signs of respiratory infections due to food aspiration. Most 22q11 genes are expressed in anlagen of craniofacial and brainstem regions critical for feeding and swallowing, and diminished expression in LgDel embryos apparently compromises development of these regions. Palate and jaw anomalies indicate divergent oro-facial morphogenesis. Altered expression and patterning of hindbrain transcriptional regulators, especially those related to retinoic acid (RA signaling, prefigures these disruptions. Subsequently, gene expression, axon growth and sensory ganglion formation in the trigeminal (V, glossopharyngeal (IX or vagus (X cranial nerves (CNs that innervate targets essential for feeding, swallowing and digestion are disrupted. Posterior CN IX and X ganglia anomalies primarily reflect diminished dosage of the 22q11DS candidate gene Tbx1. Genetic modification of RA signaling in LgDel embryos rescues the anterior CN V phenotype and returns expression levels or pattern of RA-sensitive genes to those in wild-type embryos. Thus, diminished 22q11 gene dosage, including but not limited to Tbx1, disrupts oro-facial and CN development by modifying RA-modulated anterior-posterior hindbrain differentiation. These disruptions likely contribute to dysphagia in infants and young children with 22q11DS.

  20. Dysphagia and disrupted cranial nerve development in a mouse model of DiGeorge (22q11) deletion syndrome.

    Science.gov (United States)

    Karpinski, Beverly A; Maynard, Thomas M; Fralish, Matthew S; Nuwayhid, Samer; Zohn, Irene E; Moody, Sally A; LaMantia, Anthony-S

    2014-02-01

    We assessed feeding-related developmental anomalies in the LgDel mouse model of chromosome 22q11 deletion syndrome (22q11DS), a common developmental disorder that frequently includes perinatal dysphagia--debilitating feeding, swallowing and nutrition difficulties from birth onward--within its phenotypic spectrum. LgDel pups gain significantly less weight during the first postnatal weeks, and have several signs of respiratory infections due to food aspiration. Most 22q11 genes are expressed in anlagen of craniofacial and brainstem regions critical for feeding and swallowing, and diminished expression in LgDel embryos apparently compromises development of these regions. Palate and jaw anomalies indicate divergent oro-facial morphogenesis. Altered expression and patterning of hindbrain transcriptional regulators, especially those related to retinoic acid (RA) signaling, prefigures these disruptions. Subsequently, gene expression, axon growth and sensory ganglion formation in the trigeminal (V), glossopharyngeal (IX) or vagus (X) cranial nerves (CNs) that innervate targets essential for feeding, swallowing and digestion are disrupted. Posterior CN IX and X ganglia anomalies primarily reflect diminished dosage of the 22q11DS candidate gene Tbx1. Genetic modification of RA signaling in LgDel embryos rescues the anterior CN V phenotype and returns expression levels or pattern of RA-sensitive genes to those in wild-type embryos. Thus, diminished 22q11 gene dosage, including but not limited to Tbx1, disrupts oro-facial and CN development by modifying RA-modulated anterior-posterior hindbrain differentiation. These disruptions likely contribute to dysphagia in infants and young children with 22q11DS.

  1. Quality of life in oncological patients with oropharyngeal dysphagia: validity and reliability of the Dutch version of the MD Anderson Dysphagia Inventory and the Deglutition Handicap Index.

    Science.gov (United States)

    Speyer, Renée; Heijnen, Bas J; Baijens, Laura W; Vrijenhoef, Femke H; Otters, Elsemieke F; Roodenburg, Nel; Bogaardt, Hans C

    2011-12-01

    Quality of life is an important outcome measurement in objectifying the current health status or therapy effects in patients with oropharyngeal dysphagia. In this study, the validity and reliability of the Dutch version of the Deglutition Handicap Index (DHI) and the MD Anderson Dysphagia Inventory (MDADI) have been determined for oncological patients with oropharyngeal dysphagia. At Maastricht University Medical Center, 76 consecutive patients were selected and asked to fill in three questionnaires on quality of life related to oropharyngeal dysphagia (the SWAL-QOL, the MDADI, and the DHI) as well as a simple one-item visual analog Dysphagia Severity Scale. None of the quality-of-life questionnaires showed any floor or ceiling effect. The test-retest reliability of the MDADI and the Dysphagia Severity Scale proved to be good. The test-retest reliability of the DHI could not be determined because of insufficient data, but the intraclass correlation coefficients were rather high. The internal consistency proved to be good. However, confirmatory factor analysis could not distinguish the underlying constructs as defined by the subscales per questionnaire. When assessing criterion validity, both the MDADI and the DHI showed satisfactory associations with the SWAL-QOL (reference or gold standard) after having removed the less relevant subscales of the SWAL-QOL. In conclusion, when assessing the validity and reliability of the Dutch version of the DHI or the MDADI, not all psychometric properties have been adequately met. In general, because of difficulties in the interpretation of study results when using questionnaires lacking sufficient psychometric quality, it is recommended that researchers strive to use questionnaires with the most optimal psychometric properties.

  2. Validation of the Persian version of the dysphagia handicap index in patients with neurological disorders.

    Science.gov (United States)

    Barzegar-Bafrooei, Ebrahim; Bakhtiary, Jalal; Khatoonabadi, Ahmad Reza; Fatehi, Farzad; Maroufizadeh, Saman; Fathali, Mojtaba

    2016-07-06

    Dysphagia as a common condition affecting many aspects of the patient's life. The Dysphagia Handicap Index (DHI) is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient's quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia. A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach's alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC). The internal consistency of the Persian DHI (P-DHI) was considered to be good; Cronbach's alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC. The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population.

  3. Familial gastrointestinal stromal tumors associated with dysphagia and novel type germline mutation of KIT gene.

    Science.gov (United States)

    Hirota, Seiichi; Nishida, Toshirou; Isozaki, Koji; Taniguchi, Masahiko; Nishikawa, Kazuhiro; Ohashi, Akiko; Takabayashi, Arimichi; Obayashi, Tadashi; Okuno, Tomoko; Kinoshita, Kazuo; Chen, Hui; Shinomura, Yasuhisa; Kitamura, Yukihiko

    2002-05-01

    A family with multiple gastrointestinal stromal tumors (GISTs), a new type of germline mutation of KIT gene, and dysphagia is reported. The mutation was observed at Asp-820 in tyrosine kinase (TK) II domain. Mutations in TK II domain have been found in mast cell and germ cell tumors but not in GISTs, and the present family members are the first reported cases of GISTs with TK II domain mutations, including sporadic GISTs. Because interleukin 3-dependent Ba/F3 murine lymphoid cells transfected with the mutant KIT complementary DNA grew autonomously without any growth factors and formed tumors in nude mice, the mutation was considered to be gain-of-function type. Family members with the germline KIT mutation reported dysphagia, but those without the mutation did not. The mechanism of dysphagia was examined with gastrointestinal fiberscopy, endoscopic ultrasonography, and esophageal manometry. No mechanical obstruction was found, and the esophagus was not remarkably dilated. In the family members with dysphagia, endoscopic ultrasonography at the esophagocardiac junction showed a thickened hyperechoic layer between the circular and longitudinal muscle layers, suggesting hyperplasia of interstitial cells of Cajal at the myenteric plexus layer. Manometry showed low resting lower esophageal sphincter pressure and abnormal simultaneous contractions of the esophagus without normal peristalsis. These findings indicate that the dysphagia of the present family is different from typical achalasia. This is the first report of familial dysphagia caused by germline gain-of-function mutation of the KIT gene at the TK II domain.

  4. Functional magnetic resonance imaging study on dysphagia after unilateral hemispheric stroke: a preliminary study.

    Science.gov (United States)

    Li, S; Luo, C; Yu, B; Yan, B; Gong, Q; He, C; He, L; Huang, X; Yao, D; Lui, S; Tang, H; Chen, Q; Zeng, Y; Zhou, D

    2009-12-01

    Swallowing dysfunction is common and disabling after acute stroke; however, the mechanism of dysphagia or recovery of swallowing from dysphagia remains uncertain. The purpose of this study was to explore cerebral activation of swallowing in dysphagia using functional MRI (fMRI) to compare the functional anatomy of swallowing in unilateral hemispheric stroke patients and healthy adults. In total, five left hemispheric stroke patients with dysphagia, five right hemispheric stroke patients with dysphagia and 10 healthy controls were examined with event related fMRI while laryngeal swallow related movements were recorded. Data were processed using the general linear model. A multifocal cerebral representation of swallowing was identified predominantly in the left hemisphere, in a bilateral and asymmetrical manner. Cerebral activation during swallowing tasks was localised to the precentral, postcentral and anterior cingulate gyri, insula and thalamus in all groups. Activation of volitional swallowing in dysphagic unilateral hemispheric stroke patients might require reorganisation of the dominant hemispheric motor cortex, or a compensatory shift in activation to unaffected areas of the hemisphere. The results indicate that unilateral stroke of either cerebral hemisphere can produce dysphagia. Effective recovery is associated with cerebral activation related to cortical swallowing representation in the compensating or recruited areas of the intact hemisphere. Functional MRI is a useful method for exploring the spatial localisation of changes in neuronal activity during tasks that may be related to recovery. Therefore, the subsequent information gleaned from changes in neural plasticity could be useful for assessing the prognosis of dysphagic stroke.

  5. Incidence and impact of dysphagia in patients receiving prolonged endotracheal intubation after cardiac surgery.

    Science.gov (United States)

    Barker, Jennifer; Martino, Rosemary; Reichardt, Beatrix; Hickey, Edward J; Ralph-Edwards, Anthony

    2009-04-01

    Cardiac surgery is frequently associated with prolonged endotracheal intubation. Because oral feeding is an important component of patient recovery after high-risk surgery, we sought to examine the contribution of dysphagia in the recuperation process after prolonged endotracheal intubation. All 254 adult patients who survived cardiac surgery between 2001 and 2004 at the Toronto General Hospital and in whom endotracheal intubation lasted for 48 hours or longer were eligible for our retrospective review. We used multivariate regression analysis and parametric modelling to identify patient-specific characteristics associated with postextubation dysphagia and the subsequent resumption of normal oral feeding. Dysphagia was diagnosed in 130 (51%) patients. Incremental factors associated with an increased risk for postextubation dysphagia included duration of endotracheal intubation (p index procedural characteristics were influential factors. The occurrence of dysphagia (p endotracheal intubation (p endotracheal intubation (p endotracheal intubation events (p endotracheal intubation after cardiac surgery than has previously been reported. The duration of postoperative endotracheal intubation is a strong predictor of subsequent dysphagia that both prolongs the return to normal oral feeding and delays subsequent hospital discharge. Patient-or procedure-specific factors are not good predictors. To accelerate discharge of high-risk patients, aggressive nutritional supplementation should pre-empt extubation and swallowing surveillance should follow.

  6. Detecting signs of dysphagia in patients with Alzheimer's disease with oral feeding in daily life.

    Science.gov (United States)

    Sato, Emiko; Hirano, Hirohiko; Watanabe, Yutaka; Edahiro, Ayako; Sato, Kazumichi; Yamane, Genyuki; Katakura, Akira

    2014-07-01

    It is important to understand dysphagia in patients with dementia, as it is associated with malnutrition and aspiration pneumonia. Particularly in patients with Alzheimer's disease (AD), mortality from pneumonia is high and accounts for 70% of the causes of death. However, the standard swallowing tests are often difficult to use for patients with dementia, and methods to assess daily swallowing function are required. Therefore, the purpose of the present study was to identify signs of dysphagia in AD patients in daily life. A total of 155 AD patients underwent evaluation of their swallowing function (modified water swallowing test), oral status (residual teeth, occlusal contacts), oral functions (lips function, tongue function, rinsing and gargling ability), vital functions (Barthel Index, Vitality Index), nutritional status (serum albumin, body mass index), cognitive function and neurological signs (Mini-Mental State Examination, Clinical Dementia Rating, limb contractures), and diet-related assessments (storing food in the mouth, stuffing food into the mouth, appetite, caloric intake). The severity of AD was significantly associated with swallowing function (P dysphagia was "rinsing ability" (P = 0.001, odds ratio 4.8, 95% confidence interval 1.9-12.1). The factors that affect swallowing function in AD patients were examined. The swallowing function of severe AD patients was poor, and an association between AD and dysphagia was shown. Defective rinsing ability was identified as a risk factor for dysphagia. Therefore, observation of daily rinsing ability appears to be useful to identify signs of dysphagia in AD patients. © 2013 Japan Geriatrics Society.

  7. Development of dysphagia and trismus developed after c1-2 posterior fusion in extended position.

    Science.gov (United States)

    Misawa, Haruo; Tanaka, Masato; Sugimoto, Yoshihisa; Koshimune, Kouichiro; Ozaki, Toshifumi

    2013-01-01

    Cervical misalignment after upper cervical fusion including the occipital bone may cause trismus or dysphagia, because the occipito-atlanto joint is associated with most of the flex and extended motion of the cervical spine. There are no reports of dysphagia and trismus after C1-2 fusion. The purpose of this paper is to demonstrate the potential risk of dysphagia and trismus even after upper cervical short fusion without the occipital bone. The patient was a 69-year-old man with myelopathy caused by os odontoideum and Klippel-Feil syndrome, who developed dysphagia and trismus immediately after C1-2 fusion and C3-6 laminoplasty. Radiographs and CT revealed that his neck posture was extended, but his symptoms still existed a week after surgery. The fixation angle was hyperextended 12 days after the first surgery. His symptoms disappeared immediately after revision surgery. The fixation in the neck-flexed position is thought to be the main cause of the patient's post-operative dysphagia and trismus. Dysphagia and trismus may occur even after short upper cervical fusion without the occipital bone or cervical fusion in the neck-extended position. The pre-operative cervical alignment and range of motion of each segment should be thoroughly evaluated.

  8. Development of Dysphagia and Trismus Developed after C1-2 Posterior Fusion in Extended Position

    Directory of Open Access Journals (Sweden)

    Misawa,Haruo

    2013-06-01

    Full Text Available Cervical misalignment after upper cervical fusion including the occipital bone may cause trismus or dysphagia, because the occipito-atlanto joint is associated with most of the flex and extended motion of the cervical spine. There are no reports of dysphagia and trismus after C1-2 fusion. The purpose of this paper is to demonstrate the potential risk of dysphagia and trismus even after upper cervical short fusion without the occipital bone. The patient was a 69-year-old man with myelopathy caused by os odontoideum and Klippel-Feil syndrome, who developed dysphagia and trismus immediately after C1-2 fusion and C3-6 laminoplasty. Radiographs and CT revealed that his neck posture was extended, but his symptoms still existed a week after surgery. The fixation angle was hyperextended 12 days after the first surgery. His symptoms disappeared immediately after revision surgery. The fixation in the neck-flexed position is thought to be the main cause of the patientʼs post-operative dysphagia and trismus. Dysphagia and trismus may occur even after short upper cervical fusion without the occipital bone or cervical fusion in the neck-extended position. The pre-operative cervical alignment and range of motion of each segment should be thoroughly evaluated.

  9. Possible involvement of GABAergic mechanism in protective effect of melatonin against sleep deprivation-induced behavior modification and oxidative damage in mice.

    Science.gov (United States)

    Kumar, Anil; Singh, Anant; Kumar, Puneet

    2011-03-01

    Sleep deprivation for 72 h caused anxiety like behavior, weight loss, impaired locomotor activity and oxidative damage as indicated by increase in lipid peroxidation, nitrite level and depletion of reduced glutathione and catalase activity in sleep deprived mice brain. Treatment with melatonin (5 and 10 mg/kg, ip) significantly improved locomotor activity, weight loss and antianxiety effect as compared to control (sleep deprived). Biochemically, melatonin treatment significantly restored depleted reduced glutathione, catalase activity, attenuated lipid peroxidation and nitrite level as compared to control (72 h sleep-deprived) animals. A combination of flumazenil (0.5 mg/kg, ip) and picrotoxin (0.5 mg/kg, ip) with lower dose of melatonin (5 mg/kg, ip) significantly antagonized the protective effect of melatonin. However, combination of muscimol (0.05 mg/kg, ip) with melatonin (5 mg/kg, ip) potentiated protective effect of melatonin as compared to their effect per se. The results suggest that melatonin may produce its protective effect by involving GABAergic system against sleep deprivation-induced anxiety like behavior and related oxidative damage.

  10. Multifunctional Involvement of a C2H2 Zinc Finger Protein (PbZfp in Malaria Transmission, Histone Modification, and Susceptibility to DNA Damage Response

    Directory of Open Access Journals (Sweden)

    Anusha M. Gopalakrishnan

    2017-08-01

    Full Text Available In sexually reproducing organisms, meiosis is an essential step responsible for generation of haploid gametes from diploid somatic cells. The quest for understanding regulatory mechanisms of meiotic recombination in Plasmodium led to identification of a gene encoding a protein that contains 11 copies of C2H2 zinc fingers (ZnF. Reverse genetic approaches were used to create Plasmodium berghei parasites either lacking expression of full-length Plasmodium berghei zinc finger protein (PbZfp (knockout [KO] or expressing PbZfp lacking C-terminal zinc finger region (truncated [Trunc]. Mice infected with KO parasites survived two times longer (P 95% oocyst reduction. KO parasites revealed a total lack of trimethylation of histone 3 at several lysine residues (K4, K27, and K36 without any effect on acetylation patterns (H3K9, H3K14, and H4K16. Reduced DNA damage and reduced expression of topoisomerase-like Spo11 in the KO parasites with normal Rad51 expression further suggest a functional role for PbZfp during genetic recombination that involves DNA double-strand break (DSB formation followed by DNA repair. These finding raise the possibility of some convergent similarities of PbZfp functions to functions of mammalian PRDM9, also a C2H2 ZnF protein with histone 3 lysine 4 (H3K4 methyltransferase activity. These functions include the major role played by the latter in binding recombination hotspots in the genome during meiosis and trimethylation of the associated histones and subsequent chromatin recruitment of topoisomerase-like Spo11 to catalyze DNA DSB formation and DMC1/Rad51-mediated DNA repair and homologous recombination.

  11. Structural and Functional Characterization of PseC, an Aminotransferase Involved in the Biosynthesis of Pseudaminic Acid, an Essential Flagellar Modification in Helicobacter Pylori

    Energy Technology Data Exchange (ETDEWEB)

    Schoenhofen,I.; Lunin, V.; Julien, J.; Li, Y.; Ajamian, E.; Matte, A.; Cygler, M.; Brisson, J.; Aubry, A.; et al.

    2006-01-01

    Helicobacter pylori flagellin is heavily glycosylated with the novel sialic acid-like nonulosonate, pseudaminic acid (Pse). The glycosylation process is essential for assembly of functional flagellar filaments and consequent bacterial motility. As motility is a key virulence factor for this and other important pathogens, the Pse biosynthetic pathway offers potential for novel therapeutic targets. From recent NMR analyses, we determined that the conversion of UDP-a-D-GlcNAc to the central intermediate in the pathway, UDP-4-amino-4,6-dideoxy-{beta}-L-AltNAc, proceeds by formation of UDP-2-acetamido-2,6-dideoxy-{beta}-L-arabino-4-hexulose by the dehydratase/epimerase PseB (HP0840) followed with amino transfer by the aminotransferase, PseC (HP0366). The central role of PseC in the H. pylori Pse biosynthetic pathway prompted us to determine crystal structures of the native protein, its complexes with pyridoxal phosphate alone and in combination with the UDP-4-amino-4,6-dideoxy-{beta}-L-AltNAc product, the latter being converted to the external aldimine form in the enzyme's active site. In the binding site, the AltNAc sugar ring adopts a 4C1 chair conformation which is different from the predominant 1C4 form found in solution. The enzyme forms a homodimer where each monomer contributes to the active site, and these structures have permitted the identification of key residues involved in stabilization, and possibly catalysis, of the {beta}-L-arabino intermediate during the amino transfer reaction. The essential role of Lys183 in the catalytic event was confirmed by site-directed mutagenesis. This work presents for the first time a nucleotide-sugar aminotransferase co-crystallized with its natural ligand, and in conjunction with the recent functional characterization of this enzyme, will assist in elucidating the aminotransferase reaction mechanism within the Pse biosynthetic pathway.

  12. The Effect of Early Neuromuscular Electrical Stimulation Therapy in Acute/Subacute Ischemic Stroke Patients With Dysphagia

    OpenAIRE

    Lee, Kyeong Woo; Kim, Sang Beom; Lee, Jong Hwa; Lee, Sook Joung; Ri, Jae Won; Park, Jin Gee

    2014-01-01

    Objective To compare the outcome of an early application of neuromuscular electrical stimulation (NMES) combined with traditional dysphagia therapy (TDT) versus traditional dysphagia therapy only in acute/subacute ischemic stroke patients with moderate to severe dysphagia by videofluoroscopic swallowing study (VFSS). Methods Fifty-seven dysphagic stroke patients were enrolled in a VFSS within 10 days after stroke onset. Patients were randomly assigned into two treatment groups. Thirty-one pat...

  13. Economic analysis of esophageal stenting for management of malignant dysphagia.

    Science.gov (United States)

    Rao, C; Haycock, A; Zacharakis, E; Krasopoulos, G; Yakoub, D; Protopapas, A; Darzi, A; Hanna, G B; Athanasiou, T

    2009-01-01

    Over half of patients diagnosed with esophageal cancer are unsuitable for curative resection. A significant proportion of these patients will subsequently require palliative stenting to alleviate dysphagia. There is growing consensus in the literature that the deployment of a Self-Expanding Metal Stent is the optimum stenting strategy; however, it remains unclear whether covered or uncovered metal stents are more cost-effective. In order to determine which type of prosthesis is more cost-effective, we compared the different stenting strategies in terms of 1-year stent-related mortality, health-related quality of life, and cost. A decision analytical model was constructed to compare the 1-year stent-related mortality, health-related quality of life, and cost between covered and uncovered stents. Probabilistic sensitivity analysis was performed to quantify the uncertainty associated with our results. Value of Information analysis was performed to assess the value of further research. In order to fully characterize the uncertainty associated with this decision, plastic stents were included in our analysis. Stent-related mortality was slightly lower following covered stent deployment compared with uncovered stent deployment (1.00% vs. 1.26%). Covered stents were more effective by 0.0013 Quality-Adjusted Life Years (Standard Deviation [SD] 0.0013 Quality-Adjusted Life Years). They were also less expensive by $729.58 (SD $390.63). Probabilistic sensitivity analysis suggested that these results were not sensitive to model parameter uncertainty. Plastic stents deployment was $2832.64 (SD $1182.72) more expensive than uncovered metal stent deployment. Value of Information analysis suggests that the maximum value of further research in the UK is $61,124.30. The results of this study represent strong evidence for the cost-effectiveness of covered compared with uncovered self-expanding metal stents for the palliation of patients with malignant dysphagia. The findings support

  14. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function.

    Science.gov (United States)

    Cabib, Christopher; Ortega, Omar; Kumru, Hatice; Palomeras, Ernest; Vilardell, Natalia; Alvarez-Berdugo, Daniel; Muriana, Desirée; Rofes, Laia; Terré, Rosa; Mearin, Fermín; Clavé, Pere

    2016-09-01

    Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. This review covers advances in the pathophysiology, diagnosis, and physiologically based neurorehabilitation strategies for poststroke OD. The pathophysiology of oropharyngeal biomechanics can be assessed by videofluoroscopy, as delayed laryngeal vestibule closure is closely associated with aspiration. Stroke may affect afferent or efferent neuronal circuits participating in deglutition. The integrity of oropharyngeal-cortical afferent pathways can be assessed by electroencephalography through sensory-evoked potentials by pharyngeal electrical stimulation, while corticopharyngeal efferent pathways can be characterized by electromyography through motor-evoked potentials by transcranial magnetic stimulation. Dysfunction in both cortico-mediated evoked responses is associated with delayed swallow response and aspiration. Studies have reported hemispherical asymmetry on motor control of swallowing and the relevance of impaired oropharyngeal sensitivity on aspiration. Advances in treatment include improvements in compensatory strategies but are mainly focused on (1) peripheral stimulation strategies and (2) central, noninvasive stimulation strategies with evidence of their clinical benefits. Characterization of poststroke OD is evolving from the assessment of impaired biomechanics to the sensorimotor integration processes involved in deglutition. Treatment is also changing from compensatory strategies to promoting brain plasticity, both to recover swallow function and to improve brain-related swallowing dysfunction. © 2016 New York Academy of Sciences.

  15. Injection of Botulinum Toxin a to Upper Esophageal Sphincter for Oropharyngeal Dysphagia in Two Patients with Inclusion Body Myositis

    Directory of Open Access Journals (Sweden)

    Louis WC Liu

    2004-01-01

    Full Text Available Inclusion body myositis (IBM is a progressive degenerative skeletal muscle disease leading to weakening and atrophy of both proximal and distal muscles. Dysphagia is reported in up to 86% of IBM patients. Surgical cricopharyngeal myotomy may be effective for cricopharyngeal dysphagia and there is one published report that botulinum toxin A, injected into the cricopharyngeus muscle using a hypopharyngoscope under general anesthesia, relieved IBM-associated dysphagia. This report presents the first documentation of botulinum toxin A injection into the upper esophageal sphincter using a flexible esophagogastroduodenoscope under conscious sedation, to reduce upper esophageal sphincter pressure and successfully alleviate oropharyngeal dysphagia in two IBM patients.

  16. Ocular, bulbar, limb, and cardiopulmonary involvement in oculopharyngeal muscular dystrophy

    DEFF Research Database (Denmark)

    Witting, N; Mensah, A; Køber, L;

    2014-01-01

    ophthalmoplegia was found in 9 patients. Dysphagia, tested by cold-water swallowing test, was abnormal in 9 patients (17-116 s, ref wheelchair bound and one used a rollator. Six patients had reduced FEV1 (range 23%-59%). No cardiac involvement...

  17. Primary tuberculosis involving epiglottis: a rare case report.

    Science.gov (United States)

    Edizer, Deniz Tuna; Karaman, Emin; Mercan, Hasan; Alimoglu, Yalcin; Esen, Tugce; Cansiz, Harun

    2010-09-01

    The case of a 29-year-old patient with active laryngeal tuberculosis predominantly involving the epiglottis, without pulmonary disease, is presented. The predominant symptoms are dysphagia, odynophagia, and hoarseness. Laryngeal carcinoma, which shares almost the same symptoms and signs, should be ruled out immediately. Laryngeal tuberculosis is discussed with a brief literature review.

  18. [Relationship between dysphagia and malnutritition in patients over 65 years of age].

    Science.gov (United States)

    Galán Sánchez-Heredero, María José; Santander Vaquero, Cecilio; Cortázar Sáez, Milagros; de la Morena López, Felipe; Susi García, Rosario; Martínez Rincón, María Del Carmen

    2014-01-01

    The main objective of this study was to understand the relationship between oropharyngeal dysphagia, nutritional risk factors and functional impairment in the elderly (>65y) admitted to a medical-surgical hospital unit. Secondary objectives were to determine the prevalence of oropharyngeal dysphagia, the nutritional status and their functional capacity. A cross-sectional observational study was performed. It included patients over 65 years of age admitted to the Gastroenterology-Urology Department in La Princesa University Hospital (Madrid, Spain) during the months of February and March. The following variables were recorded: age, sex, body mass index, family support, diagnosis, comorbidity, oropharyngeal dysphagia (EAT-10 and volume-viscosity evaluation method), malnutrition (Mininutritional Assessment) and functional capacity (Barthel index). A total of 167 patients were recruited, with 30.8% and 15.4% prevalence of dysphagia and malnutrition, respectively. Prevalence of malnutrition increased to 75% in patients with oropharyngeal dysphagia. The logistic regression analysis showed how conditions as low score on the Barthel index (OR 0.97 [95% CI, 0.95-0.99]), comorbidity (OR 7.98 [CI 95%, 3.09-20.61]) and dysphagia (OR 4.07 [CI 95%, 1.57-10.52]) were associated with a greater likelihood of suffering malnutrition. Oropharyngeal dysphagia is one of the most underdiagnosed and underestimated conditions among elderly patients and one that has a greater effect on their nutritional status. Accordingly, we suggest using established diagnostic methods with a multidisciplinary team collaboration for its early detection. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke

    Directory of Open Access Journals (Sweden)

    Jalal Bakhtiyari

    2015-10-01

    Full Text Available Background: Dysphagia is common after stroke. The onset time of swallowing rehabilitation following stroke has an important role in the recovery of dysphagia and preventing of its complications, but it was either highly variable or was not stated in previous trials. The aim of this study was investigation effects of onset time of swallowing therapy on recovery from dysphagia following stroke.Methods: Sixty dysphagia patients due to stroke range of age 60-74 (67.1 ± 3.8, participated in this randomized clinical trial study. The patients allocated in Early, Medium and Late groups, on the base of initiation of swallowing therapy after the stroke. After basic clinical and video fluoroscopic swallowing study assessments, traditional swallowing therapy was initiated 3 times per week for 3 months. The outcome measures were North-Western dysphagia patient check sheet, functional oral intake scale, video fluoroscopy, and frequency of pneumonia. Statistical analysis was done by repeated measure ANOVA, Bonferroni and χ2 tests.Results: Three groups of patients in terms of demographic and clinical characteristics were similar in the pre-treatment P > 0.050. Onset time of swallowing therapy after stroke was effective on swallowing recovery on the main outcome variables. So that in first group patients, recovery was rather than other groups P < 0.050. Furthermore, the frequency of pneumonia in the early group was less than other groups and in the early group no patients experienced pneumonia P = 0.002.Conclusion: Our data suggested that early interventions for dysphagia in stroke have an important role in recovery from dysphagia and prevention of complications like aspiration pneumonia.

  20. Value of the Cervical Auscultation in Patients Affected by Neurogenic Dysphagia

    Directory of Open Access Journals (Sweden)

    Fontoura, Elisiane Godoy

    2009-12-01

    Full Text Available Introduction: The cervical auscultation is an instrumental resource used in the functional clinical phonoaudiological approach of feeding and the pulmonary auscultation is a semiotic method for clinical exploitation of the thorax and the heart. Objective: To relate noises from cervical and pulmonary auscultations. Method: Prospective, clinical and experimental, quantitative and comparative study between the cervical and the pulmonary auscultations and sample composed by 19 adult patients with clinical diagnosis of oropharyngeal neurogenic dysphagia, after encephalic vascular accident, with mean age of 59.11 years. We established percentages for variables considering two evaluators. The statistical analysis confirms the presence of slight dysphagia in 66.67%; moderate dysphagia in 16.67% and severe dysphagia in 16.67%. In the cervical auscultation the presence of dry clicks occurred between 42.11% and 78.95% for the different evaluators, and we observed a higher frequency of alterations for evaluator 1. In the pulmonary auscultation the higher frequency was of normal vesicular respiration for both evaluators. We also verified a significant difference between the levels of dysphagia for the cervical and pulmonary auscultations variables, whose correlation shows a low concordance; and a significant discordance between the evaluators for the cervical auscultation and perfect concordance for the pulmonary auscultation. Conclusion: there is no relationship between the noises listened, even with the respiratory function as a base and with the evaluation region being close; but we confirm a relation between dysphagia and pulmonary auscultation, whose results set a frequency of 100% of alterations in the pulmonary auscultation in the dysphagia pictures, with moderate and severe affection levels.

  1. Psychometric characteristics of health-related quality-of-life questionnaires in oropharyngeal dysphagia.

    Science.gov (United States)

    Timmerman, Angelique A; Speyer, Renée; Heijnen, Bas J; Klijn-Zwijnenberg, Iris R

    2014-04-01

    Dysphagia can have severe consequences for the patient's health, influencing health-related quality of life (HRQoL). Sound psychometric properties of HRQoL questionnaires are a precondition for assessing the impact of dysphagia, the focus of this study, resulting in recommendations for the appropriate use of these questionnaires in both clinical practice and research contexts. We performed a systematic review starting with a search for and retrieval of all full-text articles on the development of HRQoL questionnaires related to oropharyngeal dysphagia and/or their psychometric validation from the electronic databases PubMed and Embase published up to June 2011. Psychometric properties were judged according to quality criteria proposed for health status questionnaires. Eight questionnaires were included in this study. Four are aimed solely at HRQoL in oropharyngeal dysphagia: the deglutition handicap index (DHI), dysphagia handicap index (DHI'), M.D. Anderson Dysphagia Inventory (MDADI), and SWAL-QOL, while the EDGQ, EORTC QLQ-STO 22, EORTC QLQ-OG 25 and EORTC QLQ-H&N35 focus on other primary diseases resulting in dysphagia. The psychometric properties of the DHI, DHI', MDADI, and SWAL-QOL were evaluated. For appropriate applicability of HRQoL questionnaires, strong scores on the psychometric criteria face validity, criterion validity, and interpretability are prerequisites. The SWAL-QOL has the strongest ratings for these criteria, while the DHI' is the most easy to apply given its 25 items and the use of a uniform scoring format. For optimal use of HRQoL questionnaires in diverse settings, it is necessary to combine psychometric and utility approaches.

  2. Dysphagia and nutritional status at the time of hospital admission for ischemic stroke.

    Science.gov (United States)

    Crary, Michael A; Carnaby-Mann, Giselle D; Miller, Leslie; Antonios, Nader; Silliman, Scott

    2006-01-01

    Dysphagia and poor nutritional status occur frequently after stroke; however, potential associations between them are unknown. We evaluated potential associations between dysphagia and poor nutritional status in patients with acute ischemic stroke. Potential associations between these outcomes and more global stroke severity measures were also assessed. In all, 76 patients with acute ischemic stroke were recruited on admission to the dedicated stroke department of an academic medical center. All patients were assessed with a clinical swallowing evaluation, Functional Oral Intake Scale, Mini Nutritional Assessment, body mass index, percent body fat, National Institutes of Health Stroke Scale, modified Rankin Scale, and modified Barthel Index. Associations were evaluated among dysphagia, nutrition, and stroke severity measures. On clinical examination 52.6% of study patients demonstrated dysphagia and 26.3% were identified with poor nutritional status. Dysphagia, based on clinical assessment, was associated with stroke severity (National Institutes of Health Stroke Scale, odds ratio [OR] 4.6, 95% confidence interval [CI] 1.6-13.1; modified Rankin Scale, OR 12.3, 95% CI 3.2-47.4) and with functional oral intake (OR 29.2, 95% CI 8.4-101.8), but not with measures of nutritional status (Mini Nutritional Assessment, OR 1.0, 95% CI 0.4-2.8). Nutritional measures did not correlate with swallowing or stroke severity measures. Dysphagia and poor nutritional status are prevalent in patients with acute ischemic stroke, however, they are not associated with each other at the time of hospital admission. Furthermore, dysphagia, but not nutritional status, is associated with stroke severity measures.

  3. The incidence of dysphagia in patients receiving cerebral reperfusion therapy poststroke.

    Science.gov (United States)

    Ribeiro, Priscila W; Cola, Paula C; Gatto, Ana R; da Silva, Roberta G; Luvizutto, Gustavo J; Braga, Gabriel P; Schelp, Arthur O; de Arruda Henry, Maria A C; Bazan, Rodrigo

    2014-07-01

    The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann-Whitney test and considered significant if P is less than .05. The moderate and severe degrees of dysphagia were more frequent (P=.013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia (P=.045). We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  4. [Causes, diagnosis and treatment of neurogenic dysphagia as an interdisciplinary clinical problem].

    Science.gov (United States)

    Olszewski, Jurek

    2006-01-01

    The intricate mechanism of swallowing can be divided into three phases: oral, pharyngeal, and esophageal. Dysphagia is a disruption in the swallowing process, which include difficulty in transporting (or a lack of transporting) a food or liquid bolus from the mouth through the pharynx and esophagus into the stomach. Causes of disruptions in the swallowing process can be divided into superior (oropharyngeal) and inferior (esophageal) according to Paradowski et al. Neurlologic dysphagia may be caused by a disruption in different parts of the central nervous system (supranuclear level, level of motor and sensory nuclei taking part in swallowing process, peripherial nerves level and a pathology of muscle cells and spindles) or neuromuscular and muscular disorders. Neuromuscular disorders causes according to Waśko-Czopnik et al. are: stroke, brain tumors, brain injury, bulbar and pseudobulbar paralysis, neurodegenerative diseases (amyotrophic lateral sclerosis, multiple sclerosis), tabes dorsalis, multisystem degenerations, Parkinson's disease, delayed dyskineses, Huntington's disease, myasthenia and myasthenic syndromes, myopathies and peripherial neuropathies. The correct diagnosis evaluation include history taking, physical examination with palpation and consultations (laryngological, gastrological and neurological). According to Halama radiological esophagogram, videofluoroscopy, flexible endoscopic examination, ultrasound examination, manometry, electromyography, scintigraphy and 24 hour pH monitoring are main diagnostic procedures of dysphagia. Some of the reasons for the neurologic dysphagia may be treated by surgical and pharmacological methods. Neurologic dysphagia rehabilitation is difficult, long-lasting and often falling far short of expected results. Primary it should include neurologic cause treatment if it is possible. According to WHO International Classification of Functioning and Health in 2001 non-invasive methods of dysphagia treatment may be

  5. Dysphagia and cerebrovascular accident: relationship between severity degree and level of neurological impairment.

    Science.gov (United States)

    Itaquy, Roberta Baldino; Favero, Samara Regina; Ribeiro, Marlise de Castro; Barea, Liselotte Menke; Almeida, Sheila Tamanini de; Mancopes, Renata

    2011-12-01

    The aim of this case study was to verify the occurrence of dysphagia in acute ischemic stroke within 48 hours after the onset of the first symptoms, in order to establish a possible relationship between the level of neurologic impairment and the severity degree of dysphagia. After emergency hospital admission, three patients underwent neurological clinical evaluation (general physical examination, neurological examination, and application of the National Institute of Health Stroke Scale - NIHSS), and clinical assessment of swallowing using the Protocolo Fonoaudiológico de Avaliação do Risco para Disfagia (PARD--Speech-Language Pathology Protocol for Risk Evaluation for Dysphagia). One of the patients presented functional swallowing (NIHSS score 11), while the other two had mild and moderate oropharyngeal dysphagia (NIHSS scores 15 and 19, respectively). The service flow and the delay on the patients' search for medical care determined the small sample. The findings corroborate literature data regarding the severity of the neurological condition and the manifestation of dysphagia.

  6. Long-Term Results of External Upper Esophageal Sphincter Myotomy for Oropharyngeal Dysphagia

    Science.gov (United States)

    David, Eric F.; Klinkenberg-Knol, Elly C.; Mahieu, Hans F.

    2009-01-01

    The aim of this work was to assess the efficacy of external myotomy of the upper esophageal sphincter (UES) for oropharyngeal dysphagia. In the period 1991–2006, 28 patients with longstanding dysphagia and/or aspiration problems of different etiologies underwent UES myotomy as a single surgical treatment. The main symptoms were difficulties in swallowing of a solid-food bolus, aspiration, and recurrent incidents of solid-food blockages. Pre- and postoperative manometry and videofluoroscopy were used to assess deglutition and aspiration. Outcome was defined as success in the case of complete relief or marked improvement of dysphagia and aspiration and as failure in the case of partial improvement or no improvement. Initial results showed success in 21 and failure in 7 patients. The best outcomes were observed in patients with dysphagia of unknown origin, noncancer-related iatrogenic etiology, and neuromuscular disease. No correlation was found between preoperative constrictor pharyngeal muscle activity and success rate. After follow-up of more than 1 year, 20 patients were marked as success and 3 as failure. All successful patients had full oral intake with a normal bolus consistency without clinically significant aspiration. We conclude that in select cases of oropharyngeal dysphagia success may be achieved by UES myotomy with restoration of oral intake of normal bolus consistency. PMID:19760460

  7. Effectiveness of Chin-tuck Maneuver to Facilitate Swallowing in Neurologic Dysphagia

    Directory of Open Access Journals (Sweden)

    Saconato, Mariana

    2015-10-01

    Full Text Available Introduction The chin-tuck maneuver is the most frequently employed postural maneuver in the treatment of neurogenic oropharyngeal dysphagia caused by encephalic vascular strokes and degenerative diseases. Objective The purpose of this study was to investigate the effectiveness of this maneuver in patients with neurogenic dysphagia and factors that could interfere in it. Methods In this retrospective cohort, we analyzed the medical files and videofluoroscopy exams of 35 patients (19 male – 54% and 16 female – 46%; age range between 20 and 89 years old; mean = 69 years. Results The results suggest that the effectiveness of chin-tuck maneuver is related to the overall degree of dysphagia: the more severe the dysphagia, the less effective the maneuver. Conclusion Chin-tuck maneuver should benefit dysphagic patients with delay in the swallowing trigger, reduced laryngeal elevation, and difficulties to swallow liquids, but is not the best compensatory strategy for patients with severe dysphagia.

  8. [Surface electromyographic activities of submental muscles among stroke patients with dysphagia].

    Science.gov (United States)

    Xiao, Ling-jun; Xue, Jing-jing; Yan, Tie-bin; Wu, Shao-ling

    2013-06-18

    To explore the swallowing functions of stroke patients with dysphagia. A total of 41 subjects were recruited.There were 15 stroke patients with dysphagia, 12 stroke patients without swallowing disorders and 14 age-and gender-matched healthy controls.Surface electromyography (sEMG) was employed over the suprahyoid muscle group.Single swallow was applied twice with 5 and 10 ml of thin liquid barium as well as 5 and 10 ml of paste barium.The duration, average amplitude of sEMG and peak amplitude of submental muscle contraction were compared among three groups.Three-way analysis of variance (ANOVA) was performed. No significant differences existed in the general data among three groups (P > 0.05).However, all volumes, consistencies and durations [ (1.38 ± 0.21), (1.66 ± 0.30), (1.46 ± 0.24), (1.78 ± 0.28) s] were significantly longer for the group of dysphagia patients than for those without dysphagia and healthy subjects (P 0.05). As a simple and useful tool, sEMG is feasible for evaluating swallowing function and quantifying the strength of swallowing muscles in post-stroke patients with dysphagia.

  9. Orotracheal intubation and dysphagia: comparison of patients with and without brain damage

    Directory of Open Access Journals (Sweden)

    Aline Rodrigues Padovani

    2008-09-01

    Full Text Available Objectives: To compare the swallowing and feeding abilities in extubated patients with and without brain injury. Methods: A retrospective study including 44 patients aged 20 to 50 years submitted to prolonged orotracheal intubation (> 48 hours. Two groups were analyzed: Group 1 composed of nontraumatic brain injury patients, and Group 2 composed of patients with traumatic brain injury. Two scales for characterization of functional swallowing and feeding abilities were used to compare both groups; the levels of alertness, awareness and patient collaboration were also assessed. Rresults: The groups were equal in age, number and time of orotracheal intubation and extubation on the date of the assessment. Regarding the speech and language diagnosis, Group 1 presented higher percentage of functional swallowing and mild dysphagia, while Group 2 showed higher rates of moderate to severe dysphagia and severe dysphagia. The Functional Oral Intake Scale average was higher in Group 1. In addition, the injured brain group was sleepier, less collaborative and had less contact in the first evaluation. Cconclusions: In this study, patients who underwent prolonged orotracheal intubation had dysphagia in different degrees, but the patients with brain injury presented more frequent and severe disorder. Thus, this study suggested that orotracheal intubation cannot be considered as the single factor causing dysphagia, especially in neurological patients. Moreover, some cognitive factors may influence the possibility of providing oral feeding.

  10. Transcranial direct current stimulation in post-stroke dysphagia: a systematic review of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Kavian Ghandehari

    2016-07-01

    Full Text Available Introduction: The aim of this research was to systematically review all the randomized controlled trials that have evaluated the effect of transcranial direct current stimulation (tDCS on post-stroke dysphagia. Methods: Three electronic databases were searched for relevant articles that were uploaded from their inception to March 2015: PubMed, Cochrane Library (Cochrane Central Register of Controlled Trials, and Scopus. All data was that was related to the location of the cerebrovascular accident (CVA, the parameters of tDCS, post-stroke time to commencement of tDCS, the stimulated hemisphere, stimulation dose, any outcome measurements, and follow-up duration were extracted and assessed. Finally, a number of observations were generated through a qualitative synthesis of the extracted data.Result: Three eligible randomized controlled trials were included in the systematic review. All three trials reported that, in comparison to a placebo, tDCS had a statistically significant effect on post-stroke dysphagia.Discussion: The results of our systematic review suggest that tDCS may represent a promising novel treatment for post-stroke dysphagia. However, to date, little is known about the optimal parameters of tDCS for relieving post-stroke dysphagia. Further studies are warranted to refine this promising intervention by exploring the optimal parameters of tDCS.Conclusion: Since brainstem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brainstem swallowing may facilitate recovery from dysphagia.

  11. Esophageal dysphagia and reflux symptoms before and after oral IQoro(R) training.

    Science.gov (United States)

    Hägg, Mary; Tibbling, Lita; Franzén, Thomas

    2015-06-28

    To examine whether muscle training with an oral IQoro(R) screen (IQS) improves esophageal dysphagia and reflux symptoms. A total of 43 adult patients (21 women and 22 men) were consecutively referred to a swallowing center for the treatment and investigation of long-lasting nonstenotic esophageal dysphagia. Hiatal hernia was confirmed by radiologic examination in 21 patients before enrollment in the study (group A; median age 52 years, range: 19-85 years). No hiatal hernia was detected by radiologic examination in the remaining 22 patients (group B; median age 57 years, range: 22-85 years). Before and after training with an oral IQS for 6-8 mo, the patients were evaluated using a symptom questionnaire (esophageal dysphagia and acid chest symptoms; score 0-3), visual analogue scale (ability to swallow food: score 0-100), lip force test (≥ 15 N), velopharyngeal closure test (≥ 10 s), orofacial motor tests, and an oral sensory test. Another twelve patients (median age 53 years, range: 22-68 years) with hiatal hernia were evaluated using oral IQS traction maneuvers with pressure recordings of the upper esophageal sphincter and hiatus canal as assessed by high-resolution manometry. Esophageal dysphagia was present in all 43 patients at entry, and 98% of patients showed improvement after IQS training [mean score (range): 2.5 (1-3) vs 0.9 (0-2), P dysphagia and reflux symptoms in adults, likely due to improved hiatal competence.

  12. The relationship between limit of Dysphagia and average volume per swallow in patients with Parkinson's disease.

    Science.gov (United States)

    Belo, Luciana Rodrigues; Gomes, Nathália Angelina Costa; Coriolano, Maria das Graças Wanderley de Sales; de Souza, Elizabete Santos; Moura, Danielle Albuquerque Alves; Asano, Amdore Guescel; Lins, Otávio Gomes

    2014-08-01

    The goal of this study was to obtain the limit of dysphagia and the average volume per swallow in patients with mild to moderate Parkinson's disease (PD) but without swallowing complaints and in normal subjects, and to investigate the relationship between them. We hypothesize there is a direct relationship between these two measurements. The study included 10 patients with idiopathic PD and 10 age-matched normal controls. Surface electromyography was recorded over the suprahyoid muscle group. The limit of dysphagia was obtained by offering increasing volumes of water until piecemeal deglutition occurred. The average volume per swallow was calculated by dividing the time taken by the number of swallows used to drink 100 ml of water. The PD group showed a significantly lower dysphagia limit and lower average volume per swallow. There was a significantly moderate direct correlation and association between the two measurements. About half of the PD patients had an abnormally low dysphagia limit and average volume per swallow, although none had spontaneously related swallowing problems. Both measurements may be used as a quick objective screening test for the early identification of swallowing alterations that may lead to dysphagia in PD patients, but the determination of the average volume per swallow is much quicker and simpler.

  13. Rehabilitation and nutritional support for sarcopenic dysphagia and tongue atrophy after glossectomy: A case report.

    Science.gov (United States)

    Hashida, Nao; Shamoto, Hiroshi; Maeda, Keisuke; Wakabayashi, Hidetaka; Suzuki, Motoyuki; Fujii, Takashi

    2017-03-01

    Swallowing dysfunction is related to long-term weight loss and reduced body mass index in patients with head and neck cancer. We describe a 76-y-old woman who had severe sarcopenic dysphagia and atrophy of the reconstructed tongue for 17 mo after subtotal glossectomy due to tongue cancer and lost 14 kg during that period. Upon admission, the patient received diagnoses of malnutrition in the context of social or environmental circumstances with insufficient energy intake, loss of muscle mass, localized fluid accumulation, weight loss, and sarcopenia due to reduced skeletal muscle mass (skeletal muscle index dysphagia rehabilitation to improve sarcopenia, atrophy of the reconstructed tongue, and dysphagia. After 20 mo of treatment, she was considered to be no longer malnourished (11 kg weight gain) and without sarcopenia (skeletal muscle index 4.01 cm(2)/m(2)), and the volume of the reconstructed tongue was increased. Sarcopenia and atrophy of the reconstructed tongue may cause dysphagia after glossectomy due to tongue cancer. Additionally, nutritional support and rehabilitation could improve such dysphagia. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Validity and reliability of swallowing screening tools used by nurses for dysphagia: A systematic review.

    Science.gov (United States)

    Jiang, Jiin-Ling; Fu, Shu-Ying; Wang, Wan-Hsiang; Ma, Yu-Chin

    2016-01-01

    Dysphagia following neurological impairment increases the risk of dehydration, malnutrition, aspiration pneumonia, and even death. Screening for dysphagia has been reported to change negative outcomes. This review evaluated the validity and reliability of measurement tools for screening dysphagia in patients with neurological disorders to identify a feasible tool that can be used by nurses. Electronic databases were searched for studies from 1992 to 2015 related to dysphagia screening measurements. The search was applied to the Pubmed, CINAHL, Cochrane, Medline, EBSCO host, and CEPS + CETD databases. A checklist was used to evaluate the psychometric quality. The tools were evaluated for their feasibility for incorporation into routine care by nurses in hospitals. A total of 104 papers were retrieved, and eight articles finally met the inclusion criteria. The sensitivity and specificity of the screening tools ranged from 29% to 100% and from 65% to 100%, respectively. The interrater reliability ranged from good to excellent agreement. On the basis of quality evaluations, all the included studies had a risk of bias because of inadequate methodological characteristics. The Standardized Swallowing Assessment is the most suitable tool for detecting dysphagia because its psychometric properties and feasibility are higher than those of other screening tools that can be administered by nurses.

  15. RNA modification in Cajal bodies.

    Science.gov (United States)

    Meier, U Thomas

    2016-10-24

    Aside from nucleoli, Cajal bodies (CBs) are the best-characterized organelles of mammalian cell nuclei. Like nucleoli, CBs concentrate ribonucleoproteins (RNPs), in particular, spliceosomal small nuclear RNPs (snRNPs) and small nucleolar RNPs (snoRNPs). In one of the best-defined functions of CBs, most of the snoRNPs are involved in site-specific modification of snRNAs. The two major modifications are pseudouridylation and 2'-O-methylation that are guided by the box H/ACA and C/D snoRNPs, respectively. This review details the modifications, their function, the mechanism of modification, and the machineries involved. We dissect the different classes of noncoding RNAs that meet in CBs, guides and substrates. Open questions and conundrums, often raised and appearing due to experimental limitations, are pointed out and discussed. The emphasis of the review is on mammalian CBs and their function in modification of noncoding RNAs.

  16. Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures

    OpenAIRE

    van der Molen, L.; Heemsbergen, W.D.; de Jong, R.; van Rossum, M.A.; Smeele, L.E.; Rasch, C. R. N.; HILGERS, F.J.M.

    2013-01-01

    Background and purpose: Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Material and methods: Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment (N=37). Calculation of dose-volume parameters for swallowing (inferior (IC), middle (MC), and superior constrictors (SC)), and mastication structures (e.g. masseter). Investigation of relationships ...

  17. Subjective dysphagia in older care home residents: a cross-sectional, multi-centre point prevalence measurement

    NARCIS (Netherlands)

    Maarel-Wierink, C.D. van der; Meijers, J.M.M.; Visschere, L.M. De; Baat, C. de; Halfens, R.J.; Schols, J.M.

    2014-01-01

    BACKGROUND: Dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people. Aspiration pneumonia is causing high hospitalization rates, morbidity, and often death. Better insight in the prevalence of (subjective) dysphagia in frail older people may improve its ear

  18. Survivors' Experiences of Dysphagia-Related Services Following Head and Neck Cancer: Implications for Clinical Practice

    Science.gov (United States)

    Nund, Rebecca L.; Ward, Elizabeth C.; Scarinci, Nerina A.; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V.

    2014-01-01

    Background: It is known that people with dysphagia experience a number of negative consequences as a result of their swallowing difficulties following head and neck cancer management (HNC). However their perceptions and experiences of adjusting to dysphagia in the post-treatment phase, and the services received to assist this process, has not been…

  19. Rehabilitation or Compensation: Time for a Fresh Perspective on Speech and Language Therapy for Dysphagia and Parkinson's Disease?

    Science.gov (United States)

    Smith, Sarah K.; Roddam, Hazel; Sheldrick, Heulwen

    2012-01-01

    Background: Dysphagia is a common symptom of Parkinson's disease and can have negative consequences for physical health and quality of life. A variety of treatment options are available to clinicians working with people who have dysphagia and Parkinson's disease. These options can be broadly categorized as being compensatory or rehabilitative in…

  20. Oropharyngeal Dysphagia in a Community-Based Elderly Cohort: the Korean Longitudinal Study on Health and Aging

    Science.gov (United States)

    Yang, Eun Joo; Kim, Mi Hyun; Lim, Jae-young

    2013-01-01

    This study was conducted to investigate the prevalence of dysphagia and evaluated the association of dysphagia and activities of daily living in a geriatric population residing in an independent-living facility in Korea. Korean men and women 65-yr and older living in a single, typical South Korean city (n=415) were enrolled in the Korean Longitudinal Study on Health and Aging study. Dysphagia was assessed using the Standardized Swallowing Assessment. Data were collected on activities of daily living (ADL), instrumental ADL (IADL), and medical history and laboratory. The overall prevalence of dysphagia in the random sample was 33.7% (95% CI, 29.1-38.4), including 39.5% in men and 28.4% in women. The identified risk factors for dysphagia were men (OR, 3.6, P=0.023), history of stroke (OR, 2.7, P=0.042) and presence of major depressive disorder (OR, 3.0, P=0.022). Dysphagia was associated with impairment in IADL domains of preparing meals and taking medicine (P=0.013 and P=0.007, respectively). This is the first published report of the prevalence of dysphagia in older community-dwelling Koreans. Dysphagia is a common problem among elderly people that limits some IADL domains. PMID:24133362

  1. Survivors' Experiences of Dysphagia-Related Services Following Head and Neck Cancer: Implications for Clinical Practice

    Science.gov (United States)

    Nund, Rebecca L.; Ward, Elizabeth C.; Scarinci, Nerina A.; Cartmill, Bena; Kuipers, Pim; Porceddu, Sandro V.

    2014-01-01

    Background: It is known that people with dysphagia experience a number of negative consequences as a result of their swallowing difficulties following head and neck cancer management (HNC). However their perceptions and experiences of adjusting to dysphagia in the post-treatment phase, and the services received to assist this process, has not been…

  2. Rehabilitation or Compensation: Time for a Fresh Perspective on Speech and Language Therapy for Dysphagia and Parkinson's Disease?

    Science.gov (United States)

    Smith, Sarah K.; Roddam, Hazel; Sheldrick, Heulwen

    2012-01-01

    Background: Dysphagia is a common symptom of Parkinson's disease and can have negative consequences for physical health and quality of life. A variety of treatment options are available to clinicians working with people who have dysphagia and Parkinson's disease. These options can be broadly categorized as being compensatory or rehabilitative in…

  3. Subjective dysphagia in older care home residents: a cross-sectional, multi-centre point prevalence measurement

    NARCIS (Netherlands)

    Maarel-Wierink, C.D. van der; Meijers, J.M.M.; Visschere, L.M. De; Baat, C. de; Halfens, R.J.; Schols, J.M.

    2014-01-01

    BACKGROUND: Dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people. Aspiration pneumonia is causing high hospitalization rates, morbidity, and often death. Better insight in the prevalence of (subjective) dysphagia in frail older people may improve its

  4. Dysphagia in Duchenne muscular dystrophy assessed objectively by surface electromyography.

    Science.gov (United States)

    Archer, Sally K; Garrod, Rachel; Hart, Nicholas; Miller, Simon

    2013-06-01

    Objective swallowing assessment is indicated in the management of patients with Duchenne muscular dystrophy (DMD). Surface electromyography (sEMG) provides a non-invasive, objective method of quantifying muscle activity. It was hypothesised that the measurement of sEMG activity during swallowing would distinguish between preserved and disordered swallow function in DMD. This comparative study investigated the peak, duration, and relative timing of muscle activity during swallowing of four muscle groups: orbicularis oris, masseter, submental, and infrahyoid. The study included three groups of participants: Nine DMD patients with dysphagia (mean age = 21.7 ± 4.2 years), six DMD patients with preserved swallow function (21.0 ± 3.0 years), and 12 healthy controls (24.8 ± 3.1 years). Dysphagic DMD participants produced significantly higher normalised peak amplitude measurements than the healthy control group for masseter (61.77 vs. 5.07; p ≤ 0.01) and orbicularis oris muscles (71.87 vs. 26.22; p ≤ 0.05). Intrasubject variability for masseter peak amplitude was significantly greater for dysphagic DMD participants than the other groups (16.01 vs. 5.86 vs. 2.18; p ≤ 0.05). There were no differences in timing measurements between groups. Different characteristic sEMG waveforms were observed for the three groups. sEMG provides useful physiological information for the evaluation of swallowing in DMD patients, justifying further study.

  5. [Maintenance of logopedic orientation in a patient with oropharyngeal dysphagia of neurogenic origin].

    Science.gov (United States)

    Zambran-Toledo, N

    Speech therapy treatment on patients who have a neurogenically induced dysphagia begins at hospital, in the intensive rehabilitation units. This study shows some of the difficulties found dealing with and orienting the family and the patient from a therapy point of view, mainly during his return to home surroundings. To better understand the dysphagic situation, normal swallowing steps (oral, pharyngeal and esophageal) steps have been described. These were then related to the dysphagic problems, with their evaluation, classification and characteristics. Under dysphagia rehabilitation the therapeutic guidance should be lead by the appropriate nutritional demands, and prevent aspirations. Some of the therapeutic procedures for treating and controlling neurogenic dysphagia have been described (head posture control, tactile and thermal stimuli, etc.). The author questions the difficulties found controlling orientation and maintaining conduct outside the hospital environment, principally with patients at risk from aspirations.

  6. Laryngospasm, dysphagia, and emaciation associated with hyperkalemic periodic paralysis in a horse.

    Science.gov (United States)

    Guglick, M A; MacAllister, C G; Breazile, J E

    1996-07-01

    An 18-month-old Quarter Horse gelding was examined because of weight loss and dysphagia of 1 month's duration. Clinical signs included lethargy, dehydration, ptyalism, and probable aspiration pneumonia. Severe dyspnea and cyanosis were evident after mild exercise. Endoscopy revealed laryngospasm and pharyngospasm. Because clinical signs and endoscopic findings were suggestive of hyperkalemic periodic paralysis (HPP), acetazolamide treatment was instituted. Marked improvement was observed within 48 hours. The horse was determined to be homozygous for HPP. It is likely that this horse's dysphagia, with resultant weight loss and aspiration pneumonia, were clinical manifestations and consequences of HPP. Regardless of age and serum potassium concentration, HPP should be considered as a differential diagnosis for pharyngeal and laryngeal abnormalities and dysphagia in horses with Quarter Horse breeding.

  7. Dysphagia training after head and neck cancer fails to follow legislation and national recommendations

    DEFF Research Database (Denmark)

    Fredslund, Sara Vinther; Høgdal, Nina; Christensen, Malene Bæk

    2015-01-01

    INTRODUCTION: Dysphagia is a known sequela after head and neck cancer (HNC) and causes malnutrition, aspiration pneumonia and a reduced quality of life. Due to improved survival rates, the number of patients with sequelae is increasing. Evidence on the ideal HNC-specific rehabilitation of dysphagia...... is lacking, but several studies indicate that early initiation is crucial. The aim of this study was to map the existing dysphagia rehabilitation programmes for HNC patients in Denmark. METHODS: Occupational therapists (OTs), oncologists and surgeons from five hospitals participated in a nationwide...... questionnaire-based survey, along with OTs from 39 municipal health centres. RESULTS: HNC patients rarely receive preventive occupational therapy before treatment, and hospital-based OTs mainly attend to HNC patients undergoing surgery. Far from all oncology and surgical departments complete the required...

  8. Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: an updated systematic review.

    Science.gov (United States)

    Kertscher, Berit; Speyer, Renée; Palmieri, Maria; Plant, Chris

    2014-04-01

    Oropharyngeal dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may le to outcomes of aspiration pneumonia ranging from hospitalization to death. Therefore, an early identification of risk followed by an accurate diagnosis of oropharyngeal dysphagia is fundamental. This systematic review provides an update of currently available bedside screenings to identify oropharyngeal dysphagia in neurological patients. An electronic search was carried out in the databases PubMed, Embase, CINAHL, and PsychInfo (formerly PsychLit), and all hits from 2008 up to December 2012 were included in the review. Only studies with sufficient methodological quality were considered, after which the psychometric characteristics of the screening tools were determined. Two relevant bedside screenings were identified, with a minimum sensitivity and specificity of ≥70 and ≥60 %, respectively.

  9. Dysphagia training after head and neck cancer fails to follow legislation and national recommendations

    DEFF Research Database (Denmark)

    Fredslund, Sara Vinther; Høgdal, Nina; Christensen, Malene Bæk;

    2015-01-01

    INTRODUCTION: Dysphagia is a known sequela after head and neck cancer (HNC) and causes malnutrition, aspiration pneumonia and a reduced quality of life. Due to improved survival rates, the number of patients with sequelae is increasing. Evidence on the ideal HNC-specific rehabilitation of dysphagia...... questionnaire-based survey, along with OTs from 39 municipal health centres. RESULTS: HNC patients rarely receive preventive occupational therapy before treatment, and hospital-based OTs mainly attend to HNC patients undergoing surgery. Far from all oncology and surgical departments complete the required...... a fraction of HNC patients are offered rehabilitation and often long after completing treatment. Municipal rehabilitation services vary considerably in terms of type, duration, intensity and expertise. Dysphagia-related rehabilitation requires an improved monitoration, possibly with an increase in the uptake...

  10. Oropharyngeal dysphagia assessment and treatment efficacy: setting the record straight (response to Campbell-Taylor).

    Science.gov (United States)

    Coyle, James L; Davis, Lori A; Easterling, Caryn; Graner, Darlene E; Langmore, Susan; Leder, Steven B; Lefton-Greif, Maureen A; Leslie, Paula; Logemann, Jeri A; Mackay, Linda; Martin-Harris, Bonnie; Murray, Joseph T; Sonies, Barbara; Steele, Catriona M

    2009-01-01

    In September 2008, an article was published in the Journal of the American Medical Directors Association criticizing current dysphagia assessment and management practices performed by speech-language pathologists in Long-Term Care (LTC) settings. In the same issue, an editorial invited dialogue on the points raised by Campbell-Taylor. We are responding to this call for dialogue. We find Campbell-Taylor's interpretation of the literature to be incomplete and one-sided, leading to misleading and pessimistic conclusions. We offer a complementary perspective to balance this discussion on the 4 specific questions raised: (1) Is the use of videofluoroscopy warranted for evaluating dysphagia in the LTC population? (2) How effective are thickened liquids and other interventions for preventing aspiration and do they contribute to reduction of morbidity? (3) Can aspiration be prevented and is its prevention important? and (4) Is there sufficient evidence to justify dysphagia intervention by speech language pathologists?

  11. [FEES for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German Stroke Society].

    Science.gov (United States)

    Dziewas, R; Glahn, J; Helfer, C; Ickenstein, G; Keller, J; Lapa, S; Ledl, C; Lindner-Pfleghar, B; Nabavi, D; Prosiegel, M; Riecker, A; Stanschus, S; Warnecke, T; Busse, O

    2014-08-01

    Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has yet not been established. The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational program is applicable to other clinicians and speech language therapists with expertise in dysphagia as well.

  12. Outcome of Rehabilitation and Swallowing Therapy after Percutaneous Endoscopic Gastrostomy in Dysphagia Patients.

    Science.gov (United States)

    Toh Yoon, Ezekiel Wong; Hirao, Jun; Minoda, Naoko

    2016-12-01

    The objective of this study was to investigate the outcomes of rehabilitation (with swallowing therapy) after percutaneous endoscopic gastrostomy (PEG) in patients with neurogenic dysphagia. Forty-seven patients (29 males and 18 females) who were transferred to the rehabilitation ward of our hospital after receiving PEG tube placements during a 5-year period were enrolled in this study. Patients' demographic data, comorbidities, nutritional statuses, and laboratory biomarkers before the PEG procedure were collected. Rehabilitation (with swallowing therapy) outcomes such as changes in Functional Independence Measure (FIM) and dysphagia grade (using Fujishima's classification) were evaluated. Significant improvements in FIM scores and dysphagia grades after rehabilitation therapy were observed. Twenty-seven patients (57.4 %) were discharged with some oral intake and 10 patients (21.3%) were discharged PEG-free (defined as the PEG tube not being used or removed). Factors associated with being discharged with some oral intake were increase in FIM score (adjusted OR 1.10, 95 % CI 1.02-1.19) and higher baseline dysphagia grade (adjusted OR 1.88, 95 % CI 1.04-3.39). Factors associated with being discharged PEG-free were longer rehabilitation period (OR 1.03, 95 % CI 1.01-1.04), absence of respiratory disorders (OR 0.12, 95 % CI 0.03-0.35), and increase in FIM score (OR 1.17, 95 % CI 1.08-1.28). Changes in dysphagia grade were significantly correlated with changes in FIM score (r (2) = 0.46, p dysphagia.

  13. Prediction of outcome in neurogenic oropharyngeal dysphagia within 72 hours of acute stroke.

    Science.gov (United States)

    Ickenstein, Guntram W; Höhlig, Carolin; Prosiegel, Mario; Koch, Horst; Dziewas, Rainer; Bodechtel, Ulf; Müller, Rainer; Reichmann, Heinz; Riecker, Axel

    2012-10-01

    Stroke is the most frequent cause of neurogenic oropharyngeal dysphagia (NOD). In the acute phase of stroke, the frequency of NOD is greater than 50% and, half of this patient population return to good swallowing within 14 days while the other half develop chronic dysphagia. Because dysphagia leads to aspiration pneumonia, malnutrition, and in-hospital mortality, it is important to pay attention to swallowing problems. The question arises if a prediction of severe chronic dysphagia is possible within the first 72 hours of acute stroke. On admission to the stroke unit, all stroke patients were screened for swallowing problems by the nursing staff within 2 hours. Patients showing signs of aspiration were included in the study (n = 114) and were given a clinical swallowing examination (CSE) by the swallowing/speech therapist within 24 hours and a swallowing endoscopy within 72 hours by the physician. The primary outcome of the study was the functional communication measure (FCM) of swallowing (score 1-3, tube feeding dependency) on day 90. The grading system with the FCM swallowing and the penetration-aspiration scale (PAS) in the first 72 hours was tested in a multivariate analysis for its predictive value for tube feeding-dependency on day 90. For the FCM level 1 to 3 (P dysphagia scales to prevent aspiration pneumonia and malnutrition. A dysphagia program can lead to better communication within the stroke unit team to initiate the appropriate diagnostics and swallowing therapy as soon as possible. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  14. Multiple cervical levels: increased risk of dysphagia and dysphonia during anterior cervical discectomy.

    Science.gov (United States)

    Danto, Joseph; DiCapua, John; Nardi, Dominic; Pekmezaris, Renee; Moise, Gregory; Lesser, Martin; Dimarzio, Paola

    2012-10-01

    Anterior cervical discectomy (ACD) is widely used for symptomatic cervical spine pathologies. The most common complications associated with this type of surgery are dysphagia and dysphonia; however, the risk factors associated with them have not been adequately elucidated. The purpose of this study is to assess the incidence of self-reported dysphagia and dysphonia and the associated risk factors after ACD. This study used a retrospective chart review of 149 patients who underwent ACD at a tertiary care facility operating in the New York metropolitan area over a period of 2½ years. Charts for ACD patients were reviewed by 6 trained researchers. Incidence rates for self-reported dysphagia and dysphonia were calculated using 95% exact confidence intervals (CI). Risk factors such as age, sex, surgical hours, number of disc levels, airway class, American Society of Anesthesiologists class, fiberoptic intubation, and intubation difficulty were assessed using logistic regression. The incidence of self-reported dysphagia was 12.1% (95% exact CI, 7.3%-18.4%); for dysphonia the self-reported incidence was 5.4% (95% exact CI, 2.3%-10.3%). Patients who underwent surgery at ≥4 cervical levels had a significant 4-fold increased risk (odds ratio=4; 95% CI, 1.1-13.8) of developing dysphonia and/or dysphagia compared with patients who underwent surgery at a single surgical level. This study confirms previous findings that the risk of developing dysphagia and/or dysphonia increases with the number of surgical levels, with multiple cervical levels representing a significantly higher postoperative risk, as compared with surgery at 1 level.

  15. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly.

    Science.gov (United States)

    Maeda, Keisuke; Akagi, Junji

    2015-02-01

    The aim of this study was to clarify the association between tongue pressure and factors related to sarcopenia such as aging, activities of daily living, nutritional state, and dysphagia. One-hundred-and-four patients without a history of treatment of stroke and without a diagnosis of neurodegenerative disease (36 men and 68 women), with a mean age of 84.1 ± 5.6 years, hospitalized from May 2013 to June 2013 were included in this study. Maximum voluntary tongue pressure against the palate (MTP) was measured by a device consisting of a disposable oral balloon probe. Nutritional and anthropometric parameters such as serum albumin concentration, Mini-Nutritional Assessment short form (MNA-SF), body mass index, arm muscle area (AMA), and others and presence of sarcopenia and dysphagia were analyzed to evaluate their relationships. Correlation analysis and univariate or multivariate analysis were performed. Simple correlation analysis showed that MTP correlated with Barthel index (BI), MNA-SF, serum albumin concentration, body mass index, and AMA. Univariate and multivariate analysis showed that sarcopenia, BI, MNA-SF, and age were the independent explanatory factors for decreased MTP, and the propensity score for dysphagia, including causes of primary or secondary sarcopenia, and the presence of sarcopenia were significantly associated with the presence of dysphagia. Decreased MTP and dysphagia were related to sarcopenia or the causes of sarcopenia in the studied population. Furthermore, the clinical condition of sarcopenic dysphagia may be partially interpreted as the presence of sarcopenia and causal factors for sarcopenia.

  16. Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia.

    Science.gov (United States)

    Park, Eunhee; Kim, Min Su; Chang, Won Hyuk; Oh, Su Mi; Kim, Yun Kwan; Lee, Ahee; Kim, Yun-Hee

    Optimal protocol of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia remains uncertain with regard to its clinical efficacy. The aim of the present study is to investigate the effects of high-frequency rTMS at the bilateral motor cortices over the cortical representation of the mylohyoid muscles in the patients with post-stroke dysphagia. This study was a single-blind, randomized controlled study with a blinded observer. Thirty-five stroke patients were randomly divided into three intervention groups: the bilateral stimulation group, the unilateral stimulation group, and the sham stimulation group. For the bilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional and 500 pulses of 10 Hz rTMS over the contralesional motor cortices over the cortical areas that project to the mylohyoid muscles were administered daily for 2 consecutive weeks. For the unilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional motor cortex over the cortical representation of the mylohyoid muscle and the same amount of sham rTMS over the contralesional hemisphere were applied. For the sham stimulation group, sham rTMS was applied at the bilateral motor cortices. Clinical swallowing function and videofluoroscopic swallowing studies were assessed before the intervention (T0), immediately after the intervention (T1) and 3 weeks after the intervention (T2) using Clinical Dysphagia Scale (CDS), Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and Videofluoroscopic Dysphagia Scale (VDS). There were significant time and intervention interaction effects in the CDS, DOSS, PAS, and VDS scores (p dysphagia therapies. Copyright © 2016. Published by Elsevier Inc.

  17. Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia

    Institute of Scientific and Technical Information of China (English)

    Giorgio Diamantis; Marco Scarpa; Paolo Bocus; Stefano Realdon; Carlo Castoro; Ermanno Ancona; Giorgio Battaglia

    2011-01-01

    Incidence of esophageal cancer (EC) is rising more rapidly in the Western world than that of any other cancer.Despite advances in therapy, more than 50% of patients have incurable disease at the time of presentation. This precludes curative treatment and makes palliative treatment a more realistic option for most of these patients.Dysphagia is the predominant symptom in more than 70% of patients with EC and although several management options have been developed in recent years to palliate this symptom, the optimum management is not established. Self-expanding metal stents (SEMS) are a well-established palliation modality for dysphagia in such patients. Health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic or palliative intervention. To date, only a few published studies can be found on Medline examining HRQoL in patients with advanced EC treated with SEMS implantation.The aim of this study was to review the impact on HRQoL of SEMS implantation as palliative treatment in patients with EC. All Medline articles regarding HRQoL in patients with advanced EC, particularly those related to SEMS, were reviewed. In most studies, relief of dysphagia was the only aspect of HRQoL being measured and SEMS implantation was compared with other palliative treatments such as brachytherapy and laser therapy.SEMS insertion provides a swift palliation of dysphagia compared to brachytherapy and no evidence was found to suggest that stent implantation is different to laser treatment in terms of improving dysphagia, recurrent dysphagia and better HRQoL, although SEMS insertion has a better technical success rate and also reduces the number of repeat interventions.

  18. Evaluating a novel approach to enhancing dysphagia management: workplace-based, blended e-learning.

    Science.gov (United States)

    Ilott, Irene; Bennett, Bev; Gerrish, Kate; Pownall, Sue; Jones, Amanda; Garth, Andrew

    2014-05-01

    To evaluate the learning effect and resource use cost of workplace-based, blended e-learning about dysphagia for stroke rehabilitation nurses. Dysphagia is a potentially life-threatening problem that compromises quality of life. In many countries, nurses play a crucial role in supporting the management of patients with swallowing problems, yet the literature reports a need for training. A single-group, pre- and post-study with mixed methods. Each blended e-learning session comprised a needs analysis, e-learning programmes, practical skills about modifying fluids and action planning to transfer learning into practice. Participants were the population of registered nurses (n = 22) and healthcare assistants (n = 10) on a stroke rehabilitation ward in a large, teaching hospital in England between August 2010-March 2011. Data collection comprised observation (34 hours), questionnaires administered at four time points to examine change in attitude, knowledge and practice, and estimating the resource use cost for the service. Nonparametric tests and content analysis were used to analyse the data. All participants achieved a nationally recognised level of competence. The learning effect was evident on the post- and follow-up measures, with some items of dysphagia knowledge and attitude achieving significance at the p ≤ 0·05 level. The most common self-reported changes in practice related to medicines management, thickening fluids and oral hygiene. The resource use cost was estimated at £2688 for 108 hours training. Workplace-based, blended e-learning was an acceptable, cost effective way of delivering essential clinical knowledge and skills about dysphagia. Dysphagia should be viewed as a patient safety issue because of the risks of malnutrition, dehydration and aspiration pneumonia. As such, it is pertinent to many members of the interdisciplinary team. Consideration should be given to including dysphagia management in initial education and continuing professional

  19. Validity and Reliability of the Persian Version of the Dysphagia Handicap Index (DHI

    Directory of Open Access Journals (Sweden)

    faezeh asadollahpour

    2015-05-01

    Full Text Available Introduction: The Dysphagia Handicap Index (DHI is one of the instruments used for measuring a dysphagic patient’s self-assessment. In some ways, it reflects the patient’s quality of life. Although it has been recognized and widely applied in English speaking populations, it has not been used in its present forms in Persian speaking countries. The purpose of this study was to adapt a Persian version of the DHI and to evaluate its validity, consistency, and reliability in the Persian population with oropharyngeal dysphagia.   Materials and Methods: Some stages for cross-cultural adaptation were performed, which consisted in translation, synthesis, back translation, review by an expert committee, and final proof reading. The generated Persian DHI was administered to 85 patients with oropharyngeal dysphagia and 89 control subjects at Zahedan city between May 2013 and August 2013. The patients and control subjects answered the same questionnaire 2 weeks later to verify the test-retest reliability. Internal consistency and test-retest reliability were evaluated. The results of the patients and the control group were compared.   Results: The Persian DHI showed good internal consistency (Cronbach’s alpha coefficients range from 0.82 to 0.94. Also, good test-retest reliability was found for the total scores of the Persian DHI (r=0.89. There was a significant difference between the DHI scores of the control group and those of the oropharyngeal dysphagia group (P‹0.001.   Conclusion:  The Persian version of the DHI achieved Face and translation validity. This study demonstrated that the Persian DHI is a valid tool for self-assessment of the handicapping effects of dysphagia on the physical, functional, and emotional aspects of patient life and can be a useful tool for screening and treatment planning for the Persian-speaking dysphagic patients, regardless of the cause or the severity of the dysphagia.

  20. Dysphagia in a psychotic patient: Diagnostic challenges and a systematic management approach.

    Science.gov (United States)

    Baheshree, Ramanaganga D; Jonas, Suganthan S

    2012-07-01

    Dysphagia can be due to a variety of causes in a psychotic patient. It could be a side-effect of anti-psychotic medication or the manifestation of a psychotic phenomenon or even due to a co-morbid medical cause. We report a case of dysphagia in a young lady with psychosis who had been recently started on anti-psychotic medication. We would specifically like to highlight the practical challenges regarding its diagnosis and report success with a systematic management approach.

  1. Management of Dysphagia Pre- and Postoperatively in a Case of Eagle’s Syndrome

    Directory of Open Access Journals (Sweden)

    Vicki Lewis

    2015-01-01

    Full Text Available Eagle’s syndrome (ES is rare condition, most frequently described within the context of case study presentation. ES results from elongation of the styloid process, contributing to symptoms such as globus sensation in the throat, as well as pain localized to the ear, neck, face, or tongue. Additional symptoms can include hypersalivation, change in vocal quality, submandibular swelling, and dysphagia. This report discusses evaluation, diagnosis, and surgical intervention with respect to Eagle’s Syndrome in a patient presenting with moderate-severe dysphagia.

  2. Poor consistency in evaluating South African adults with neurogenic dysphagia.

    Science.gov (United States)

    Andrews, Mckinley; Pillay, Mershen

    2017-01-23

    Speech-language therapists are specifically trained in clinically evaluating swallowing in adults with acute stroke. Incidence of dysphagia following acute stroke is high in South Africa, and health implications can be fatal, making optimal management of this patient population crucial. However, despite training and guidelines for best practice in clinically evaluating swallowing in adults with acute stroke, there are low levels of consistency in these practice patterns. The aim was to explore the clinical practice activities of speech-language therapists in the clinical evaluation of swallowing in adults with acute stroke. Practice activities reviewed included the use and consistency of clinical components and resources utilised. Clinical components were the individual elements evaluated in the clinical evaluation of swallowing (e.g. lip seal, vocal quality, etc.)Methods: The questionnaire used in the study was replicated and adapted from a study increasing content- and criterion-related validity. A narrative literature review determined what practice patterns existed in the clinical evaluation of swallowing in adults. A pilot study was conducted to increase validity and reliability. Purposive sampling was used by sending a self-administered, electronic questionnaire to members of the South African Speech-Language-Hearing Association. Thirty-eight participants took part in the study. Descriptive statistics were used to analyse the data and the small qualitative component was subjected to textual analysis. There was high frequency of use of 41% of the clinical components in more than 90% of participants (n = 38). Less than 50% of participants frequently assessed sensory function and gag reflex and used pulse oximetry, cervical auscultation and indirect laryngoscopy. Approximately a third of participants showed high (30.8%), moderate (35.9%) and poor (33.3%) consistency of practice each. Nurses, food and liquids and medical consumables were used usually and

  3. Poor consistency in evaluating South African adults with neurogenic dysphagia

    Directory of Open Access Journals (Sweden)

    Mckinley Andrews

    2017-01-01

    Full Text Available Background: Speech-language therapists are specifically trained in clinically evaluating swallowing in adults with acute stroke. Incidence of dysphagia following acute stroke is high in South Africa, and health implications can be fatal, making optimal management of this patient population crucial. However, despite training and guidelines for best practice in clinically evaluating swallowing in adults with acute stroke, there are low levels of consistency in these practice patterns.Objective: The aim was to explore the clinical practice activities of speech-language therapists in the clinical evaluation of swallowing in adults with acute stroke. Practice activities reviewed included the use and consistency of clinical components and resources utilised. Clinical components were the individual elements evaluated in the clinical evaluation of swallowing (e.g. lip seal, vocal quality, etc.Methods: The questionnaire used in the study was replicated and adapted from a study increasing content- and criterion-related validity. A narrative literature review determined what practice patterns existed in the clinical evaluation of swallowing in adults. A pilot study was conducted to increase validity and reliability. Purposive sampling was used by sending a self-administered, electronic questionnaire to members of the South African Speech-Language-Hearing Association. Thirty-eight participants took part in the study. Descriptive statistics were used to analyse the data and the small qualitative component was subjected to textual analysis.Results: There was high frequency of use of 41% of the clinical components in more than 90% of participants (n = 38. Less than 50% of participants frequently assessed sensory function and gag reflex and used pulse oximetry, cervical auscultation and indirect laryngoscopy. Approximately a third of participants showed high (30.8%, moderate (35.9% and poor (33.3% consistency of practice each. Nurses, food and liquids and

  4. Gastrointestinal involvement in systemic sclerosis.

    Science.gov (United States)

    Savarino, Edoardo; Furnari, Manuele; de Bortoli, Nicola; Martinucci, Irene; Bodini, Giorgia; Ghio, Massimo; Savarino, Vincenzo

    2014-10-01

    Systemic sclerosis is an autoimmune chronic disease characterised by microvascular, muscular and immunologic abnormalities that lead to progressive and systemic deposition of connective tissue in the skin and internal organs. The gastrointestinal tract is often overlooked by physicians but it is the most affected organ after the skin, from the mouth to the anus. Indeed, 80% of SSc patients may present with gastrointestinal involvement. Gastrointestinal manifestations range from bloating and heartburn to dysphagia and anorectal dysfunction to severe weight loss and malabsorption. However, the gastrointestinal involvement is rarely the direct cause of death, but has great impact on quality of life and leads to several comorbidities that subsequently affect patients' survival. Treatments, including nutritional support and prokinetics provide limited benefits and do not arrest the progressive course of the disease, but earlier detection of gastrointestinal involvement may reduce the risk of complications such as malnutrition.

  5. Therapeutic effects of acupuncture for neurogenic dysphagia--a randomized controlled trial.

    Science.gov (United States)

    Chan, Sze-Ling; Or, Ka-Hang; Sun, Wai-Zhu; Ng, Kwan-Yee; Lo, See-Kit; Lee, Yuet-Sheung

    2012-03-01

    To evaluate the therapeutic effects and long-term efficacy of acupuncture for neurogenic dysphagia. Subjects with neurogenic dysphagia undergoing routine swallowing management were randomized to receive either 20 sessions of true acupuncture (experimental group) or sham acupuncture (control group 1) for approximately one and a half months. A third group (control group 2) comprised of non-randomized subjects with neurogenic dysphagia who received routine care were recruited from separate wards. The outcomes were assessed by the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), as well as by the consistencies of ingested food and fluid. A total of 87 subjects (experimental group, n = 20; control group 1, n = 19; control group 2, n = 48) were recruited into the trial. The average RBHOMS score showed a greater improvement in the experimental group and in control group 1 than in control group 2. The average levels of food and fluid consistencies displayed greater improvement in the experimental group than in the two control groups. This study demonstrates that acupuncture may have therapeutic effects and long-term efficacy for neurogenic dysphagia. However, due to an insufficient sample size and the lack of follow-up for control group 2, multi-centre trials employing a larger sample size may be required to draw concrete conclusions.

  6. A Review Of Different Oropharyngeal Dysphagia Therapies By Speech And Language Pathologists

    Directory of Open Access Journals (Sweden)

    Ehsan Nadeifar

    2017-02-01

    Full Text Available Background and aims: Oropharyngeal dysphagia is one of the common symptoms after stroke and is a marker for poor prognosis. Select the best therapy procedure is important. This study reviews the various therapy methods available to clinicians. Methods: An electronic database search was performed on PubMed and Embase. The search was limited to English publications. Terms such as stroke, dysphagia, swallowing disorders; deglutition, deglutition disorders, treatment outcome, electro-stimulation-therapy, thermal-stimulation, muscle-training, rehabilitation, also extensive manual searching was conducted. Results: oropharyngeal dysphagia interventions are divided into 5 groups based on the type of therapy: 1- bolus modifications and management (Compensatory Techniques, 2- swallow maneuvers and postures (Compensatory Techniques and/or Rehabilitative Techniques 3- combination of interventions (Compensatory Techniques and/or Rehabilitative Techniques, 4- electro-stimulation and thermo-tactile stimulation (Facilitation Techniques, 5- other interventions (Rehabilitative Techniques. Conclusion: There are different therapy procedures that can be use for Oropharyngeal dysphagia after stroke, but there are questions about the most effective of therapy, although some positive significant outcome studies have been published.

  7. Dysphagia training for speech-language pathologists: implications for clinical practice.

    Science.gov (United States)

    Kamal, Rahayu Mustaffa; Ward, Elizabeth; Cornwell, Petrea

    2012-12-01

    There are competency standards available in countries with established speech-language pathology services to guide basic dysphagia training with ongoing workplace mentoring for advanced skills development. Such training processes, however, are not as well established in countries where speech-language pathology training and practice is relatively new, such as Malaysia. The current study examines the extent of dysphagia training and workplace support available to speech-language pathologists (SLPs) in Malaysia and Queensland, Australia, and explores clinicians' perceptions of the training and support provided, and of their knowledge, skills, and confidence. Using a matched cohort cross-sectional design, a purpose-built survey was administered to 30 SLPs working in Malaysian government hospitals and 30 SLPs working in Queensland Health settings in Australia. Malaysian clinicians were found to have received significantly less university training, less mentoring in the workplace, and were lacking key infrastructure needed to support professional development in dysphagia management. Over 90% of Queensland clinicians were confident and felt they had adequate skills in dysphagia management; in contrast, significantly lower levels of knowledge, skills, and confidence were observed in the Malaysian cohort. The findings identify a need for improved university training and increased opportunities for workplace mentoring, training, and support for Malaysian SLPs.

  8. Effect of human saliva on the consistency of thickened drinks for individuals with dysphagia

    NARCIS (Netherlands)

    Vallons, K.J.R.; Helmens, H.J.; Oudhuis, A.A.C.M.

    2015-01-01

    Background Thickening of foods and fluids is commonly used in the management of dysphagia to reduce the risk of aspiration. The use of starch-based thickeners is established. However, the use of gums in thickeners is gaining interest as they are resistant to salivary amylase, which may promote safer

  9. Acoustic analysis of swallowing sounds: a new technique for assessing dysphagia.

    Science.gov (United States)

    Santamato, Andrea; Panza, Francesco; Solfrizzi, Vincenzo; Russo, Anna; Frisardi, Vincenza; Megna, Marisa; Ranieri, Maurizio; Fiore, Pietro

    2009-07-01

    To perform acoustic analysis of swallowing sounds, using a microphone and a notebook computer system, in healthy subjects and patients with dysphagia affected by neurological diseases, testing the positive/negative predictive value of a pathological pattern of swallowing sounds for penetration/aspiration. Diagnostic test study, prospective, not blinded, with the penetration/aspiration evaluated by fibreoptic endoscopy of swallowing as criterion standard. Data from a previously recorded database of normal swallowing sounds for 60 healthy subjects according to gender, age, and bolus consistency was compared with those of 15 patients with dysphagia from a university hospital referral centre who were affected by various neurological diseases. Mean duration of the swallowing sounds and post-swallowing apnoea were recorded. Penetration/aspiration was verified by fibreoptic endoscopy of swallowing in all patients with dysphagia. The mean duration of swallowing sounds for a liquid bolus of 10 ml water was significantly different between patients with dysphagia and healthy patients. We also described patterns of swallowing sounds and tested the negative/positive predictive values of post-swallowing apnoea for penetration/aspiration verified by fibreoptic endoscopy of swallowing (sensitivity 0.67 (95% confidence interval 0.24-0.94); specificity 1.00 (95% confidence interval 0.56-1.00)). The proposed technique for recording and measuring swallowing sounds could be incorporated into the bedside evaluation, but it should not replace the use of more diagnostic and valuable measures.

  10. Bulbar muscle MRI changes in patients with SMA with reduced mouth opening and dysphagia.

    NARCIS (Netherlands)

    Wadman, R.I.; Bruggen, H.W. van; Witkamp, T.D.; Kalaykova, S.I.; Stam, M.; Berg, L.H. van den; Steenks, M.H.; Pol, W.L. van der

    2014-01-01

    OBJECTIVE: We performed a study in patients with proximal spinal muscular atrophy (SMA) to determine the prevalence of reduced maximal mouth opening (MMO) and its association with dysphagia as a reflection of bulbar dysfunction and visualized the underlying mechanisms using MRI. METHODS: We

  11. Effect of Human Saliva on the Consistency of Thickened Drinks for Individuals with Dysphagia

    Science.gov (United States)

    Vallons, Katleen J. R.; Helmens, Harold J.; Oudhuis, A. A. C. M.

    2015-01-01

    Background: Thickening of foods and fluids is commonly used in the management of dysphagia to reduce the risk of aspiration. The use of starch-based thickeners is established. However, the use of gums in thickeners is gaining interest as they are resistant to salivary amylase, which may promote safer swallowing. Aims: To compare the effect of…

  12. Isolated dysphagia as initial sign of anti-IgLON5 syndrome

    Science.gov (United States)

    Melzer, Nico; Ruck, Tobias; Heidbreder, Anna; Kleffner, Ilka; Dittrich, Ralf; Muhle, Paul; Warnecke, Tobias; Dziewas, Rainer

    2016-01-01

    Objective: To report on dysphagia as initial sign in a case of anti-IgLON5 syndrome and provide an overview of the current literature. Methods: The diagnostic workup included cerebral MRI, fiber optic endoscopic evaluation of swallowing (FEES) with the FEES tensilon test, a videofluoroscopic swallowing study, evoked potentials and peripheral nerve conduction studies, polysomnography, lumbar puncture, and screening for neural autoantibodies. A systematic review of all published cases of IgLON5 syndrome is provided. Results: We report a case of anti-IgLON5 syndrome presenting with slowly progressive neurogenic dysphagia. FEES revealed severe neurogenic dysphagia and bilateral palsy of the vocal cords. Autoantibody screening was positive for IgLON5 IgG (+++, 1:1,000) serum levels but no other known neural autoantibody. Polysomnography was highly suggestive of non-REM parasomnia. Symptoms were partially responsive to immunotherapy. Conclusions: Slowly progressive neurogenic dysphagia may occur as initial sign of anti-IgLON5 syndrome highlighting another clinical presentation of this rare disease. PMID:27900347

  13. Swallowing and Dysphagia Rehabilitation: Translating Principles of Neural Plasticity into Clinically Oriented Evidence

    Science.gov (United States)

    Robbins, JoAnne; Butler, Susan G.; Daniels, Stephanie K.; Gross, Roxann Diez; Langmore, Susan; Lazarus, Cathy L.; Martin-Harris, Bonnie; McCabe, Daniel; Musson, Nan; Rosenbek, John

    2008-01-01

    Purpose: This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between clinical and basic scientists to expand the positive influences of dysphagia rehabilitation in synergy with growth in technology and knowledge. The…

  14. The Utility of Pitch Elevation in the Evaluation of Oropharyngeal Dysphagia: Preliminary Findings

    Science.gov (United States)

    Malandraki, Georgia A.; Hind, Jacqueline A.; Gangnon, Ronald; Logemann, Jeri A.; Robbins, JoAnne

    2011-01-01

    Purpose: To evaluate the utility of a pitch elevation task in the assessment of oropharyngeal dysphagia. Method: This study was a pilot prospective cohort study including 40 consecutive patients (16 male and 24 female) who were referred by their physician for a swallowing evaluation. Patients were evaluated with a noninstrumental clinical…

  15. Decreased diaphragm excursion in stroke patients with dysphagia as assessed by M-mode sonography.

    Science.gov (United States)

    Park, Geun-Young; Kim, Seong-Rim; Kim, Young Woo; Jo, Kwang Wook; Lee, Eu Jeen; Kim, Young Moon; Im, Sun

    2015-01-01

    To record diaphragm excursion via M-mode ultrasonography in stroke patients with dysphagia and determine whether they present reduced diaphragm excursion during voluntary cough compared with stroke patients without dysphagia and healthy subjects. Prospective cross-sectional study. University rehabilitation hospital. Acute stroke patients with dysphagia (n=23), acute stroke patients without dysphagia (n=24), and healthy control participants (n=27) (N=74). Not applicable. Diaphragm motions during quiet breathing, deep breathing, and voluntary coughing were recorded via ultrasonography using M-mode tracing (mm). Maximum inspiratory and expiratory pressures (cmH2O) and peak cough flow (L/min) during voluntary coughing were measured. The mean diaphragm movement (mm) of the hemiplegic side for all groups during quiet breathing, deep breathing, and voluntary coughing was 14.8±4.3, 17.6±4.8, and 20.9±3.7 (Pdysphagia explained up to 60% (Pdysphagia have decreased diaphragm excursion and compromised respiratory function during voluntary coughing. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Developing clinical skills in paediatric dysphagia management using human patient simulation (HPS).

    Science.gov (United States)

    Ward, Elizabeth C; Hill, Anne E; Nund, Rebecca L; Rumbach, Anna F; Walker-Smith, Katie; Wright, Sarah E; Kelly, Kris; Dodrill, Pamela

    2015-06-01

    The use of simulated learning environments to develop clinical skills is gaining momentum in speech-language pathology training programs. The aim of the current study was to examine the benefits of adding Human Patient Simulation (HPS) into the university curriculum in the area of paediatric dysphagia. University students enrolled in a mandatory dysphagia course (n = 29) completed two, 2-hour HPS scenarios: (a) performing a clinical feeding assessment with a medically complex infant; and (b) conducting a clinical swallow examination (CSE) with a child with a tracheostomy. Scenarios covered technical and non-technical skills in paediatric dysphagia management. Surveys relating to students' perceived knowledge, skills, confidence and levels of anxiety were conducted: (a) pre-lectures; (b) post-lectures, but pre-HPS; and (c) post-HPS. A fourth survey was completed following clinical placements with real clients. Results demonstrate significant additive value in knowledge, skills and confidence obtained through HPS. Anxiety about working clinically reduced following HPS. Students rated simulation as very useful in preparing for clinical practice. Post-clinic, students indicated that HPS was an important component in their preparation to work as a clinician. This trial supports the benefits of incorporating HPS as part of clinical preparation for paediatric dysphagia management.

  17. Dysarthria and dysphagia following treatment for a fourth ventricle choroid plexus papilloma.

    Science.gov (United States)

    Cornwell, P L; Murdoch, B E; Ward, E C; Morgan, A

    2003-07-01

    The present case report describes the presence of a persistent dysarthria and dysphagia as a consequence of surgical intervention for a choroid plexus papilloma (CPP). WM was a nine year ten month old male who at the time of the present study was seven years post-surgery. A comprehensive perceptual and instrumental test battery was used to document the nature of the dysarthria incorporating all components of speech production including respiration, phonation, resonance, articulation, and prosody. The nature of the dysphagia was evaluated through the use of videofluoroscopic evaluation of swallowing (VFS). Assessments confirmed the presence of a LMN dysarthria, marked by deficits in phonation, respiration, and prosody. Dysphagia assessment revealed deficits in oral preparatory, oral and pharyngeal stages of the swallow. The presence of persistent dysarthria and dysphagia in this case has a number of important implications for the management of children undergoing surgery for fourth ventricle CPPs, in particular the need for appropriate treatment, as well as counselling prior to surgery of the possible negative outcomes related to speech and swallowing.

  18. Dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour.

    Science.gov (United States)

    Cornwell, Petrea L; Murdoch, Bruce E; Ward, Elizabeth C; Morgan, Angela

    2003-01-01

    The current case report provides a comprehensive description of the persistent dysarthria and dysphagia evident in a 7.5 year old child treated for recurrent posterior fossa tumour (PFT). AC was assessed on a comprehensive perceptual and instrumental test battery incorporating all components of the speech production system (respiration, phonation, resonance, articulation and prosody) 2 years and 4 months following completion of her treatment. The nature of her swallowing impairment was investigated through the use of videofluoroscopic evaluation of swallowing (VFS). A mild dysarthria with ataxic and LMN components was identified, although overall speech intelligibility was not affected. A moderate dysphagia was also identified with impairment in all three phases of the swallowing process; oral preparatory, oral and pharyngeal. Dysarthria and dysphagia as persistent sequelae in children treated for PFT have implications for the long-term management of these children. The need for appropriate treatment regimes, as well as pre-surgical counselling regarding dysarthria and dysphagia as possible outcomes following surgery are highlighted.

  19. Dental management in dysphagia syndrome patients with previously acquired brain damages

    Directory of Open Access Journals (Sweden)

    Ennio Bramanti

    2012-01-01

    Full Text Available Dysphagia is defined as difficulty in swallowing food (semi-solid or solid, liquid, or both. Difficulty in swallowing affects approximately 7% of population, with risk incidence increasing with age. There are many disorder conditions predisposing to dysphagia such as mechanical strokes or esophageal diseases even if neurological diseases represent the principal one. Cerebrovascular pathology is today the leading cause of death in developing countries, and it occurs most frequently in individuals who are at least 60 years old. Swallowing disorders related to a stroke event are common occurrences. The incidence ranging is estimated from 18% to 81% in the acute phase and with a prevalence of 12% among such patients. Cerebral, cerebellar, or brain stem strokes can influence swallowing physiology while cerebral lesions can interrupt voluntary control of mastication and bolus transport during the oral phase. Among the most frequent complications of dysphagia are increased mortality and pulmonary risks such as aspiration pneumonia, dehydration, malnutrition, and long-term hospitalization. This review article discusses the epidemiology of dysphagia, the normal swallowing process, pathophysiology, signs and symptoms, diagnostics, and dental management of patients affected.

  20. Effect of Human Saliva on the Consistency of Thickened Drinks for Individuals with Dysphagia

    Science.gov (United States)

    Vallons, Katleen J. R.; Helmens, Harold J.; Oudhuis, A. A. C. M.

    2015-01-01

    Background: Thickening of foods and fluids is commonly used in the management of dysphagia to reduce the risk of aspiration. The use of starch-based thickeners is established. However, the use of gums in thickeners is gaining interest as they are resistant to salivary amylase, which may promote safer swallowing. Aims: To compare the effect of…

  1. Dental management in dysphagia syndrome patients with previously acquired brain damages

    Science.gov (United States)

    Bramanti, Ennio; Arcuri, Claudio; Cecchetti, Francesco; Cervino, Gabriele; Nucera, Riccardo; Cicciù, Marco

    2012-01-01

    Dysphagia is defined as difficulty in swallowing food (semi-solid or solid), liquid, or both. Difficulty in swallowing affects approximately 7% of population, with risk incidence increasing with age. There are many disorder conditions predisposing to dysphagia such as mechanical strokes or esophageal diseases even if neurological diseases represent the principal one. Cerebrovascular pathology is today the leading cause of death in developing countries, and it occurs most frequently in individuals who are at least 60 years old. Swallowing disorders related to a stroke event are common occurrences. The incidence ranging is estimated from 18% to 81% in the acute phase and with a prevalence of 12% among such patients. Cerebral, cerebellar, or brain stem strokes can influence swallowing physiology while cerebral lesions can interrupt voluntary control of mastication and bolus transport during the oral phase. Among the most frequent complications of dysphagia are increased mortality and pulmonary risks such as aspiration pneumonia, dehydration, malnutrition, and long-term hospitalization. This review article discusses the epidemiology of dysphagia, the normal swallowing process, pathophysiology, signs and symptoms, diagnostics, and dental management of patients affected. PMID:23162574

  2. Correlating Computed Tomography Perfusion Changes in the Pharyngeal Constrictor Muscles During Head-and-Neck Radiotherapy to Dysphagia Outcome

    Energy Technology Data Exchange (ETDEWEB)

    Truong, Minh Tam, E-mail: mitruong@bu.edu [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Lee, Richard [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Saito, Naoko [Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Qureshi, Muhammad M. [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Ozonoff, Al [Department of Biostatistics, Boston University School of Public Health, Boston, MA (United States); Romesser, Paul B. [Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States); Wang, Jimmy; Sakai, Osamu [Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, MA (United States)

    2012-02-01

    Purpose: To measure changes in perfusion of the pharyngeal constrictor muscles (PCM) using CT perfusion (CTP) imaging during a course of definitive radiotherapy (RT) in head-and-neck cancer (HNC) patients and correlate with dysphagia outcome after RT. Methods and Materials: Fifteen HNC patients underwent CTP imaging of the PCM at baseline and Weeks 2, 4, and 6 during RT and 6 weeks after RT. Blood flow and blood volume were measured in the PCM, and percentage change from baseline scan was determined. A single physician-based assessment of dysphagia was performed every 3 months after RT using the Common Terminology Criteria for Adverse Events, version 3.0 grading system. Results: With a median follow-up of 28 months (range, 6-44 months), Grade 3 dysphagia was present in 7 of 15 patients, and 8 patients experienced Grade 0-2 dysphagia. The CTP parameters at Week 2 of RT demonstrated an increase in mean PCM blood flow of 161.9% vs. 12.3% (p = 0.007) and an increase in mean PCM blood volume of 96.6% vs. 8.7% (p = 0.039) in patients with 6-month post-RT Grade 3 dysphagia and Grade 0-2 dysphagia, respectively. On multivariate analysis, when adjusting for smoking history, tumor volume, and baseline dysphagia status, an increase in blood flow in the second week of RT was significant for 3- and 6-month Grade 3 dysphagia (p < 0.05). Conclusions: Perfusion changes in the PCM during Week 2 of RT in the PCM may predict the severity of dysphagia after HNC RT.

  3. Oral conditions and dysphagia in Japanese, community-dwelling middle- and older- aged adults, independent in daily living

    Science.gov (United States)

    Inui, Akinari; Takahashi, Ippei; Kurauchi, Sizuka; Soma, Yuki; Oyama, Toshiaki; Tamura, Yoshihiro; Noguchi, Takao; Murashita, Kouichi; Nakaji, Shigeyuki; Kobayashi, Wataru

    2017-01-01

    Purpose Prevention, early detection and effective rehabilitation of dysphagia are important issues to be considered in an aging society. Previous studies have shown conflicting findings regarding the association between dysphagia and its potential risk factors, including age, malnutrition, oral conditions, lifestyle and medical history. Herein, we assessed the prevalence and association of dysphagia with potential risk factors in 50- to 79-year-old adults dwelling in a community in Japan. Patients and methods In this study, there were 532 participants (185 males and 347 females). Participants who responded positively to the question “Do you sometimes choke on drinks/food such as tea and soup?” or those who presented with abnormal repetitive saliva swallowing test findings were diagnosed with dysphagia. The data collected from these participants included the following: number of teeth, occurrence of oral dryness, age, body mass index, serum albumin concentration, smoking, drinking and exercise habits, presence of diseases, such as diabetes mellitus and hypertension, and questions from the Mini–Mental State Examination. Results Dysphagia was observed in 33 males (17.8%) and 76 females (21.9%). To explore the effect of the potential risk factors on the prevalence of dysphagia, a model was built by multivariate logistic regression analysis. Using the forced entry method, oral dryness (odds ratio [OR] =3.683 and P=0.003 in males; OR =1.797 and P=0.032 in females) and the number of teeth (OR =0.946 and P=0.038 in males) were found to be significantly related to dysphagia. Conclusion This cross-sectional study demonstrated associations between oral conditions and dysphagia. Factors such as oral dryness and number of teeth may contribute to dysphagia more so than aging, lifestyle and comorbidity in community-dwelling adults over the age of 50. PMID:28352164

  4. HMG Modifications and Nuclear Function

    OpenAIRE

    Zhang, Qingchun; Wang, Yinsheng

    2010-01-01

    High mobility group (HMG) proteins assume important roles in regulating chromatin dynamics, transcriptional activities of genes and other cellular processes. Post-translational modifications of HMG proteins can alter their interactions with DNA and proteins, and consequently, affect their biological activities. Although the mechanisms through which these modifications are involved in regulating biological processes in different cellular contexts are not fully understood, new insights into the...

  5. Posttranslational Protein Modification in Archaea

    OpenAIRE

    Eichler, Jerry; Adams, Michael W. W.

    2005-01-01

    One of the first hurdles to be negotiated in the postgenomic era involves the description of the entire protein content of the cell, the proteome. Such efforts are presently complicated by the various posttranslational modifications that proteins can experience, including glycosylation, lipid attachment, phosphorylation, methylation, disulfide bond formation, and proteolytic cleavage. Whereas these and other posttranslational protein modifications have been well characterized in Eucarya and B...

  6. Biomechanics, diagnosis, and treatment outcome in inflammatory myopathy presenting as oropharyngeal dysphagia

    Science.gov (United States)

    Williams, R B; Grehan, M J; Hersch, M; Andre, J; Cook, I J

    2003-01-01

    Aims: In patients with inflammatory myopathy and dysphagia, our aims were to determine: (1) the diagnostic utility of clinical and laboratory indicators; (2) the biomechanical properties of the pharyngo-oesophageal segment; (3) the usefulness of pharyngeal videomanometry in distinguishing neuropathic from myopathic dysphagia; and (4) clinical outcome. Methods: Clinical, laboratory, and videomanometric assessment was performed in 13 patients with myositis and dysphagia, in 17 disease controls with dysphagia (due to proven CNS disease), and in 22 healthy age matched controls. The diagnostic accuracy of creatine kinase (CPK), erythrocyte sedimentation rate, antinuclear antibody, and electromyography (EMG) were compared with the gold standard muscle biopsy. The biomechanical properties of the pharyngo-oesophageal segment were assessed by videomanometry. Results: Mean time from dysphagia onset to the diagnosis of myositis was 55 months (range 1–180). One third had no extrapharyngeal muscle weakness; 25% had normal CPK, and EMG was unhelpful in 28%. Compared with neurogenic controls, myositis patients had more prevalent cricopharyngeal restrictive disorders (69% v 14%; p=0.0003), reduced upper oesophageal sphincter (UOS) opening (p=0.01), and elevated hypopharyngeal intrabolus pressures (p=0.001). Videomanometric features favouring a myopathic over a neuropathic aetiology were: preserved pharyngeal swallow response, complete UOS relaxation, and normal swallow coordination. The 12 month mortality was 31%. Conclusions: The notable lack of supportive clinical signs and significant false negative rates for laboratory tests contribute to the marked delay in diagnosis. The myopathic process is strongly associated with restricted sphincter opening suggesting that cricopharyngeal disruption is a useful adjunct to immunosuppressive therapy. The condition has a poor prognosis. PMID:12631653

  7. Dysphagia in inflammatory myopathy: clinical characteristics, treatment strategies, and outcome in 62 patients.

    Science.gov (United States)

    Oh, Terry H; Brumfield, Kathlyn A; Hoskin, Tanya L; Stolp, Kathryn A; Murray, Joseph A; Bassford, Jeffrey R

    2007-04-01

    To assess the clinical characteristics, treatment, and outcome of patients with inflammatory myopathy-associated dysphagia. We retrospectively reviewed the medical records of all patients with inflammatory myopathy-associated dysphagia seen at the Mayo Clinic in Rochester, Minn, between January 1, 1997, and December 31, 2001. A total of 783 patients were diagnosed as having inflammatory myopathy during the 5-year study period. Of these, 62 patients (41 women and 21 men; mean age, 68.6 years) had inflammatory myopathy-associated dysphagia: 26 with inclusion body myositis (IBM), 18 with dermatomyositis, 9 with polymyositis, and 9 with overlap syndrome. Dysphagia was a presenting symptom in 13 patients (21%), with the highest incidence in the IBM group. Videofluoroscopic examinations revealed pharyngeal pooling and impaired oropharyngeal and cricopharyngeal function. The benefits of swallowing compensation techniques and exercises were difficult to establish. Interventional procedures were performed in 24 patients (39%) and most frequently (62%) in patients with IBM, with cricopharyngeal myotomy being most beneficial. Patients with IBM had the least symptomatic improvement. Overall, 11 patients died during the median follow-up of 38 months, with respiratory failure due to aspiration pneumonia as the most common cause. Mortality was high in patients who required percutaneous endoscopic gastrostomy (7/11, 64%), and 1- year mortality was highest (31%) in those with dermatomyositis. Dysphagia is a serious and at times presenting problem in patients with inflammatory myopathy. It occurs most frequently and appears to be most refractory in patients with IBM. The mortality rate was high in patients who required percutaneous endoscopic gastrostomy, and the 1-year mortality rate was the highest in patients with dermatomyositis.

  8. Acoustic characteristics of voluntary expiratory sounds after swallow for detecting dysphagia.

    Science.gov (United States)

    Yamashita, M; Yokoyama, K; Takei, Y; Furuya, N; Nakamichi, Y; Ihara, Y; Takahashi, K; Groher, M E

    2014-09-01

    This research was designed to investigate the acoustic characteristics of voluntary expiratory sounds after swallow for detecting dysphagia. Forty-nine patients with complaints of swallow difficulty received a videofluorographic (VF) examination. They were divided into three groups: nine who did not have any apparent disease (Group N), 22 patients with head and neck cancer (Group H&N) and 18 patients with other diseases including cerebrovascular disease (Group OD). After liquid barium swallows, they exhaled voluntarily without voicing. Videofluorographic findings were classified into four groups: normal (Normal), acceptable swallow (Acceptable), swallow with residue (Resid) and swallows with penetration or aspiration (Pen/Asp). The duration of expiratory sounds was measured on the time waveform. Frequency characteristics of expiratory sounds were obtained using one-third octave band analysis ranging from 62·5 to 2000·0 Hz of central frequency. The averaged level of the 1000·0-Hz band was chosen as the reference band level (RB level). The revised averaged level of each band was obtained by subtracting the RB level from the averaged level of each band. Zero decibel of the revised magnitude of the 125·0-Hz band was set as the critical value to differentiate dysphagia (Resid or Pen/Asp) from no dysphagia (Normal or Acceptable). Comparison of this assessment with VF findings showed a significant percentage agreement (85·4%). These results suggest that frequency characteristics of post-swallow expiratory sounds can differentiate dysphagia from no dysphagia among multiple dysphagic patient groups. © 2014 John Wiley & Sons Ltd.

  9. Effect of Feeding Management on Aspiration Pneu-monia in Elderly Patients with Dysphagia

    Institute of Scientific and Technical Information of China (English)

    Min Li; Zheng Wang; Wei-Jia Han; Shi-Yin Lu; Ya-Zhen Fang

    2015-01-01

    Objective: To investigate the effects of feeding safety instructions and dietary intervention on as-piration pneumonia in elderly patients with dysphagia. Methods: The study included 40 long-term hospitalized elderly patients with dysphagia who nee-ded oral intake. According to the voluntary and matching principle, participants were divided into the intervention group ( n=20) and control group ( n=20) . We formed a multi-disciplinary team including clinical nurses, rehabilitation therapists and nutritionists. Clinical nurses collaborated with nutritionists and rehabilitation therapists to carry out feeding management. The patients in the control group were fed with semi-solid food, thick liquid, a partial mushy diet and so on accord-ing to their swallowing situations and tastes or preferences. The patients in the intervention group were fed with an all mushy diet. Patients in both groups were able to eat foods on their own or with assistance. Results: After a three-month intervention, the incidence of aspiration pneumonia in both groups was decreased, and the difference was statistically significant ( P<0. 05) . In the control group, seven patients had aspiration pneumonia, including two cases who died after nasogastric feeding due to aggravated dysphagia. In the control group, seven patients had aspiration pneumonia, in-cluding two cases was given nasogastric feeding due to aggravated dysphagia and then one case died. In the intervention group, four patients had aspiration pneumonia. There was no dropouts in either group. Conclusions: Elderly patients with dysphagia require a multidisciplinary team to work closely with them to carry out feeding management. Nurses should conduct safety guidance for care cate-ring and encouraging patients to actively eat a mushy diet. The diet can reduce the incidence of as-piration pneumonia, maintain oral intake and improve the quality of life.

  10. [Cervicogenic dysphagia: swallowing difficulties caused by functional and organic disorders of the cervical spine].

    Science.gov (United States)

    Grgić, Vjekoslav

    2013-01-01

    Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia; CD) are: chronic multisegmental/MS dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes, anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis, injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors. According to our clinical observations, degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints are disorders which can cause swallowing difficulties. However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in differential diagnosis. Because of the close anatomical relationship of cervical spine with the pharynx and cervical part of esophagus, the consequences of the degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints such as the changes in the physiological curvature of the cervical spine, changes in elasticity and contractility in the neck muscles and decreased mobility of the cervical spine, adversely affect the dimensions of the pharynx and cervical part of esophagus, that is, swallowing capacity which can result in dysphagia. Degenerative changes in the cervical discs and facet joints are common additional cause of dysphagia in elderly people with disorders of the central control of swallowing (stroke, Parkinson's disease, senile dementia etc). The most important therapeutic options in patients with CD are: medicamentous therapy, physical therapy, manual therapy, kinesiotherapy and surgical treatment. The aim of the conservative therapy in patients with CD is to improve the swallowing capacity (for example, soft tissue techniques, stretching of the

  11. [Efficacy observation of dysphagia after acute stroke treated with acupuncture and functional electric stimulation].

    Science.gov (United States)

    Chang, Ling; He, Peng-Lan; Zhou, Zhen-Zhong; Li, Yan-Hua

    2014-08-01

    To observe the impacts on the recovery of swallowing function in patients of dysphagia after acute stroke treated with acupuncture and functional electric stimulation. Seventy-four patients were randomized into an acupuncture plus electric stimulation group (38 cases) and an electric stimulation group (36 cases). The functional electric stimulator was used in the two groups. The electric pads were placed on the hyoid bone, the upper part of thyroid cartilage, the masseter muscle and the mandibular joint. The treatment lasted for 30 mm each time. In the acupuncture plus electric stimulation group, acupuncture was supplemented at motor area of Jiao's scalp acupuncture, lower 2/5 of sensory area, Baihui (CV 20), Lianquan (CV 23), Jinjin (EX-HN 12) and Yuye (EX-HN 13), 30 mm each time. The treatment was given once a day, 6 treatments for one session and there was 1 day at interval between the sessions, 4 sessions were required totally in the two groups. The dysphagia scale was adopted for efficacy evaluation before treatment and after 4 sessions of treatment in the two groups. The removal rate of nasal feeding tube was observed after treatment. The dysphagia score was increased apparently after treatment compared with that before treatment in the two groups (both P electric stimulation group, the dysphagia score was increased much more apparently than that in the electric stimulation group (8.01 +/- 1.25 vs 6.73 +/- 1.36, P electric stimulation group, better than 58.3% (21/36) in the electric stimulation group (P electric stimulation group, which was higher than 50. 0% (18/36) in the electric stimulation group (P electric stimulation achieves the much better efficacy on dysphagia after acute stroke and promotes the early removal of nasal feeding tube. The efficacy is better than that of the simple electric stimulation therapy.

  12. 脑卒中后吞咽困难常用量表的临床应用特点%The Clinical Application Characteristics of Usual Measuring Scales for Dysphagia after Stroke

    Institute of Scientific and Technical Information of China (English)

    王宇; 周鸿飞

    2016-01-01

    Dysphagia is a common complication of stroke, which main clinical manifestations are irritating cough, malnutrition and language disor-ders. Because it involves the subjective feelings of patients and doctors, so the clinical evaluation methods often appear in the form of scales, choos-ing a safe and accurate scale has positive significance to the rehabilitation of dysphagia patients. However, scales for dysphagia in clinical practice are multifarious and complex, studies on the rational choice of scales are still not deep enough, so this article tries to summarize the scales for dyspha-gia after stroke and their characteristics to provide some references for clinical practice.%吞咽困难为脑卒中后常见并发症,以呛咳、营养不良及语言障碍为主要临床表现。因其涉及患者及医生的主观感受,故临床上的评估方法常以量表形式出现,选择安全、准确的评估量表对吞咽困难的康复有积极意义。然而,目前临床上用于评价吞咽困难的量表多而繁杂,在量表合理化选择上的研究尚不够深入,故本文拟对用于评价脑卒中后吞咽困难的量表及其特点加以归纳总结,以供临床参考。

  13. A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.

    Science.gov (United States)

    Albayrak, Ilknur; Bağcacı, Sinan; Sallı, Ali; Kucuksen, Sami; Uğurlu, Hatice

    2013-09-01

    Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

  14. Severe dysphagia as the presenting symptom of Wernicke-Korsakoff syndrome in a non-alcoholic man.

    Science.gov (United States)

    Karaiskos, Ilias; Katsarolis, Ioannis; Stefanis, Leonidas

    2008-02-01

    We present the case of a non-alcoholic man, who, following severe malnutrition, presented with dysphagia that necessitated gastrostomy tube placement. The patient subsequently developed encephalopathy, at which point thiamine deficiency was suspected and thiamine supplementation initiated. The encephalopathy and the dysphagia resolved, but the patient was left with a dense amnestic deficit consistent with Korsakoff syndrome. MRI at the time of the encephalopathy revealed lesions consistent with Wernicke-Korsakoff syndrome. This case represents a remarkable example of Wernicke-Korsakoff syndrome that for a prolonged time period had as its sole manifestation severe dysphagia. To our knowledge, there is only one similar case reported in the literature. This case serves to alert neurologists that isolated dysphagia may be the presenting symptom of this classic neurological syndrome even in the absence of alcoholism.

  15. Dysphagia in acute stroke: Correlation with stroke subtype, vascular territory and in-hospital respiratory morbidity and mortality

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    Sundar Uma

    2008-01-01

    Full Text Available Aims: The study aimed at correlation of post-stroke dysphagia with area and volume of infarct/ bleed, and with subsequent in-hospital respiratory morbidity and mortality. Materials and Methods: 50 patients of acute stroke were serially recruited. Standard Staff swallowing assessment was performed within 24 hours of admission along with pulse oximetry. Ischemic strokes were classified as per OCPS registry. In-hospital respiratory morbidity and mortality, mode of nutrition and disability status at discharge were noted. Results: 21/50 (42% patients had post-stroke dysphagia during their hospital course. Among infarcts, Total Anterior Circulation Infarcts (TACI had 100% incidence of dysphagia, followed by Partial Anterior Circulation Infarcts (PACI-36%, Posterior Circulation infarcts (POCI-33%, and Lacunar infarcts (LACI-18%. 67% of hemorrhages had post-stroke dysphagia. Staff swallowing assessment had a sensitivity and specificity of 75% and 73% respy., for predicting respiratory morbidity. The corresponding figures for Pulse oximetry were 79% and 91%.

  16. Mediastinal tuberculous lymphadenitis presenting as an esophageal intramural tumor: A very rare but important cause for dysphagia

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Dysphagia associated with esophageal mechanical obstruction is usually related to malignant esophageal diseases. Benign lesions are rarely a cause for this type of dysphagia, and usually occur either as an intramural tumor or as an extrinsic compression.Mediastinal tuberculous lymphadenitis is rare in adults, and even more rarely causes dysphagia. We report two cases of dysphagia in adult patients caused by mediastinal tuberculous lymphadenitis, presenting radiologically and endoscopically as an esophageal submucosal tumor.Based on the clinical and imaging diagnosis, the patients underwent a right thoracotomy, and excision of the mass attached to and compressing the esophagus. Pathological examination of the specimens showed a chronic granulomatous inflammation with caseous necrosis,which was consistent with tuberculous lymphadenitis.

  17. Preliminary Evaluation of the Pathomechanisms of Dysphagia After Occipitospinal Fusion: Kinematic Analysis by Videofluoroscopic Swallowing Study.

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    Kaneyama, Shuichi; Sumi, Masatoshi; Takabatake, Masato; Kasahara, Koichi; Kanemura, Aritetsu; Koh, Akihiro; Hirata, Hiroaki

    2016-12-01

    Kinematic analysis of swallowing function using videofluoroscopic swallowing study (VFSS). The aims of this study were to analyze swallowing process in the patients who underwent occipitospinal fusion (OSF) and elucidate the pathomechanism of dysphagia after OSF. Although several hypotheses about the pathomechanisms of dysphagia after OSF were suggested, there has been little tangible evidence to support these hypotheses since these hypotheses were based on the analysis of static radiogram or CT. Considering that swallowing is a compositive motion of oropharyngeal structures, the etiology of postoperative dysphagia should be investigated through kinematic approaches. Each four patients with or without postoperative dysphagia (group D and N, respectively) participated in this study. For VFSS, all patients were monitored to swallow 5-mL diluted barium solution by fluoroscopy, and then dynamic passing pattern of the barium solution was analyzed. Additionally, O-C2 angle (O-C2A) was measured for the assessment of craniocervical alignment. O-C2A in group D was -7.5 degrees, which was relatively smaller than 10.3 degrees in group N (P = 0.07). In group D, all cases presented smooth medium passing without any obstruction at the upper cervical level regardless of O-C2A, whereas the obstruction to the passage of medium was detected at the apex of mid-lower cervical ocurvature, where the anterior protrusion of mid-lower cervical spine compressed directly the pharyngeal space. In group N, all cases showed smooth passing of medium through the whole process of swallowing. This study presented that postoperative dysphagia did not occur at the upper cervical level even though there was smaller angle of O-C2A and demonstrated the narrowing of the oropharyngeal space towing to direct compression by the anterior protrusion of mid-lower cervical spine was the etiology of dysphagia after OSF. Therefore, surgeon should pay attention to the alignment of mid-cervical spine as well as

  18. Demonstration of vascular abnormalities compressing esophagus by MDCT: Special focus on dysphagia lusoria

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    Alper, Fatih [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey)]. E-mail: fatihrad@yahoo.com; Akgun, Metin [Department of Chest Diseases, Medical Faculty, Atatuerk University, Erzurum (Turkey); Kantarci, Mecit [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey); Eroglu, Atilla [Department of Thoracic Surgery, Medical Faculty, Atatuerk University, Erzurum (Turkey); Ceyhan, Elvan [Department of Mathematics, College of Arts and Sciences, Koc University, Istanbul (Turkey); Onbas, Omer [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey); Duran, Cihan [Department of Radiology, Florence Nightingale Hospital, Istanbul (Turkey); Okur, Adnan [Department of Radiology, Medical Faculty, Atatuerk University, Erzurum (Turkey)

    2006-07-15

    Purpose: Dysphagia lusoria (DL) is described in the literature as difficulty in swallowing caused by vascular abnormalities. The most common cause is an aberrant right subclavian artery (SCA) which passes behind the esophagus and is also called arteria lusoria (AL). Our aim was to demonstrate the use of multidetector computed tomography (MDCT) in the diagnosis of AL, as there is no comprehensive study investigating the role of MDCT in such cases. Material and methods: A total of 38 consecutive patients, comprising of 23 females (61%) and 15 males (39%), who had extrinsic compression were included in the study. These patients are selected from the cases who were admitted due to their gastrointestinal symptoms, such as dysphagia, epigastric pain, chronic nausea, vomiting, etc. The mean age of patients was 40 {+-} 25 years (range 15-65). Following barium esophagogram and then endoscopy performed, MDCT angiography was carried out on the same or the following few days. MDCT sections were examined to determine the following: presence of vascular abnormality; the diameter and angle of that vascular structure; and the compressed area of esophagus. Radiological findings and dysphagia scores were also compared. Results: In each of 15 cases, there was a compression due to vascular abnormality which were all located between the esophagus and the spine. There was an esophageal compression in each of 12 cases, due to right aberrant SCA, in one case due to right superior aortic arch and in two cases due to both right aortic arch and left SCA with Kommerell's diverticulum. The mean diameter and the angle of AL were 16.4 mm and 48.8{sup o}, respectively, and the mean area of pressured esophagus was 194.7 mm{sup 2}. Dysphagia scores of the cases was 1 in thirteen cases and 2 in two cases. However, dysphagia scores were not correlated with these parameters. Conclusions: MDCT angiography is a useful diagnostic tool for evaluation of patients with dysphagia, especially caused by a

  19. Analysis of the level of Dysphagia, anxiety, and nutritional status before and after speech therapy in patients with stroke.

    Science.gov (United States)

    Drozdz, Daniela; Mancopes, Renata; Silva, Ana Maria Toniolo; Reppold, Caroline

    2014-04-01

     The rehabilitation in oropharyngeal dysphagia evidence-based implies the relationship between the interventions and their results.  Analyze level of dysphagia, oral ingestion, anxiety levels and nutritional status of patients with stroke diagnosis, before and after speech therapy.  Clinical assessment of dysphagia partially using the Protocol of Risk Assessment for Dysphagia (PARD), applying the scale Functional Oral Intake Scale for Dysphagia in Stroke Patients (FOIS), Beck Anxiety Inventory (BAI) and the Mini Nutritional Assessment MNA(®). The sample consisted of 12 patients, mean age of 64.6 years, with a medical diagnosis of hemorrhagic and ischemic stroke and without cognitive disorders. All tests were applied before and after speech therapy (15 sessions). Statistical analysis was performed using the chi-square test or Fisher's exact test, McNemar's test, Bowker's symmetry test and Wilcoxon's test.  During the pre-speech therapy assessments, 33.3% of patients had mild to moderate dysphagia, 88.2% did not receive food orally, 47.1% of the patients showed malnutrition and 35.3% of patients had mild anxiety level. After the therapy sessions, it was found that 33.3% of patients had mild dysphagia, 16.7% were malnourished and 50% of patients had minimal level of anxiety.   There were statistically significant evolution of the level of dysphagia (p = 0.017) and oral intake (p = 0.003) post-speech therapy. Although not statistically significant, there was considerable progress in relation to the level of anxiety and nutritional status.

  20. New graduates’ perceptions of preparedness to provide speech-language therapy services in general and dysphagia services in particular

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    Shajila Singh

    2015-02-01

    Full Text Available Background: Upon graduation, newly qualified speech-language therapists are expected to provide services independently. This study describes new graduates’ perceptions of their preparedness to provide services across the scope of the profession and explores associations between perceptions of dysphagia theory and clinical learning curricula with preparedness for adult and paediatric dysphagia service delivery.Methods: New graduates of six South African universities were recruited to participate in a survey by completing an electronic questionnaire exploring their perceptions of the dysphagia curricula and their preparedness to practise across the scope of the profession of speechlanguage therapy. Results: Eighty graduates participated in the study yielding a response rate of 63.49%. Participants perceived themselves to be well prepared in some areas (e.g. child language: 100%; articulation and phonology: 97.26%, but less prepared in other areas (e.g. adult dysphagia: 50.70%; paediatric dysarthria: 46.58%; paediatric dysphagia: 38.36% and most unprepared to provide services requiring sign language (23.61% and African languages (20.55%. There was a significant relationship between perceptions of adequate theory and clinical learning opportunities with assessment and management of dysphagia and perceptions of preparedness to provide dysphagia services. Conclusion: There is a need for review of existing curricula and consideration of developing a standard speech-language therapy curriculum across universities, particularly in service provision to a multilingual population, and in both the theory and clinical learning of the assessment and management of adult and paediatric dysphagia, to better equip graduates for practice.

  1. The diagnosis and management of adult neurogenic dysphagia.

    Science.gov (United States)

    Hamdy, Shaheen

    Swallowing is a complex sensorimotor process that involves the transport of material from the mouth to the stomach for digestion. It is also involved in protecting the airway and in rejecting noxious ingested substances. Humans swallow on average once every minute and this is supplemented by the production of saliva. When we eat, swallowing increases dramatically (six to eight times a minute).

  2. Validation of the Persian version of ‎the dysphagia handicap index in ‎patients with neurological disorders

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    Ebrahim Barzegar-Bafrooei

    2016-08-01

    Full Text Available Background: Dysphagia as a common condition affecting many aspects of the patient’s life. The Dysphagia Handicap Index (DHI is a reliable self-reported questionnaire developed specifically to measure the impact of dysphagia on the patient’s quality of life. The aim of this study was to translate the questionnaire to Persian and to measure its validity and reliability in patients with neurogenic oropharyngeal dysphagia.Methods: A formal forward-backward translation of DHI was performed based on the guidelines for the cross-cultural adaptation of self-report measures. A total of 57 patients with neurogenic dysphagia who were referred to the neurology clinics of Tehran University of Medical Sciences, Iran, participated in this study. Internal consistency reliability of the DHI was examined using Cronbach’s alpha, and test-retest reliability of the scale was evaluated using intraclass correlation coefficient (ICC.Results: The internal consistency of the Persian DHI (P-DHI was considered to be good; Cronbach’s alpha coefficient for the total P-DHI was 0.88. The test-retest reliability for the total and three subscales of the P-DHI ranged from 0.95 to 0.98 using ICC.Conclusion: The P-DHI demonstrated a good reliability, and it can be a valid instrument for evaluating the dysphagia effects on quality of life among Persian language population.

  3. Training and self-reported confidence for dysphagia management among speech-language pathologists in the schools.

    Science.gov (United States)

    O'Donoghue, Cynthia R; Dean-Claytor, Ashli

    2008-04-01

    The number of children requiring dysphagia management in the schools is increasing. This article reports survey findings relative to speech-language pathologists' (SLPs') training and self-rated confidence to treat children with swallowing and feeding disorders in the schools. Surveys were completed by 222 SLPs representing Virginia and its contiguous states. Queries on dysphagia training targeted formal education, on-the-job experiences, and current caseload information. In addition, participants self-rated their confidence to treat dysphagia. Statistically significant relationships between training and self-confidence levels were demonstrated. Specifically, participation in continuing education and currency of educational activities revealed significant and moderately strong correlations to self-reported confidence to treat children with dysphagia in the school setting. Findings support continuing education as a correlate to self-reported confidence to treat dysphagia in the school setting among SLPs in Virginia and its contiguous states. Further research is merited to ascertain if these findings reflect national trends. Quantifiable, cost-effective, and evidenced-based dysphagia training, consultancy, and management models are needed if school-based SLPs are to meet the increasing challenges of their diverse caseloads.

  4. Identification of dysphagia using the Toronto Bedside Swallowing Screening Test (TOR-BSST©): are 10 teaspoons of water necessary?

    Science.gov (United States)

    Martino, Rosemary; Maki, Ellen; Diamant, Nicholas

    2014-06-01

    Dysphagia screening often includes administration of water. This study assessed the accuracy in identifying dysphagia with each additional teaspoon of water. The original research of the TOR-BSST(©) permitted this assessment. Trained nurses from acute and rehabilitation facilities prospectively administered the TOR-BSST(©) to 311 eligible stroke inpatients. A sensitivity analysis was conducted for the water item using 10 teaspoons plus a sip as the standard. The proportion of positive screenings was 59.2% in acute and 38.5% in rehabilitation. Of all four items that form the TOR-BSST(©), the water swallow item contributed to the identification of dysphagia in 42.7% in acute and 29.0% in rehabilitation patients. Across all patients, dysphagia accuracy was that five teaspoons resulted in a sensitivity of 79% (95% confidence interval [CI] = 70-86), eight a sensitivity of 92% (95% CI = 85-96) and 10 a sensitivity of 96% (95% CI = 90-99). Although a primary contributor, the water swallow item alone does not identify all patients with dysphagia. For a water swallow to accurately identify dysphagia, it is critical to administer 10 teaspoons. The TOR-BSST(©) water swallow item contributes largely to the total TOR-BSST(©)'s screening score and in making the test highly accurate and reliable.

  5. Dysphagia after definitive radiotherapy for head and neck cancer. Correlation of dose-volume parameters of the pharyngeal constrictor muscles

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    Deantonio, L.; Masini, L. [University Hospital ' Maggiore della Carita' , Novara (Italy). Radiotherapy; Brambilla, M. [University Hospital ' Maggiore della Carita' , Novara (Italy). Medical Physics; Pia, F. [University Hospital ' Maggiore della Carita' , Novara (Italy). Otolaryngology; University of ' Piemonte Orientale' , Novara (Italy). Dept. of Medical Sciences; Krengli, M. [University Hospital ' Maggiore della Carita' , Novara (Italy). Radiotherapy; University of ' Piemonte Orientale' , Novara (Italy). Dept. of Translational Medicine and BRMA

    2013-03-15

    Background: Dysphagia is a complication of head and neck cancer patients undergoing radiotherapy (RT). We analysed frequency and severity of swallowing dysfunction and correlated these findings with dose-volume histograms (DVHs) of the pharyngeal constrictor muscles. Methods: A total of 50 patients treated by radical RT were enrolled. DVHs of constrictor muscles were correlated with acute and late dysphagia and with the items of three quality of life questionnaires. Results: Mean dose to superior and middle constrictor muscles (SCM, MCM), partial volume of SCM and MCM receiving a dose {>=} 50 Gy dose to the whole constrictor muscles {>=} 60 Gy and tumour location were associated to late dysphagia at univariate analysis. Mean dose to the MCM was the only statistically significant predictor of late dysphagia at the multivariable analysis. Conclusion: The study shows a significant relationship between long-term dysphagia and mean doses to SCM, MCM, whole constrictor muscles, and oropharyngeal tumour. This finding suggests a potential advantage in reducing the RT dose to swallowing structures to avoid severe dysphagia. (orig.)

  6. Rheological Characterization and Cluster Classification of Iranian Commercial Foods, Drinks and Desserts to Recommend for Esophageal Dysphagia Diets.

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    Azizollaah Zargaraan

    2013-12-01

    Full Text Available In the absence of dysphagia-oriented food products, rheological characterization of available food items is of importance for safe swallowing and adequate nutrient intake of dysphagic patients. In this way, introducing alternative items (with similar ease of swallow is helpful to improve quality of life and nutritional intake of esophageal cancer dysphagia patients. The present study aimed at rheological characterization and cluster classification of potentially suitable foodstuffs marketed in Iran for their possible use in dysphagia diets.In this descriptive study, rheological data were obtained during January and February 2012 in Rheology Lab of National Nutrition and Food Technology Research Institute Tehran, Iran. Steady state and oscillatory shear parameters of 39 commercial samples were obtained using a Physica MCR 301 rheometer (Anton-Paar, GmbH, Graz, Austria. Matlab Fuzzy Logic Toolbox (R2012 a was utilized for cluster classification of the samples.Using an extended list of rheological parameters and fuzzy logic methods, 39 commercial samples (drinks, main courses and desserts were divided to 5 clusters and degree of membership to each cluster was stated by a number between 0 and 0.99.Considering apparent viscosity of foodstuffs as a single criterion for classification of dysphagia-oriented food products is shortcoming of current guidelines in dysphagia diets. Authors proposed to some revisions in classification of dysphagia-oriented food products and including more rheological parameters (especially, viscoelastic parameters in the classification.

  7. Characteristics of Dysphagia in Infants with Microcephaly Caused by Congenital Zika Virus Infection, Brazil, 2015

    Science.gov (United States)

    van der Linden, Vanessa; Bezerra, Thiago P.; de Valois, Luciana; Borges, Adriana C.G.; Antunes, Margarida M.C.; Brandt, Kátia G.; Moura, Catharina X.; Rodrigues, Laura C.; Ximenes, Coeli R.

    2017-01-01

    We summarize the characteristics of dysphagia in 9 infants in Brazil with microcephaly caused by congenital Zika virus infection. The Schedule for Oral Motor Assessment, fiberoptic endoscopic evaluation of swallowing, and the videofluoroscopic swallowing study were used as noninstrumental and instrumental assessments. All infants had a degree of neurologic damage and showed abnormalities in the oral phase. Of the 9 infants, 8 lacked oral and upper respiratory tract sensitivity, leading to delays in initiation of the pharyngeal phase of swallowing. Those delays, combined with marked oral dysfunction, increased the risk for aspiration of food, particularly liquid foods. Dysphagia resulting from congenital Zika virus syndrome microcephaly can develop in infants >3 months of age and is severe. PMID:28604336

  8. Kinematic analysis of laryngeal movements in patients with neurogenic dysphagia before and after swallowing rehabilitation.

    Science.gov (United States)

    Prosiegel, M; Heintze, M; Sonntag, E W; Schenk, T; Yassouridis, A

    2000-01-01

    To examine whether kinematic analysis of laryngeal movements (which are closely linked to pharyngeal swallowing) can differentiate between normal and disturbed swallowing, we used a three-dimensional ultrasound movement recording system to measure the movements of the larynx during swallowing in 32 patients with neurogenic dysphagia caused by central nervous system lesions and in 32 age- and sex-matched healthy individuals. At the beginning of an inpatient rehabilitation swallowing program, laryngeal movements in 24 patients were highly disturbed in terms of velocity curve irregularities. After rehabilitation, the majority of patients with hitherto irregular velocity profiles exhibited laryngeal kinematics that were indistinguishable from those of 32 healthy subjects. Kinematic analysis of laryngeal movements, therefore, is suitable for monitoring motor recovery of swallowing disturbances in patients with neurogenic dysphagia while undergoing swallowing rehabilitation.

  9. Submental sensitive transcutaneous electrical stimulation (SSTES) at home in neurogenic oropharyngeal dysphagia: a pilot study.

    Science.gov (United States)

    Verin, E; Maltete, D; Ouahchi, Y; Marie, J-P; Hannequin, D; Massardier, E Guegan; Leroi, A-M

    2011-09-01

    Oropharyngeal dysphagia is frequent in chronic neurological disorders and increases mortality, mainly due to pulmonary complications. Our aim was to show that submental sensitive transcutaneous electrical stimulation (SSTES) applied during swallowing at home can improve swallowing function in patients with chronic neurological disorders. Thirteen patients were recruited for the study (4 f, 68 ± 12 years). They all suffered from neurogenic oropharyngeal dysphagia. We first compared the swallowing of paste and liquid with and without SSTES. Thereafter, the patients were asked to perform SSTES at home with each meal. Swallowing was evaluated before and after six weeks of SSTES using the SWAL-QoL questionnaire. With the stimulator switch turned on, swallowing coordination improved, with a decrease in swallow reaction time for the liquid (Pdysphagia quality of life. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  10. Survey of Usual Practice: Dysphagia Therapy in Head & Neck Cancer Patients

    Science.gov (United States)

    Krisciunas, Gintas P.; Sokoloff, William; Stepas, Katherine; Langmore, Susan E.

    2012-01-01

    There is no standardized dysphagia therapy for head and neck cancer patients and scant evidence to support any particular protocol, leaving institutions and individual speech language pathologists (SLPs) to determine their own protocols based on “typical” practices or anecdotal evidence. To gain an understanding of current usual practices, a national internet-based survey was developed and disseminated to SLPs who treat HNC patients. From a random sample of 4,000 ASHA SID 13 members, 1,931 fit the inclusion criteria, and 759 complete responses were recorded for a 39.3% response rate. Results were analyzed by institution type as well as by individual clinical experience. While some interesting trends emerged from the data, a lack of uniformity and consensus regarding best practices was apparent. This is undoubtedly due to a paucity of research adequately addressing the efficacy of any one therapy for dysphagia in the HNC population. PMID:22456699

  11. Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation

    Directory of Open Access Journals (Sweden)

    Elizabeth C. Ward

    2013-01-01

    employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management.

  12. Dysphagia in the high-risk infant: potential factors and mechanisms.

    Science.gov (United States)

    Jadcherla, Sudarshan

    2016-02-01

    Neonatal dysphagia, or abnormalities of swallowing, represent a major global problem, and consequences of dysfunctional feeding patterns carry over into infancy and toddler age groups. Growth, development, and independent feeding skills are all delayed among high-risk infants. Such a group comprises premature birth, low-birth-weight, congenital anomalies, perinatal asphyxia, postsurgical, and sepsis categories. The conflict between pathophysiologic and pragmatic feeding strategies remains a major conundrum and is largely due to a lack of validated diagnostic approaches amid heterogeneity of the patient phenotype. Thus, well-tested feeding management strategies that can be generalizable are lacking. Furthermore, the aerodigestive symptoms and signs, potential risk factors, and contributory etiologies remain nonspecific. This article presents mechanistic evidence related to the pathophysiologic basis of neonatal dysphagia as well as potential opportunities to improve feeding abilities and long-term development.

  13. Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents.

    Science.gov (United States)

    Park, Yeonhwan; Oh, Seieun; Chang, Heekyung; Bang, Hwal Lan

    2015-11-01

    HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Effects of the Evidence-Based Nursing Care Algorithm of Dysphagia for Nursing Home Residents" found on pages 30-39, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until October 31, 2018. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Explain the development and testing of the Evidence-Based Nursing Care Algorithm of

  14. Managing eating and drinking difficulties (dysphagia) with children who have learning disabilities: What is effective?

    Science.gov (United States)

    Harding, Celia; Cockerill, Helen

    2015-07-01

    People who work with children who have neurological and learning disabilities frequently need to manage the health and emotional risks associated with eating, drinking and swallowing (dysphagia). Some approaches can support children to develop oral feeding competence or to maximise their ability to maintain some oral intake supplemented with tube feeding. However, some clinicians feel that oral-motor exercises can support eating and drinking skills as well as speech and language development, whereas there is little evidence to support this.The implied "beneficial" association between oral-motor exercises, speech and swallowing skills gives a false impression in terms of future outcomes for parents and carers of children with learning disabilities. This paper considers oral-motor approaches in the remediation of dysphagia and the need for a cultural shift away from this view. Realistic and useful outcomes for people with learning disabilities need to be an essential part of therapeutic intervention.

  15. Recorded incidence and management of dysphagia in an outpatient ...

    African Journals Online (AJOL)

    the involvement of allied health professionals in the management of children with neurodevelopmental impairments; and to ... children, leading to compromised growth, malnutrition, ..... collaboration, particularly for children in this population,.

  16. [The etiological differentiation of neuromuscular produced dysphagia by x-ray cinematography].

    Science.gov (United States)

    Brühlmann, W

    1991-12-01

    850 patients with dysphagia were examined by x-ray cinematography. On the basis of these examinations the normal events of swallowing are compared with the abnormalities observed. The technique is described. An algorithm has been developed depending on the presence of symmetry or asymmetry of the abnormalities and on muscle tone, which permits classification of the various aetiological groups. In addition, specific features of individual diseases often make it possible to arrive at a definite diagnosis.

  17. A new complication of hypothyroid coma: neurogenic dysphagia: presentation, diagnosis, and treatment.

    Science.gov (United States)

    Urquhart, A D; Rea, I M; Lawson, L T; Skipper, M

    2001-06-01

    We report the case of a patient with severe hypothyroid coma in whom hypothyroid-related neurogenic oropharyngeal dysphagia was suspected, videoscopically confirmed, and successfully treated. This complication has not previously been described, and may have contributed to the historically high mortality associated with severe cases of hypothyroid coma. In the future, the early detection and aggressive treatment of this complication and its sequelae should ensure a further reduction in mortality from hypothyroid coma.

  18. Lingual tonsil hypertrophy causing severe dysphagia: treatment with plasma-mediated radiofrequency-based ablation (Coblation).

    Science.gov (United States)

    Mowry, Sarah E; Ament, Marvin; Shapiro, Nina L

    2010-03-01

    Lingual tonsil hypertrophy is an uncommon cause of upper aerodigestive tract pathology. We present the case of a 17-year-old boy who developed severe dysphagia and subsequent weight loss as a result of lingual tonsil hypertrophy. He was successfully treated with plasma-mediated radiofrequency-based ablation (Coblation). In the past, traditional surgical procedures for lingual tonsil hypertrophy were difficult to perform and recovery was difficult, but the introduction of Coblation has made lingual tonsillectomy much easier.

  19. The role of gastrostomy tube placement in advanced dementia with dysphagia: a critical review

    Directory of Open Access Journals (Sweden)

    Goldberg LS

    2014-10-01

    Full Text Available Leanne S Goldberg,1 Kenneth W Altman2 1Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY, USA; 2Baylor College of Medicine, Houston, TX, USAPurpose: Over 4.5 million people in North America had a diagnosis of dementia in the year 2000, and more than half had advanced disease with potential aspiration risk. There is much controversy regarding the use and timing of enteral feeding support in these patients with dysphagia. The management of dysphagia is far more complex when considering quality of life, “comfort care” hand feeding, the use of percutaneous endoscopic gastrostomy tube (PEG, and associated mortality rates. This study seeks to critically review the literature that evaluates PEG placement in this population. Methods: A systematic literature review of PubMed, from 1995–2012, was conducted to identify studies relating to PEG placement in dementia patients with dysphagia. The principal outcomes and related survival rates for this population were compared. Results: In total, 100 articles were identified in the search. Of these, ten met the search criteria and were analyzed. There was one study with a 2b level of evidence, one with 3b, and the remainder had level 4. All studies discussed long-term survival in the PEG versus non-PEG populations. No studies showed definitive evidence to suggest long-term survival rates improved in patients who underwent PEG placement as compared to those who did not. Two studies documented median survival worse in patients over age 80 with dementia and PEG placement.Conclusion: There is presently no evidence to suggest long-term survival rates improved in patients with advanced dementia who underwent PEG placement for dysphagia. Relevance to quality of life, need for nutrition and hydration, and ethical considerations in the decision process are discussed.Keywords: PEG, aspiration, elderly, feeding tube, swallow

  20. Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, Julia; Hipp, Matthias; Koelbl, Oliver [Regensburg Univ. Medical Center (Germany). Dept. of Radiotherapy; Schaefer, Christof [Hospital St. Elisabeth Straubing (Germany). Dept. of Radiotherapy

    2011-11-15

    In the past, xerostomia was considered one of the most important determining factors of quality of life (QoL) after radiotherapy (RT) of the head and neck region. In addition, more recent studies have shown that RT-induced dysphagia has an essential influence on the QoL. Between September 2005 and August 2007, 35 patients with locally advanced squamous cell carcinoma of the head and neck region were included in the prospective study. Patients were treated by IMAT (intensity-modulated arc therapy) or IMRT (intensity-modulated radiotherapy) planned on 3D imaging. A total of 28 patients (80%) received concomitant chemotherapy. The evaluation of QoL (EORTC QLQ - C30, H and N C-35) and toxicities (CTC 2.0) were assessed at the beginning of, during, and after RT as well as up to 12 months after the end of therapy. At the end of therapy, 86% of the patients experienced difficulties in swallowing (62% CTC II-III ). Twelve months after the end of treatment, 15% still suffered from dysphagia CTC II-III . Concomitant chemotherapy exacerbated the incidence and gravity of dysphagia, resulting in increasing dietary problems. QoL (EORTC) was significantly affected by dysphagia. In particular, the global state of health and QoL were influenced at the end of treatment (p = 0.033) and at a later stage (p = 0.050). The findings of this study suggest that more emphasis should be placed on structured clinical diagnostics, therapy, and rehabilitation of deglutition problems. This means in particular to not only spare the parotids while planning the irradiation, but also to take into consideration the important structures for deglutition, like the retropharyngeal muscles. (orig.)

  1. Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia

    Directory of Open Access Journals (Sweden)

    Lisa M Poole

    2017-01-01

    Full Text Available Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5% had a sensory deficit alone, 4 (2.9% had a motor deficit alone, and 4 (2.9% had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6% underwent formal swallow evaluation, and 4 (2.9% had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9% had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%, or to home or home with home health (n = 48, 35.3%. Seven patients (5.1% died in the hospital, and eight more (5.9% were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.

  2. Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia

    Science.gov (United States)

    Poole, Lisa M.; Le, Phong; Drake, Rachel M.; Helmer, Stephen D.; Haan, James M.

    2017-01-01

    Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5%) had a sensory deficit alone, 4 (2.9%) had a motor deficit alone, and 4 (2.9%) had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6%) underwent formal swallow evaluation, and 4 (2.9%) had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9%) had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%), or to home or home with home health (n = 48, 35.3%). Seven patients (5.1%) died in the hospital, and eight more (5.9%) were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge. PMID:28243007

  3. Cricoarytenoid joint involvement in rheumatoid arthritis: radiologic evaluation.

    Science.gov (United States)

    Greco, Antonio; Fusconi, Massimo; Macri, Gian Franco; Marinelli, Caterina; Polettini, Elisabetta; Benincasa, Anna Teresa; de Vincentiis, Marco

    2012-01-01

    Rheumatoid arthritis rarely involves the cricoarytenoid joint. The possible consequent symptom includes hoarseness, dysphagia, odynophagia, dysfunctional dysphonia, and acute dyspnea. Etiologic diagnosis is possible with high-resolution computed tomography, which can show spacing of the articular cartilage, density and volume alterations, and subluxation of the cartilage. However, these radiologic signs are not pathognomonic for rheumatoid arthritis, and they should be combined with anamnestic data.

  4. Prospective evaluation of oro-pharyngeal dysphagia after severe traumatic brain injury.

    Science.gov (United States)

    Terré, Rosa; Mearin, Fermín

    2007-12-01

    To evaluate clinical, videofluoroscopic findings and clinical evolution of neurogenic dysphagia and to establish the prognostic factors. Prospective cohort study. Forty-eight patients with severe traumatic brain injury (TBI) and clinically-suspected oro-pharyngeal dysphagia were studied. Clinical evaluation of oro-pharyngeal dysphagia and videofluoroscopic examination were performed. Clinical evolution was based on feeding mode at discharge, the presence of respiratory complications and body mass index (BMI) at admission and at discharge. Sixty-five per cent of patients had impaired gag reflex and 44% cough during oral feeding. Videofluoroscopy revealed some type of disorder in 90% of cases: 65% in the oral phase and 73% in the pharyngeal phase (aspiration in 62.5%, being silent in 41%). At discharge, 45% were on normal diet, 27% on a modified oral diet, 14% combined oral intake and gastrostomy feeding and 14% were fed exclusively by gastrostomy. Feeding mode at discharge substantially correlated with RLCF score at admission (p=0.04) and with RLCF (p=0.009) and DRS (p=0.02) scores at discharge. Aspiration is very frequent in patients with severe TBI, being silent in almost half. Cognitive function evaluated with the RLCF is the best prognostic factor. At discharge, 72% of the patients were on oral food intake despite having severe TBI.

  5. [Dysphagia caused by neurogenic deglutition disorders and diffuse idiopathic skeletal hyperostosis (DISH)].

    Science.gov (United States)

    Bremke, M; Wagner, H-J; Folz, B J

    2006-09-01

    Diffuse idiopathic skeletal hyperostosis (DISH) may lead to dysphagia caused by osteophytes of the cervical spine. Osteophytes can be resected transorally or transcervically, but operative ablation should not be indicated generously because of the threat of severe complications. A fifty-year-old man with dysphagia and loss of weight of 15 kg in the last three months is presented. He also suffered from a brain damage during infancy which caused grand-mal-seizures. One seizure lead to cardiac arrest which required cardio-pulmonary resuscitation and subsequent tracheostomy. A spheric tumor of the posterior pharyngeal wall could be seen endoscopically, it appeared radiologically as an osteophytic formation of the segments C (3) - C (5). Ossification of the anterior longitudinal ligament was also seen. Diagnosis of DISH was made on the basis of these results. Contrast imaging of the esophagus and videofluoroscopy showed aspiration in terms of neurogenic disorders. The patient received a percutaneous gastrostomy after his case was discussed with neurologic and orthopaedic colleagues, because a causal therapy of the combined disease seemed to be impossible. Dysphagia in the presented case was caused by a combination of neurogenic deglutition disorders and oropharyngeal obstruction through osteophytes. Surgical removal of the osteophytes was not indicated because it would have put the patient at a certain risk, but only a part of the underlying problem would have been removed. Symptomatic therapy with a gastrostomy secures normocaloric diet. The patient's weight remained stable and he can follow his habitual daily routine.

  6. Oral muscles are progressively affected in Duchenne muscular dystrophy: implications for dysphagia treatment.

    Science.gov (United States)

    van den Engel-Hoek, Lenie; Erasmus, Corrie E; Hendriks, Jan C M; Geurts, Alexander C H; Klein, Willemijn M; Pillen, Sigrid; Sie, Lilian T; de Swart, Bert J M; de Groot, Imelda J M

    2013-05-01

    Dysphagia is reported in advanced stages of Duchenne muscular dystrophy (DMD). The population of DMD is changing due to an increasing survival. We aimed to describe the dysphagia in consecutive stages and to assess the underlying mechanisms of dysphagia in DMD, in order to develop mechanism based recommendations for safe swallowing. In this cross-sectional study, participants were divided into: early and late ambulatory stage (AS, n = 6), early non-ambulatory stage (ENAS, n = 7), and late non-ambulatory stage (LNAS, n = 11). Quantitative oral muscle ultrasound was performed to quantify echo intensity. Swallowing was assessed with a video fluoroscopic swallow study, surface electromyography (sEMG) of the submental muscle group and tongue pressure. Differences in outcome parameters among the three DMD stages were tested with analysis of variance. Oral muscles related to swallowing were progressively affected, starting in the AS with the geniohyoid muscle. Tongue (pseudo) hypertrophy was found in 70 % of patients in the ENAS and LNAS. Oral phase problems and post-swallow residue were observed, mostly in the LNAS with solid food. sEMG and tongue pressure data of swallowing solid food revealed the lowest sEMG amplitude, the longest duration and lowest tongue pressure in the LNAS. In case of swallowing problems in DMD, based on the disturbed mechanisms of swallowing, it is suggested to (1) adjust meals in terms of less solid food, and (2) drink water after meals to clear the oropharyngeal area.

  7. Dysphagia in spinal muscular atrophy type II: more than a bulbar problem?

    Science.gov (United States)

    van den Engel-Hoek, L; Erasmus, C E; van Bruggen, H W; de Swart, B J M; Sie, L T L; Steenks, M H; de Groot, I J M

    2009-11-24

    In patients with spinal muscular atrophy (SMA) type II, feeding problems and dysphagia are common, but the underlying mechanisms of these problems are not well defined. This case control study was designed to determine the underlying mechanisms of dysphagia in SMA type II. Six children with SMA type II and 6 healthy matched controls between 6.4 and 13.4 years of age were investigated during swallowing liquid and solid food in 2 different postures using surface EMG (sEMG) of the submental muscle group (SMG) and a video fluoroscopic swallow study (VFSS). The VFSS showed postswallow residue of solid food in the vallecula and above the upper esophageal sphincter (UES), which can be responsible for indirect aspiration. Better results in swallowing were achieved in a more forward head position. These findings were supported by the sEMG measurements of the SMG during swallowing. Dysphagia in spinal muscular atrophy type II is due to a neurologic dysfunction (lower motor neuron problems from the cranial nerves in the brainstem) influencing the muscle force and efficiency of movement of the tongue and the submental muscle group in combination with a biomechanical component (compensatory head posture). The results suggest an integrated treatment with an adapted posture during meals and the advice of drinking water after meals to prevent aspiration pneumonias.

  8. Treatment of post-stroke dysphagia by vitalstim therapy coupled with conventional swallowing training.

    Science.gov (United States)

    Xia, Wenguang; Zheng, Chanjuan; Lei, Qingtao; Tang, Zhouping; Hua, Qiang; Zhang, Yangpu; Zhu, Suiqiang

    2011-02-01

    To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagia, a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three groups: conventional swallowing therapy group, VitalStim therapy group, and VitalStim therapy plus conventional swallowing therapy group. Prior to and after the treatment, signals of surface electromyography (sEMG) of swallowing muscles were detected, swallowing function was evaluated by using the Standardized Swallowing Assessment (SSA) and Videofluoroscopic Swallowing Study (VFSS) tests, and swallowing-related quality of life (SWAL-QOL) was evaluated using the SWAL-QOL questionnaire. There were significant differences in sEMG value, SSA, VFSS, and SWAL-QOL scores in each group between prior to and after treatment. After 4-week treatment, sEMG value, SSA, VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing training group than in the conventional swallowing training group and VitalStim therapy group, but no significant difference existed between conventional swallowing therapy group and VitalStim therapy group. It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia.

  9. Clinical application of ICF key codes to evaluate patients with dysphagia following stroke.

    Science.gov (United States)

    Dong, Yi; Zhang, Chang-Jie; Shi, Jie; Deng, Jinggui; Lan, Chun-Na

    2016-09-01

    This study was aimed to identify and evaluate the International Classification of Functioning (ICF) key codes for dysphagia in stroke patients. Thirty patients with dysphagia after stroke were enrolled in our study. To evaluate the ICF dysphagia scale, 6 scales were used as comparisons, namely the Barthel Index (BI), Repetitive Saliva Swallowing Test (RSST), Kubota Water Swallowing Test (KWST), Frenchay Dysarthria Assessment, Mini-Mental State Examination (MMSE), and the Montreal Cognitive Assessment (MoCA). Multiple regression analysis was performed to quantitate the relationship between the ICF scale and the other 7 scales. In addition, 60 ICF scales were analyzed by the least absolute shrinkage and selection operator (LASSO) method. A total of 21 ICF codes were identified, which were closely related with the other scales. These included 13 codes from Body Function, 1 from Body Structure, 3 from Activities and Participation, and 4 from Environmental Factors. A topographic network map with 30 ICF key codes was also generated to visualize their relationships. The number of ICF codes identified is in line with other well-established evaluation methods. The network topographic map generated here could be used as an instruction tool in future evaluations. We also found that attention functions and biting were critical codes of these scales, and could be used as treatment targets.

  10. Clinical signs suggestive of pharyngeal dysphagia in preschool children with cerebral palsy.

    Science.gov (United States)

    Benfer, Katherine A; Weir, Kelly A; Bell, Kristie L; Ware, Robert S; Davies, Peter S W; Boyd, Roslyn N

    2015-03-01

    This study aimed to determine the discriminative validity, reproducibility, and prevalence of clinical signs suggestive of pharyngeal dysphagia according to gross motor function in children with cerebral palsy (CP). It was a cross-sectional population-based study of 130 children diagnosed with CP at 18-36 months (mean=27.4, 81 males) and 40 children with typical development (TD, mean=26.2, 18 males). Sixteen signs suggestive of pharyngeal phase impairment were directly observed in a videoed mealtime by a speech pathologist, and reported by parents on a questionnaire. Gross motor function was classified using the Gross Motor Function Classification System. The study found that 67.7% of children had clinical signs, and this increased with poorer gross motor function (OR=1.7, pDysphagia cut-points were modified to exclude a single cough on fluids, with a modified prevalence estimate proposed as 50.8%. Clinical signs suggestive of pharyngeal dysphagia are common in children with CP, even those with ambulatory CP. Parent-report on 16 specific signs remains a feasible screening method. While coughing was consistently identified by clinicians, it may not reflect children's regular performance, and was not sufficiently discriminative in children aged 18-36 months. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  11. Oropharyngeal dysphagia as dominant and life-threatening symptom in dermatomyositis

    Directory of Open Access Journals (Sweden)

    Đaković Zorana

    2009-01-01

    Full Text Available Background. Dysphagia can be a serious problem in patients with inflammatory myopathies. It may be associated with nutritional deficit, aspiration pneumonia, and poor prognosis. Case report. We presented a 60-year-old male, suffering from difficulty in swallowing, pain and weaknes in the proximal parts of his extremities, and skin manifestation. Laboratory findings showed increased creatine kinase and aldolase. Antinuclear antibodies to HEP-2 subtrate revealed titer of 1:40. Electromyoneurography demonstrated evidence of a proximal myopathy. A muscle biopsy revealed myositis. The baruim swallow test was remarkable for regurgitation, and nasal emerging of barium. Nuclear magnetic resonance images of cranium was normal. Tumor markers CEA, and Ca 19-9 were increased. A dose of 1 mg daily prednisolone was administered and percutaneous enteral feeding was performed. Two months later, the patient developed febrile state, aspiration pneumonia, and died due to respiratory failure. Conclusion. In cases of dermatomyositis with the serious dysphagia, percutaneous endoscopic gastrostomy should be performed as soon as possible. Owerall survival rate is low, even with an adequate therapy administration. Inflammatory myopathies should be considered in any patient with oropharyngeal dysphagia.

  12. Pressure Flow Analysis in the Assessment of Preswallow Pharyngeal Bolus Presence in Dysphagia

    Directory of Open Access Journals (Sweden)

    Lara Ferris

    2015-01-01

    Full Text Available Objectives. Preswallow pharyngeal bolus presence is evident in patients with oropharyngeal dysphagia. Pressure flow analysis (PFA using high resolution manometry with impedance (HRMI with AIMplot software is a method for objective interpretation of pharyngeal and upper esophageal sphincter (UES pressures and bolus flow patterns during swallowing. This study aimed to observe alterations in PFA metrics in the event of preswallow pharyngeal bolus presence as seen on videofluoroscopy (VFSS. Methods. Swallows from 40 broad dysphagia patients and 8 controls were recorded with a HRMI catheter during simultaneous VFSS. Evidence of bolus presence and level reached prior to pharyngeal swallow onset was recorded. AIMPlot software derived automated PFA functional metrics. Results. Patients with bolus movement to the pyriform sinuses had a higher SRI, indicating greater swallow dysfunction. Amongst individual metrics, TNadImp to PeakP was shorter and flow interval longer in patient groups compared to controls. A higher pharyngeal mean impedance and UES mean impedance differentiated the two patient groups. Conclusions. This pilot study identifies specific altered PFA metrics in patients demonstrating preswallow pharyngeal bolus presence to the pyriform sinuses. PFA metrics may be used to guide diagnosis and treatment of patients with oropharyngeal dysphagia and track changes in swallow function over time.

  13. CLINICAL OBSERVATION ON SCALP ACUPUNCTURE TREATMENT OF WINDSTROKE-CAUSED DYSPHAGIA-DYSPHONIA SYNDRONE

    Institute of Scientific and Technical Information of China (English)

    HAN Jianhua; DONG Yingli; ZHANG Ru

    2002-01-01

    Objective: To observe the therapeuticeffect of scalp acupuncture on cerebral blood flow in pseudobulbar paralysis patients for analyzing mechanisms of scalp-acupunoture in the treatment of wind stroke. Methods: A total of 38 inpatients (26 males and 12 females) were treated with electroacupuncture (EA) of scalp-point Dingzhongxian (MS 5), Dingnie Houxiexian (MS 7), Dingpangxian Ⅱ (MS 9) and Dingnie Qianxiexian (MS 6). Before and after acupuncture treatment, clinical symptoms of dysphagia and dysphonia were compared, and the mean blood flow speed (MBFS) values of the anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) detected by using Doppler blood flow meter. Results: Following two courses (4 weeks) of scalp-acupuncture treatment, of the 38 cases, 23 had their dysphagia and dysphonia cured (60.5%), 10 (25.3%) had remarkable improvement, 3(7.9% ) experienced improvement and 2 (5.3%) had no apparent changes. Simultaneously, MBFS of ACA, MCA and PCA increased significantly in comparison with that of pre-treatment (P < 0.01 ). Additionally, results also showed that scalp acupuncture could stabilize the blood circulation between both hemispheres of the brain. Conclusion: Scalp acupuncture has a fairly good therapeutic effect in improving stroke caused dysphagia and dysphonia and in facilitating cerebral blood flow.

  14. Functional magnetic stimulation using a parabolic coil for dysphagia after stroke.

    Science.gov (United States)

    Momosaki, Ryo; Abo, Masahiro; Watanabe, Shu; Kakuda, Wataru; Yamada, Naoki; Mochio, Kenjiro

    2014-10-01

    Recently, the usefulness of neuromuscular electrical stimulation and repetitive transcranial magnetic stimulation for poststroke dysphagia has been reported. However, there is no report that describes the effectiveness of functional magnetic stimulation (FMS) for dysphagia. The purpose of this study is to clarify the effectiveness of FMS for poststroke dysphagia. Twenty poststroke dysphagic patients (age at treatment: 51-80 years; interval between onset of stroke and treatment: 6 to 36 months) were randomly assigned to a real group or a sham group. In the real group, FMS of 30 Hz was applied for suprahyoid muscles in a 20-sec train using a parabolic coil for 10 min (total 1200 pulses). In the sham group, sham stimulation was applied for 10 min at the same site. Swallowing function was evaluated by the timed water swallow test, interswallow interval (ISI), swallowing volume velocity (speed), and volume per swallow (capacity) were measured before and after stimulation. All patients completed the stimulation and none showed any adverse reactions throughout the stimulation. The improvement of speed and capacity of swallowing after stimulation was significantly larger in the real group compared with the sham group (all p parabolic coil can potentially improve swallowing function in poststroke dysphagic patients. © 2013 International Neuromodulation Society.

  15. Viscosity threshold that allows safe swallow in elderly with post-stroke dysphagia

    Directory of Open Access Journals (Sweden)

    Rodolfo Peña

    2017-08-01

    Full Text Available Objective: To determine the viscosity threshold that allows safe swallowing in older adults with post-stroke dysphagia. Method: Cross-sectional analytical study. 6 patients over 60 years old with dysphagia participated. Were given six viscosities (50mPa s, 110mPa s, 170mPa s, 230mPa s, 290mPa s and 350mPa s made from no carbonated water and a corn starch-based thickener. Swallowing safety signs (wet voice, cough and oxygen saturation were assessed in each viscosity by Fiberoptic Endoscopic Evaluation of Swallowing (FEES. Viscosities’ performances in swallowing safety signs were compared in order to know which viscosity would be the safest. Results: 100% of swallowing safety signs did not appear in any viscosity assessed. Conclusions: It is not possible to determine the viscosity threshold that allows safe swallowing in patients with post-stroke dysphagia in the viscosities assessed. We discuss about multiple factors that had had affect our results: size sample, use of FEES to assess low viscosities, and viscosities’ intervals used.

  16. Application of noninvasive brain stimulation for post-stroke dysphagia rehabilitation.

    Science.gov (United States)

    Wang, Zhuo; Song, Wei-Qun; Wang, Liang

    2017-02-01

    Noninvasive brain stimulation (NIBS), commonly consisting of transcranial magnetic stimulation (TMS), transcranial direct-current stimulation (tDCS), as well as paired associative stimulation (PAS), has attracted increased interest and been applied experimentally in the treatment of post-stroke dysphagia (PSD). This review presented a synopsis of the current research for the application of NIBS on PSD. The intention here was to understand the current research progress and limitations in this field and to stimulate potential research questions not yet investigated for the application of NIBS on patients with PSD. Here we successively reviewed advances of repetitive TMS (rTMS), tDCS, and PAS techniques on both healthy participants and PSD patients in three aspects, including scientific researches about dysphagia mechanism, applied studies about stimulation parameters, and clinical trials about their therapeutic effects. The techniques of NIBS, especially rTMS, have been used by the researchers to explore the different mechanisms between swallowing recovery and extremity rehabilitation. The key findings included the important role of intact hemisphere reorganization for PSD recovery, and the use of NIBS on the contra-lesional side as a therapeutic potential for dysphagia rehabilitation. Though significant results were achieved in most studies by using NIBS on swallowing rehabilitation, it is still difficult to draw conclusions for the efficacy of these neurostimulation techniques, considering the great disparities between studies. Copyright © 2016. Published by Elsevier Taiwan.

  17. Application of noninvasive brain stimulation for post-stroke dysphagia rehabilitation

    Directory of Open Access Journals (Sweden)

    Zhuo Wang

    2017-02-01

    Full Text Available Noninvasive brain stimulation (NIBS, commonly consisting of transcranial magnetic stimulation (TMS, transcranial direct-current stimulation (tDCS, as well as paired associative stimulation (PAS, has attracted increased interest and been applied experimentally in the treatment of post-stroke dysphagia (PSD. This review presented a synopsis of the current research for the application of NIBS on PSD. The intention here was to understand the current research progress and limitations in this field and to stimulate potential research questions not yet investigated for the application of NIBS on patients with PSD. Here we successively reviewed advances of repetitive TMS (rTMS, tDCS, and PAS techniques on both healthy participants and PSD patients in three aspects, including scientific researches about dysphagia mechanism, applied studies about stimulation parameters, and clinical trials about their therapeutic effects. The techniques of NIBS, especially rTMS, have been used by the researchers to explore the different mechanisms between swallowing recovery and extremity rehabilitation. The key findings included the important role of intact hemisphere reorganization for PSD recovery, and the use of NIBS on the contra-lesional side as a therapeutic potential for dysphagia rehabilitation. Though significant results were achieved in most studies by using NIBS on swallowing rehabilitation, it is still difficult to draw conclusions for the efficacy of these neurostimulation techniques, considering the great disparities between studies.

  18. Chemical modification of the urokinase-type plasminogen activator and its receptor using tetranitromethane. Evidence for the involvement of specific tyrosine residues in both molecules during receptor-ligand interaction

    DEFF Research Database (Denmark)

    Ploug, M; Rahbek-Nielsen, H; Ellis, V

    1995-01-01

    ., Ellis, V., & Danø, K. (1994) Biochemistry 33, 8991-8997]. To identify residues engaged in the uPAR-uPA interaction, we have performed a "protein-protein footprinting" study on preformed uPAR-GFD complexes by chemical modification with tetranitromethane. All six tyrosine residues in uPAR and the single...

  19. Sintomas indicativos de disfagia em portadores de DPOC Symptoms of dysphagia in patients with COPD

    Directory of Open Access Journals (Sweden)

    Rosane de Deus Chaves

    2011-04-01

    Full Text Available OBJETIVO: Identificar os sintomas indicativos de disfagia em indivíduos portadores de DPOC a partir de um questionário de autopercepção. MÉTODOS: Foram avaliados 35 indivíduos portadores de DPOC e 35 indivíduos sem a doença pareados por gênero e idade. O grupo de estudo foi avaliado quanto a gravidade da doença, sensação de dispneia, índice de massa corpórea (IMC e sintomas de disfagia. O grupo controle foi avaliado quanto a IMC e sintomas de disfagia. RESULTADOS: Os sintomas mais frequentes de disfagia apresentados pelos participantes do grupo de estudo foram sintomas faríngeos/proteção de vias aéreas (p OBJECTIVE: To identify symptoms of dysphagia in individuals with COPD, based on their responses on a self-perception questionnaire. METHODS: The study comprised 35 individuals with COPD and 35 healthy individuals, matched for age and gender. The study group was assessed regarding COPD severity; sensation of dyspnea; body mass index (BMI; and symptoms of dysphagia. The control group was assessed regarding BMI and symptoms of dysphagia. RESULTS: The most common symptoms of dysphagia in the study group were pharyngeal symptoms/airway protection (p < 0.001; esophageal symptoms/history of pneumonia (p < 0.001; and nutritional symptoms (p < 0.001. Positive correlations were found between the following pairs of variables: FEV1 and BMI (r = 0.567; p < 0.001; pharyngeal symptoms/airway protection and dyspnea (r = 0.408; p = 0.015; and esophageal symptoms/history of pneumonia and pharyngeal symptoms/airway protection (r = 0.531; p = 0.001. There was a negative correlation between nutritional symptoms and BMI (r = -0.046; p < 0.008. CONCLUSIONS: Our results show that the individuals with COPD presented with symptoms of dysphagia that were associated with the pharyngeal and esophageal phases of swallowing, as well as with the mechanism of airway protection, a history of pneumonia, and nutritional symptoms.

  20. Palliative radiotherapy in addition to self-expanding metal stent for improving dysphagia and survival in advanced oesophageal cancer (ROCS: Radiotherapy after Oesophageal Cancer Stenting): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Adamson, Douglas; Blazeby, Jane; Nelson, Annmarie; Hurt, Chris; Nixon, Lisette; Fitzgibbon, Jim; Crosby, Tom; Staffurth, John; Evans, Mim; Kelly, Noreen Hopewell; Cohen, David; Griffiths, Gareth; Byrne, Anthony

    2014-10-22

    The single most distressing symptom for patients with advanced esophageal cancer is dysphagia. Amongst the more effective treatments for relief of dysphagia is insertion of a self-expanding metal stent (SEMS). It is possible that the addition of a palliative dose of external beam radiotherapy may prolong the relief of dysphagia and provide additional survival benefit. The ROCS trial will assess the effect of adding palliative radiotherapy after esophageal stent insertion. The study is a randomized multicenter phase III trial, with an internal pilot phase, comparing stent alone versus stent plus palliative radiotherapy in patients with incurable esophageal cancer. Eligible participants are those with advanced esophageal cancer who are in need of stent insertion for primary management of dysphagia. Radiotherapy will be administered as 20 Gray (Gy) in five fractions over one week or 30 Gy in 10 fractions over two weeks, within four weeks of stent insertion. The internal pilot will assess rates and methods of recruitment; pre-agreed criteria will determine progression to the main trial. In total, 496 patients will be randomized in a 1:1 ratio with follow up until death. The primary outcome is time to progression of patient-reported dysphagia. Secondary outcomes include survival, toxicity, health resource utilization, and quality of life. An embedded qualitative study will explore the feasibility of patient recruitment by examining patients' motivations for involvement and their experiences of consent and recruitment, including reasons for not consenting. It will also explore patients' experiences of each trial arm. The ROCS study will be a challenging trial studying palliation in patients with a poor prognosis. The internal pilot design will optimize methods for recruitment and data collection to ensure that the main trial is completed on time. As a pragmatic trial, study strengths include collection of all follow-up data in the usual place of care, and a focus on

  1. Oropharyngeal dysphagia is a risk factor for readmission for pneumonia in the very elderly persons: observational prospective study.

    Science.gov (United States)

    Cabré, Mateu; Serra-Prat, Mateu; Force, Ll; Almirall, Jordi; Palomera, Elisabet; Clavé, Pere

    2014-03-01

    To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit. Observational prospective cohort study with data collection based on clinical databases and electronic clinical notes. All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31, 2010. All individuals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination. Main outcome measure was readmission for pneumonia. Clinical notes were reviewed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia. A total of 2,359 patients (61.9% women, mean age 84.9 y) were recruited and followed for a mean of 24 months. Dysphagia was diagnosed in 47.5% of cases. Overall, 7.9% of individuals were readmitted for pneumonia during follow-up, 24.2% of these had aspiration pneumonia. The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years (95% CI 3.0-4.4) in individuals without dysphagia and 6.7 (5.5-7.8) in those with dysphagia, with an attributable risk of 3.02 readmissions per 100 person-years (1.66-4.38) and a rate ratio of 1.82 (1.41-2.36). Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia, with a hazard ratio of 1.6 (1.15-2.2) for hospitalization for pneumonia, 4.48 (2.01-10.0) for aspiration pneumonia, and 1.44 (1.02-2.03) for nonaspiration pneumonia. Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons.

  2. Acute and long-term dysphagia in critically ill patients with severe sepsis: results of a prospective controlled observational study.

    Science.gov (United States)

    Zielske, Joerg; Bohne, Silvia; Brunkhorst, Frank M; Axer, Hubertus; Guntinas-Lichius, Orlando

    2014-11-01

    Dysphagia is a major risk factor for morbidity and mortality in critically ill patients treated in intensive care units (ICUs). Structured otorhinolaryngological data on dysphagia in ICU survivors with severe sepsis are missing. In a prospective study, 30 ICU patients with severe sepsis and thirty without sepsis as control group were examined using bedside fiberoptic endoscopic evaluation of swallowing after 14 days in the ICU (T1) and 4 months after onset of critical illness (T2). Swallowing dysfunction was assessed using the Penetration-Aspiration Scale (PAS). The Functional Oral Intake Scale was applied to evaluate the diet needed. Primary endpoint was the burden of dysphagia defined as PAS score >5. At T1, 19 of 30 severe sepsis patients showed aspiration with a PAS score >5, compared to 7 of 30 in critically ill patients without severe sepsis (p = 0.002). Severe sepsis and tracheostomy were independent risk factors for severe dysphagia with aspiration (PAS > 5) at T1 (p = 0.042 and 0.006, respectively). 4-month mortality (T2) was 57 % in severe sepsis patients compared to 20 % in patients without severe sepsis (p = 0.006). At T2, more severe sepsis survivors were tracheostomy-dependent and needed more often tube or parenteral feeding (p = 0.014 and p = 0.040, respectively). Multivariate analysis revealed tracheostomy at T1 as independent risk factor for severe dysphagia at T2 (p = 0.030). Severe sepsis appears to be a relevant risk factor for long-term dysphagia. An otorhinolaryngological evaluation of dysphagia at ICU discharge is mandatory for survivors of severe critical illness to plan specific swallowing rehabilitation programs.

  3. Readers of histone modifications

    Institute of Scientific and Technical Information of China (English)

    Miyong Yun; Jun Wu; Jerry L Workman; Bing Li

    2011-01-01

    Histone modifications not only play important roles in regulating chromatin structure and nuclear processes but also can be passed to daughter cells as epigenetic marks.Accumulating evidence suggests that the key function of histone modifications is to signal for recruitment or activity of downstream effectors. Here, we discuss the latest discovery of histone-modification readers and how the modification language is interpreted.

  4. Oral conditions and dysphagia in Japanese, community-dwelling middle- and older- aged adults, independent in daily living

    Directory of Open Access Journals (Sweden)

    Inui A

    2017-03-01

    Full Text Available Akinari Inui,1 Ippei Takahashi,2 Sizuka Kurauchi,2 Yuki Soma,2 Toshiaki Oyama,1 Yoshihiro Tamura,1 Takao Noguchi,1 Kouichi Murashita,3 Shigeyuki Nakaji,2 Wataru Kobayashi1 1Department of Oral and Maxillofacial Surgery, 2Department of Social Medicine, 3COI Research Initiatives Organization, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori Prefecture, Japan Purpose: Prevention, early detection and effective rehabilitation of dysphagia are important issues to be considered in an aging society. Previous studies have shown conflicting findings regarding the association between dysphagia and its potential risk factors, including age, malnutrition, oral conditions, lifestyle and medical history. Herein, we assessed the prevalence and association of dysphagia with potential risk factors in 50- to 79-year-old adults dwelling in a community in Japan. Patients and methods: In this study, there were 532 participants (185 males and 347 females. Participants who responded positively to the question “Do you sometimes choke on drinks/food such as tea and soup?” or those who presented with abnormal repetitive saliva swallowing test findings were diagnosed with dysphagia. The data collected from these participants included the following: number of teeth, occurrence of oral dryness, age, body mass index, serum albumin concentration, smoking, drinking and exercise habits, presence of diseases, such as diabetes mellitus and hypertension, and questions from the Mini–Mental State Examination. Results: Dysphagia was observed in 33 males (17.8% and 76 females (21.9%. To explore the effect of the potential risk factors on the prevalence of dysphagia, a model was built by multivariate logistic regression analysis. Using the forced entry method, oral dryness (odds ratio [OR] =3.683 and P=0.003 in males; OR =1.797 and P=0.032 in females and the number of teeth (OR =0.946 and P=0.038 in males were found to be significantly related to dysphagia

  5. Pharyngeal Electrical Stimulation for Treatment of Poststroke Dysphagia: Individual Patient Data Meta-Analysis of Randomised Controlled Trials

    Directory of Open Access Journals (Sweden)

    Polly Scutt

    2015-01-01

    Full Text Available Background. Dysphagia after stroke is common, associated independently with poor outcome, and has limited treatment options. Pharyngeal electrical stimulation (PES is a novel treatment being evaluated for treatment of poststroke dysphagia. Methods. We searched electronically for randomised controlled trials of PES in dysphagic patients within 3 months of stroke. Individual patient data were analysed using regression, adjusted for trial, age, severity, and baseline score. The coprimary outcomes were radiological aspiration (penetration aspiration score, PAS and clinical dysphagia (dysphagia severity rating scale, DSRS at 2 weeks; secondary outcomes included functional outcome, death, and length of stay in hospital. Results. Three completed trials were identified: 73 patients, age 72 (12 years, severity (NIHSS 11 (6, DSRS 6.7 (4.3, mean PAS 4.3 (1.8. Compared with no/sham stimulation, PES was associated with lower PAS, 3.4 (1.7 versus 4.1 (1.7, mean difference −0.9 (p=0.020, and lower DSRS, 3.5 (3.8 versus 4.9 (4.4, mean difference −1.7 (p=0.040. Length of stay in hospital tended to be shorter: 50.2 (25.3 versus 71.2 (60.4 days (p=0.11. Functional outcome and death did not differ between treatment groups. Conclusions. PES was associated with less radiological aspiration and clinical dysphagia and possibly reduced length of stay in hospital across three small trials.

  6. A combined approach of bedside clinical examination and flexible endoscopic evaluation of swallowing in poststroke dysphagia: A pilot study

    Directory of Open Access Journals (Sweden)

    Sureshkumar Radhakrishnan

    2013-01-01

    Full Text Available Background: As with most neurologic conditions, stroke involves impairment of the swallowing mechanism. This could be a spectrum of issues, the worst of which is aspiration. At the same time, the prolonged presence of a naso-gastric tube (NGT has its own morbidity. Flexible endoscopic evaluation of swallowing (FEES is one reliable method to assess the structural and functional status of the oropharynx and larynx, during the swallowing process. Objective: To study the utility of FEES in decision-making with respect to resumption of oral intake in stroke patients. To document the findings of FEES in stroke patients, and to look for correlations between these and the site of stroke. Materials and Methods: Protocol insertion of naso-gastric tube in all stroke patients, at presentation. Initial assessment by a neurologist and swallowing therapist, depending on cognitive status of the patient. All patients underwent MRI Brain with diffusion weighted sequences. After detailed clinical examination, they underwent swallow exercises under the supervision of a trained swallowing therapist. The decision to remove NGT was taken clinically by the combined decision of neurologist and swallowing therapist. Then all patients underwent FEES by the ENT surgeon. The final decision for NGT removal was taken as per the FEES findings. Result: Sixteen stroke patients underwent the FEES procedure during a period of six months. The oropharyngeal and laryngeal findings varied depending on the area of stroke involvement. Of these, change in decision regarding swallowing rehabilitation or NGT removal was needed in four patients, following the FEES findings. Conclusions: FEES is an easy, efficient and reliable method to evaluate the swallowing status in stroke patients. In combination with good bedside clinical examination and swallow exercises, it can be a good tool in assessing patients with post- stroke dysphagia. Post-stroke rehabilitation and prevention of aspiration

  7. Chromatin architecture near a potential 3' end of the igh locus involves modular regulation of histone modifications during B-Cell development and in vivo occupancy at CTCF sites.

    Science.gov (United States)

    Garrett, Francine E; Emelyanov, Alexander V; Sepulveda, Manuel A; Flanagan, Patrick; Volpi, Sabrina; Li, Fubin; Loukinov, Dmitry; Eckhardt, Laurel A; Lobanenkov, Victor V; Birshtein, Barbara K

    2005-02-01

    The murine Igh locus has a 3' regulatory region (3' RR) containing four enhancers (hs3A, hs1,2, hs3B, and hs4) at DNase I-hypersensitive sites. The 3' RR exerts long-range effects on class switch recombination (CSR) to several isotypes through its control of germ line transcription. By measuring levels of acetylated histones H3 and H4 and of dimethylated H3 (K4) with chromatin immunoprecipitation assays, we found that early in B-cell development, chromatin encompassing the enhancers of the 3' RR began to attain stepwise modifications typical of an open conformation. The hs4 enhancer was associated with active chromatin initially in pro- and pre-B cells and then together with hs3A, hs1,2, and hs3B in B and plasma cells. Histone modifications were similar in resting splenic B cells and in splenic B cells induced by lipopolysaccharide to undergo CSR. From the pro-B-cell stage onward, the approximately 11-kb region immediately downstream of hs4 displayed H3 and H4 modifications indicative of open chromatin. This region contained newly identified DNase I-hypersensitive sites and several CTCF target sites, some of which were occupied in vivo in a developmentally regulated manner. The open chromatin environment of the extended 3' RR in mature B cells was flanked by regions associated with dimethylated K9 of histone H3. Together, these data suggest that 3' RR elements are located within a specific chromatin subdomain that contains CTCF binding sites and developmentally regulated modules.

  8. The effect of sensory level electrical stimulation of the masseter muscle in early stroke patients with dysphagia: A randomized controlled study.

    Science.gov (United States)

    Umay, Ebru K; Yaylaci, Atilay; Saylam, Guleser; Gundogdu, Ibrahim; Gurcay, Eda; Akcapinar, Dehen; Kirac, Zeynep

    2017-01-01

    Dysphagia is a serious cause of morbidity and mortality in stroke patients. As the first study in literature, we aimed to evaluate the effects of sensory-level electrical stimulation (SES) to bilateral masseter muscles in early stroke patients with dysphagia. This study was conducted at the Physical Medicine and Rehabilitation Clinic of our hospital between 2013 and 2015. Ninety-eight patients with dysphagia within the first month after ischemic stroke were included in this study. Patients were evaluated by bedside screening tests (Bedside Dysphagia Score, Neurological Examination Dysphagia Score, Total Dysphagia Score, and Mann Assessment of Swallowing Ability test) and by flexible fibreoptic endoscopic evaluation of swallowing (FEES) methods. All patients were included in a traditional swallowing therapy. Patients were divided into two groups, namely the "stimulation group" and "sham group." SES was applied to bilateral masseter muscles. Evaluation parameters were compared between the groups before and after therapy. The Friedman test, Wilcoxon Signed Rank test, Mann-Whitney U test, and Fisher exact test were used in this study. There was a significant improvement in dysphagia severity scores evaluated by bedside screening tests and FEES in cognitive and total functionality levels except in motor functional independence level in the stimulation group. In the sham group, there were no significant changes in the evaluation parameters. SES applied to bilateral masseter muscles may provide an effective treatment for both dysphagia and cognitive function in early stroke patients.

  9. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer

    DEFF Research Database (Denmark)

    Mortensen, Hanna Rahbek; Overgaard, Jens; Jensen, Kenneth;

    2013-01-01

    Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on informatio...

  10. 重症脑卒中吞咽障碍26例疗效分析%Therapeutic effect of dysphagia in patients with severe stroke

    Institute of Scientific and Technical Information of China (English)

    刘永明; 史长青; 常天才

    2003-01-01

    @@ INTRODUCTION Patients with severe cerebral hemorrhage and cerebral thrombus andserious dysphagia lived on nasal feeding and venous transfu-sion. These patients' quality of life, rehabilitation of paralysis,aphasia is unfavorable due to various complications. Therefore,many patients gave up treatment wearing nasal feeding tube. In thisstudy, we investigated treatment and affecting factors of dysphagia.

  11. Validation of the total dysphagia risk score (TDRS) in head and neck cancer patients in a conventional and a partially accelerated radiotherapy scheme

    NARCIS (Netherlands)

    Nevens, Daan; Deschuymer, Sarah; Langendijk, Johannes A.; Daisne, Jean -Francois; Duprez, Frederic; De Neve, Wilfried; Nuyts, Sandra

    Background and purpose: A risk model, the total dysphagia risk score (TDRS), was developed to predict which patients are most at risk to develop grade >= 2 dysphagia at 6 months following radiotherapy (RT) for head and neck cancer. The purpose of this study was to validate this model at 6 months and

  12. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer

    DEFF Research Database (Denmark)

    Mortensen, Hanna R; Overgaard, Jens; Jensen, Kenneth

    2013-01-01

    Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on information...

  13. An electrophysiological approach to the diagnosis of neurogenic dysphagia: implications for botulinum toxin treatment.

    Science.gov (United States)

    Alfonsi, E; Merlo, I M; Ponzio, M; Montomoli, C; Tassorelli, C; Biancardi, C; Lozza, A; Martignoni, E

    2010-01-01

    Botulinum toxin (BTX) injection into the cricopharyngeal (CP) muscle has been proposed for the treatment of neurogenic dysphagia due to CP hyperactivity. The aim was to determine whether an electrophysiological method exploring oropharyngeal swallowing could guide treatment and discriminate responders from non-responders, based on the association of CP dysfunction with other electrophysiological abnormalities of swallowing. Patients with different neurological disorders were examined: Parkinson disease, progressive supranuclear palsy, multiple system atrophy-Parkinson variant, multiple system atrophy cerebellar variant, stroke, multiple sclerosis and ataxia telangiectasia. All patients presented with clinical dysphagia, and with complete absence of CP muscle inhibition during the hypopharyngeal phase of swallowing. Each patient underwent clinical and electrophysiological investigations before and after treatment with BTX into the CP muscle of one side (15 units of Botox). Clinical and electrophysiological procedures were performed in a blind manner by two different investigators. The following electrophysiological measures were analysed: (1) duration of EMG activity of suprahyoid/submental muscles (SHEMG-D); (2) duration of laryngopharyngeal mechanogram (LPM-D); (3) duration of the inhibition of the CP muscle EMG activity (CPEMG-ID); and (4) interval between onset of EMG activity of suprahyoid/submental muscles and onset of laryngopharyngeal mechanogram (I-SHEMG-LPM). Two months after treatment, 50% of patients showed a significant improvement. Patients with prolonged or reduced SHEMG-D values and prolonged I-SHEMG-LPM values did not respond to BTX. Therefore, values for which BTX had no effect (warning values) were identified. This electrophysiological method can recognise swallowing abnormalities which may affect the outcome of the therapeutic approach to dysphagia with BTX treatment.

  14. Lower esophageal sphincter relaxation is impaired in older patients with dysphagia

    Institute of Scientific and Technical Information of China (English)

    Laura K Besanko; Carly M Burgstad; Reme Mountifield; Jane M Andrews; Richard Heddle; Helen Checklin; Robert JL Fraser

    2011-01-01

    AIM: To characterize the effects of age on the mechanisms underlying the common condition of esophageal dysphagia in older patients, using detailed manometric analysis. METHODS: A retrospective case-control audit was performed on 19 patients aged ≥ 80 years (mean age 85 ± 0.7 year) who underwent a manometric study for dysphagia (2004-2009). Data were compared with 19 younger dysphagic patients (32 ± 1.7 years). Detailed manometric analysis performed prospectively included basal lower esophageal sphincter pressure (BLESP), pre-swallow and nadir LESP, esophageal body pressures and peristaltic duration, during water swallows (5 mL) in right lateral (RL) and upright (UR) postures and with solids. Data are mean ± SE; a P -value < 0.05 was considered significant. RESULTS: Elderly dysphagic patients had higher BLESP than younger patients (23.4 ± 3.8 vs 14.9 ± 1.2 mmHg; P < 0.05). Pre-swallow LESP was elevated in the elderly in both postures (RL: 1 and 4 s P = 0.019 and P = 0.05; UR: P < 0.05 and P = 0.05) and solids (P < 0.01). In older patients, LES nadir pressure was higher with liquids (RL: 2.3 ± 0.6 mmHg vs 0.7 ± 0.6 mmHg, P < 0.05; UR: 3.5 ± 0.9 mmHg vs 1.6 ± 0.5 mmHg, P = 0.01) with shorter relaxation after solids (7.9 ± 1.5 s vs 9.7 ± 0.4 s, P = 0.05). No age-related differences were seen in esophageal body pressures or peristalsis duration. CONCLUSION: Basal LES pressure is elevated and swallow-induced relaxation impaired in elderly dysphagic patients. Its contribution to dysphagia and the effects of healthy ageing require further investigation.

  15. Pharyngeal mis-sequencing in dysphagia: characteristics, rehabilitative response, and etiological speculation.

    Science.gov (United States)

    Huckabee, Maggie-Lee; Lamvik, Kristin; Jones, Richard

    2014-08-15

    Clinical data are submitted as documentation of a pathophysiologic feature of dysphagia termed pharyngeal mis-sequencing and to encourage clinicians and researchers to adopt more critical approaches to diagnosis and treatment planning. Recent clinical experience has identified a cohort of patients who present with an atypical dysphagia not specifically described in the literature: mis-sequenced constriction of the pharynx when swallowing. As a result, they are unable to coordinate streamlined bolus transfer from the pharynx into the esophagus. This mis-sequencing contributes to nasal redirection, aspiration, and, for some, the inability to safely tolerate an oral diet. Sixteen patients (8 females, 8 males), with a mean age of 44 years (range=25-78), had an average time post-onset of 23 months (range=2-72) at initiation of intensive rehabilitation. A 3-channel manometric catheter was used to measure pharyngeal pressure. The average peak-to-peak latency between nadir pressures at sensor-1 and sensor-2 was 15 ms (95% CI, -2 to 33 ms), compared to normative mean latency of 239 ms (95% CI, 215 to 263 ms). Rehabilitative responses are summarized, along with a single detailed case report. It is unclear from these data if pharyngeal mis-sequencing is (i) a pathological feature of impaired motor planning from brainstem damage or (ii) a maladaptive compensation developed in response to chronic dysphagia. Future investigation is needed to provide a full report of pharyngeal mis-sequencing, and the implications on our understanding of underlying neural control of swallowing. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Jaw-opening force test to screen for Dysphagia: preliminary results.

    Science.gov (United States)

    Hara, Koji; Tohara, Haruka; Wada, Satoko; Iida, Takatoshi; Ueda, Koichiro; Ansai, Toshihiro

    2014-05-01

    To assess the jaw-opening force test (JOFT) for dysphagia screening. Criterion standard. University dental hospital. Patients complaining of dysphagia (N=95) and with symptoms of dysphagia with chronic underlying causes (mean age ± SD, 79.3±9.61y; range, 50-94y; men: n=49; mean age ± SD, 77.03±9.81y; range, 50-94y; women: n=46; mean age ± SD, 75.42±9.73y; range, 51-93y) admitted for treatment between May 2011 and December 2012 were included. None. All patients were administered the JOFT and underwent fiberoptic endoscopic evaluation of swallowing (FEES). The mean jaw-opening strength was compared with aspiration (ASP) and pharyngeal residue observations of the FEES, which was used as the criterion standard. A receiver operating characteristic (ROC) curve analysis was performed. Forces of ≤3.2kg for men and ≤4kg for women were appropriate cutoff values for predicting ASP with a sensitivity and specificity of .57 and .79 for men and .93 and .52 for women, respectively. Based on the ROC analyses for predicting pharyngeal residue, forces of ≤5.3kg in men and ≤3.9kg in women were appropriate cutoff values, with a sensitivity and specificity of .80 and .88 for men and .83 and .81 for women, respectively. The JOFT could be a useful screening tool for predicting pharyngeal residue and could provide useful information to aid in the referral of patients for further diagnostic imaging testing. However, given its low sensitivity to ASP the JOFT should be paired with other screening tests that predict ASP. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  17. Cricopharyngeal dilatation for the long-term treatment of dysphagia in oculopharyngeal muscular dystrophy.

    Science.gov (United States)

    Manjaly, Joseph G; Vaughan-Shaw, Peter G; Dale, Oliver T; Tyler, Susan; Corlett, Jonathan C R; Frost, Roger A

    2012-06-01

    Oculopharyngeal muscular dystrophy (OPMD) is a rare autosomal dominant, progressive degenerative muscle disorder featuring dysphagia with limited therapeutic options. The aim of this study was to evaluate the safety and efficacy of repeated endoscopic dilatation for OPMD over a 15-year period. All patients seen at our Regional Swallowing Clinic with OPMD confirmed by genetic analysis were included. Cricopharyngeal dilatation was performed as an outpatient procedure using a wire-guided 18-mm (54 Fr) Savary-Gilliard bougie with the patient under sedation. Patients were offered repeat endoscopic dilatation when symptoms recurred. Symptom severity prior to initial dilatation and at follow-up was evaluated using the Sydney Swallow Questionnaire (SSQ). Nine patients (7 female, 2 male) were included for analysis. Median total treatment period was 13 years (range = 3-15), median number of dilatations per patient was 7.2 (range = 1-16), and median interval between treatments was 15 months (range = 4.5-45). All patients recorded sustained symptom improvement. Mean SSQ score (out of 1,700) was 1,108.11 (SD ± 272.85) prior to first dilatation and 297.78 (SD ± 189.14) at last follow-up, representing a 73% decrease (95% CI = 52-94) in degree of dysphagia symptoms (paired t-test, P = 0.0001). All mean scores for individual questions also showed significant improvement (P < 0.05). No adverse events were reported with all patients maintaining oral feeding at last follow-up. Repeated cricopharyngeal dilatation is a safe, effective, well-tolerated, and long-lasting treatment for dysphagia in OPMD.

  18. Resolution of life-threatening dysphagia caused by caudal occipital malformation syndrome following foramen magnum decompressive surgery.

    Science.gov (United States)

    Graham, K J; Black, A P; Brain, P H

    2012-08-01

    A Cavalier King Charles Spaniel was presented with acute onset, life-threatening dysphagia suspected to be secondary to medulla oblongata compression caused by caudal occipital malformation syndrome. The patient required urgent tracheostomy tube placement to remain stable and was subsequently cured of the presenting neurological deficits by foramen magnum decompressive surgery. Neurogenic dysphagia is a relatively common presenting sign in human Chiari malformation syndromes, but has not been described as a major clinical sign in veterinary patients. Caudal occipital malformation syndrome should be included in the differential diagnosis list for susceptible breeds presenting with dysphagia. Early recognition favours expeditious surgical intervention and a positive outcome in human patients, and this may also be the case in veterinary patients. © 2012 The Authors. Australian Veterinary Journal © 2012 Australian Veterinary Association.

  19. The role of C2-C7 and O-C2 angle in the development of dysphagia after cervical spine surgery.

    Science.gov (United States)

    Tian, Wei; Yu, Jie

    2013-06-01

    Dysphagia is a known complication of cervical surgery and may be prolonged or occasionally serious. A previous study showed that dysphagia after occipitocervical fusion was caused by oropharyngeal stenosis resulting from O-C2 (upper cervical lordosis) fixation in a flexed position. However, there have been few reports analyzing the association between the C2-C7 angle (middle-lower cervical lordosis) and postoperative dysphagia. The aim of this study was to analyze the relationship between cervical lordosis and the development of dysphagia after anterior and posterior cervical spine surgery (AC and PC). Three hundred fifty-four patients were reviewed in this retrospective clinical study, including 172 patients who underwent the AC procedure and 182 patients who had the PC procedure between June 2007 and May 2010. The presence and duration of postoperative dysphagia were recorded via face-to-face questioning or telephone interview performed at least 1 year after the procedure. Plain cervical radiographs before and after surgery were collected. The O-C2 angle and the C2-C7 angle were measured. Changes in the O-C2 angle and the C2-C7 angle were defined as dO-C2 angle = postoperative O-C2 angle - preoperative O-C2 angle and dC2-C7 angle = postoperative C2-C7 angle - preoperative C2-C7 angle. The association between postoperative dysphagia with dO-C2 angle and dC2-C7 angle was studied. Results showed that 12.8 % of AC and 9.4 % of PC patients reported dysphagia after cervical surgery. The dC2-C7 angle has considerable impact on postoperative dysphagia. When the dC2-C7 angle is greater than 5°, the chance of developing postoperative dysphagia is significantly greater. The dO-C2 angle, age, gender, BMI, operative time, blood loss, procedure type, revision surgery, most cephalic operative level, and number of operative levels did not significantly influence the incidence of postoperative dysphagia. No relationship was found between the dC2-C7 angle and the degree of

  20. Surface electromyographic characteristics of swallowing in dysphagia secondary to brainstem stroke.

    Science.gov (United States)

    Crary, M A; Baldwin, B O

    1997-01-01

    Surface electromyography (SEMG) provides an noninvasive avenue for evaluating swallowing physiology. This report describes SEMG characteristics associated with swallow attempts in 6 dysphagic patients who had suffered brainstem stroke compared with 6 age and gender-matched controls. Results indicated that patients with dysphagia secondary to brainstem stroke differed in both amplitude and timing aspects of swallowing attempts from asymptomatic controls. Specifically, the results indicated that during swallow attempts, dysphagic patients produced more muscle activity over a shorter duration and with less coordination than controls. Potential physiological mechanisms of these results are discussed.

  1. [Dermatomyositis. Presentation of a mild to moderate case with early dysphagia].

    Science.gov (United States)

    Sánchez Carbonell, M; Climent Antolí, H; Leandro Fonseca, A L; Paricio Talayero, J M; Escrivá Tomás, P

    2015-01-01

    We report the case of a twelve year old female patient with juvenile dermatomyositis. The diagnosis was made in our unit a few days after starting with proximal muscular weakness and a skin rash. A combination of oral corticosteroids and methotrexate was administered. There was an initial improvent in the skin lesions, but with no changes in the muscle weakness. The appearance of dysphagia a few days after starting the treatment led us to add three pulses of parenteral methylprednisolone to her initial treatment. We report the case to illustrate the difficulties in deciding initial treatment options.

  2. Effect of Low-Frequency rTMS and NMES on Subacute Unilateral Hemispheric Stroke With Dysphagia

    Science.gov (United States)

    Lim, Kil-Byung; Lee, Hong-Jae; Yoo, Jeehyun

    2014-01-01

    Objective To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on post-stroke dysphagia. Methods Subacute (<3 months), unilateral hemispheric stroke patients with dysphagia were randomly assigned to the conventional dysphagia therapy (CDT), rTMS, or NMES groups. In rTMS group, rTMS was performed at 100% resting motor threshold with 1 Hz frequency for 20 minutes per session (5 days per week for 2 weeks). In NMES group, electrical stimulation was applied to the anterior neck for 30 minutes per session (5 days per week for 2 weeks). All three groups were given conventional dysphagia therapy for 4 weeks. We evaluated the functional dysphagia scale (FDS), pharyngeal transit time (PTT), the penetration-aspiration scale (PAS), and the American Speech-Language Hearing Association National Outcomes Measurement System (ASHA NOMS) swallowing scale at baseline, after 2 weeks, and after 4 weeks. Results Forty-seven patients completed the study; 15 in the CDT group, 14 in the rTMS group, and 18 in the NMES group. Mean changes in FDS and PAS for liquid during first 2 weeks in the rTMS and NMES groups were significantly higher than those in the CDT group, but no significant differences were found between the rTMS and NMES group. No significant difference in mean changes of FDS and PAS for semi-solid, PTT, and ASHA NOMS was observed among the three groups. Conclusion These results indicated that both low-frequency rTMS and NMES could induce early recovery from dysphagia; therefore, they both could be useful therapeutic options for dysphagic stroke patients. PMID:25379488

  3. Critical Dysphagia is Common in Parkinson Disease and Occurs Even in Early Stages: A Prospective Cohort Study.

    Science.gov (United States)

    Pflug, Christina; Bihler, Moritz; Emich, Katharina; Niessen, Almut; Nienstedt, Julie Cläre; Flügel, Till; Koseki, Jana-Christiane; Plaetke, Rosemarie; Hidding, Ute; Gerloff, Christian; Buhmann, Carsten

    2017-08-21

    To assess the prevalence of dysphagia and its typical findings in unselected "real-world" Parkinson patients using an objective gold-standard method. This was a prospective, controlled, cross-sectional study conducted in 119 consecutive Parkinson patients of all stages independent of subjective dysphagia. Patients and 32 controls were clinically and endoscopically examined by flexible endoscopic evaluation of swallowing (FEES) to evaluate the deglutition with regard to three consistencies (water, biscuit, and bread). Typical findings of dysphagia like penetration and aspiration, residues, and leakage were assessed. Dysphagia was common in Parkinson patients and occurred in all, even early, disease stages. Only 5% (6/119) of patients showed a completely unremarkable deglutition. Aspiration was seen in 25% (30/119) of patients and always related to water. Residues occurred in 93% (111/119), most commonly for bread. Leakage was much less frequent and was found in only 3-18%, depending on consistency. In a significant fraction of patients, objective dysphagia was not subjectively perceived. A total of 16% of asymptomatic patients suffered from critical aspiration. Significant swallowing deficiencies already occurred in early disease. Aspiration was found in 4 of 20 (20%) patients with disease duration of less than 2 years. Seven of 57 patients (12%) with Hoehn and Yahr stage 2 suffered from severe aspiration. Given the high frequency of critical aspiration in Parkinson disease, these patients should be evaluated early for dysphagia to avoid complications and recommend an adequate therapy. FEES is a simple, cost efficient, minimally invasive method that is ideally suited for this purpose.

  4. Hoarseness of voice, respiratory distress and dysphagia due to giant primary posterior mediastinal ectopic goitre: a rare clinical entity.

    Science.gov (United States)

    Chaudhry, Ikram Ulhaq; Cheema, Ahsan Iqbal; AlShamasi, Zahra; Mutairi, Hadi

    2016-04-25

    Primary posterior mediastinal ectopic goitre is an extremely rare entity; we report a case of a 28-year-old man who presented with dysphagia, respiratory distress and hoarseness of voice, gradually worsening over a period of 3 months. CT scan of the thorax revealed a giant posterior mediastinal ectopic goitre. The mass was removed through a right posterolateral thoracotomy. The patient's symptoms, respiratory distress and dysphagia disappeared immediately after surgery while his voice gradually returned to normal after 6 weeks.

  5. Aspiration in children and adolescents with neurogenic dysphagia: comparison of clinical judgment and fiberoptic endoscopic evaluation of swallowing.

    Science.gov (United States)

    Beer, Sabrina; Hartlieb, Till; Müller, Arnd; Granel, Michael; Staudt, Martin

    2014-12-01

    A total of 30 children and adolescents with dysphagia due to various chronic neurological disorders were assessed for their risk of aspiration. This assessment was performed clinically by experienced speech and swallowing therapists, and verified thereafter by fiberoptic endoscopy. We found the clinical judgment to be correct in only 70% (for aspiration of saliva), 55% (of puree), and 67% (of thin liquids). We conclude that, because of this unacceptably high error rate of clinical assessment, a fiberoptic evaluation of swallowing is a necessary diagnostic step both for the planning of therapy and for the development of feeding strategies in children and adolescents with neurogenic dysphagia. Georg Thieme Verlag KG Stuttgart · New York.

  6. [Aural Stimulation with Capsaicin Ointment Improved the Swallowing Function in Patients with Dysphagia: Evaluation by the SMRC Scale].

    Science.gov (United States)

    Kondo, Eiji; Jinnouchi, Osamu; Ohnishi, Hiroki; Kawata, Ikuji; Takeda, Noriaki

    2015-11-01

    Cough and swallowing reflexes are important airway-protective mechanisms against aspiration. Angiotensin-converting enzyme (ACE) inhibitors, one of the side effects of which is cough, have been reported to reduce the incidence of aspiration pneumonia in hypertensive patients with stroke. ACE inhibitors have also been reported to improve the swallowing function in post-stroke patients. On the other hand, stimulation of the Arnold nerve, the auricular branch of the vagus, triggers the cough reflex (Arnold's ear-cough reflex). Capsaicin, an agonist of Transient Receptor Potential Vanilloid 1 (TRPV1), has been shown to activate the peripheral sensory C-fibers. Stimulation of the sensory branches of the vagus in the laryngotracheal mucosa with capsaicin induces the cough reflex and has been reported to improve the swallowing function in patients with dysphagia. In our previous study, we showed that aural stimulation of the Arnold nerve with 0.025% capsaicin ointment improved the swallowing function, as evaluated by the endoscopic swallowing score, in 26 patients with dysphagia. In the present study, the video images of swallowing recorded in the previous study were re-evaluated using the SMRC scale by an independent otolaryngologist who was blinded to the information about the patients and the endoscopic swallowing score. The SMRC scale is used to evaluate four aspects of the swallowing function: 1) Sensory: the initiation of the swallowing reflex as assessed by the white-out timing; 2) Motion: the ability to hold blue-dyed water in the oral cavity and induce laryngeal elevation; 3) Reflex: glottal closure and the cough reflex induced by touching the epiglottis or arytenoid with the endoscope; 4) Clearance: pharyngeal clearance of the blue-dyed water after swallowing. Accordingly, we demonstrated that a single application of capsaicin ointment to the external auditory canal of patients with dysphagia significantly improved the R, but not the S, M or C scores, and this

  7. Effect of the patient-to-patient communication model on dysphagia caused by total laryngectomy.

    Science.gov (United States)

    Tian, L; An, R; Zhang, J; Sun, Y; Zhao, R; Liu, M

    2017-03-01

    The study aimed to evaluate the effect of a patient-to-patient communication model on dysphagia in laryngeal cancer patients after total laryngectomy. Sixty-five patients who had undergone total laryngectomy were randomly divided into three groups: a routine communication group, a patient communication group (that received the patient-to-patient communication model) and a physician communication group. Questionnaires were used to compare quality of life and swallowing problems among all patient groups. The main factors causing dysphagia in total laryngectomy patients were related to fear and mental health. The patient communication group had improved visual analogue scale scores at one week after starting to eat. Quality of life in swallowing disorders questionnaire scores were significantly higher in the patient communication and physician communication groups than in the routine communication group. In addition, swallowing problems were much more severe in patients educated to high school level and above than in others. The patient-to-patient communication model can be used to resolve swallowing problems caused by psychological factors in total laryngectomy patients.

  8. The effect of bolus viscosity on swallowing function in neurogenic dysphagia.

    Science.gov (United States)

    Clavé, P; de Kraa, M; Arreola, V; Girvent, M; Farré, R; Palomera, E; Serra-Prat, M

    2006-11-01

    To assess the pathophysiology and treatment of neurogenic dysphagia. 46 patients with brain damage, 46 with neurodegenerative diseases and eight healthy volunteers were studied by videofluoroscopy while swallowing 3-20 mL liquid (20.4 mPa s), nectar (274.4 mPa s) and pudding (3931.2 mPa s) boluses. Volunteers presented a safe and efficacious swallow, short swallow response ( or =0.33 mJ). Brain damage patients presented: (i) 21.6% aspiration of liquids, reduced by nectar (10.5%) and pudding (5.3%) viscosity (P or =806 ms) with a delay in laryngeal closure (> or =245 ms), and weak bolus propulsion forces (neurogenic dysphagia presented high prevalence of videofluoroscopic signs of impaired safety and efficacy of swallow, and were at high risk of respiratory and nutritional complications. Impaired safety is associated with slow oropharyngeal reconfiguration and impaired efficacy with low bolus propulsion. Increasing bolus viscosity greatly improves swallowing function in neurological patients.

  9. Evaluation of dysphagia at the initial diagnosis of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Murono, Shigeyuki; Hamaguchi, Tsuyoshi; Yoshida, Hiroshi; Nakanishi, Yosuke; Tsuji, Akira; Endo, Kazuhira; Kondo, Satoru; Wakisaka, Naohiro; Yamada, Masahito; Yoshizaki, Tomokazu

    2015-06-01

    Dysphagia eventually occurs in amyotrophic lateral sclerosis (ALS). Swallowing in patients with ALS at their initial diagnosis was evaluated using videofluoroscopy (VF). Nineteen consecutive patients with ALS, 14 with bulbar symptoms, and 5 without them, underwent VF. Fourteen physiologic components, 6 oral and 8 pharyngeal components, were assessed during the examination. Significantly poorer scores were observed in three of the 6 oral components and 3 of the 8 pharyngeal components in patients with bulbar symptoms. Furthermore, bolus transport from the oral cavity to pharynx, pharyngeal constriction, oral residue and pharyngeal residue were impaired in patients even without bulbar symptoms. On the other hand, pharyngoesophageal segment opening was preserved in patients even with bulbar symptoms. Bolus transport and initiation of pharyngeal swallow were correlated with the swallowing category of the ALS severity scale. Defining types of impairment in patients with or without bulbar symptoms is useful for evaluating dysphagia in this disease. Although VF showed impairment of oral and pharyngeal phases of swallowing, the oral phase affected the eating habit in ALS at the initial diagnosis. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  10. Psychometric Properties of Questionnaires on Functional Health Status in Oropharyngeal Dysphagia: A Systematic Literature Review

    Science.gov (United States)

    Speyer, Renée; Cordier, Reinie; Kertscher, Berit; Heijnen, Bas J

    2014-01-01

    Introduction. Questionnaires on Functional Health Status (FHS) are part of the assessment of oropharyngeal dysphagia. Objective. To conduct a systematic review of the literature on the psychometric properties of English-language FHS questionnaires in adults with oropharyngeal dysphagia. Methods. A systematic search was performed using the electronic databases Pubmed and Embase. The psychometric properties of the questionnaires were determined based on the COSMIN taxonomy of measurement properties and definitions for health-related patient-reported outcomes and the COSMIN checklist using preset psychometric criteria. Results. Three questionnaires were included: the Eating Assessment Tool (EAT-10), the Swallowing Outcome after Laryngectomy (SOAL), and the Self-report Symptom Inventory. The Sydney Swallow Questionnaire (SSQ) proved to be identical to the Modified Self-report Symptom Inventory. All FHS questionnaires obtained poor overall methodological quality scores for most measurement properties. Conclusions. The retrieved FHS questionnaires need psychometric reevaluation; if the overall methodological quality shows satisfactory improvement on most measurement properties, the use of the questionnaires in daily clinic and research can be justified. However, in case of insufficient validity and/or reliability scores, new FHS questionnaires need to be developed using and reporting on preestablished psychometric criteria as recommended in literature. PMID:24877095

  11. Therapeutic efficacy of neuromuscular electrical stimulation and electromyographic biofeedback on Alzheimer's disease patients with dysphagia.

    Science.gov (United States)

    Tang, Yi; Lin, Xiang; Lin, Xiao-Juan; Zheng, Wei; Zheng, Zhi-Kai; Lin, Zhao-Min; Chen, Jian-Hao

    2017-09-01

    To study the therapeutic effect of neuromuscular electrical stimulation and electromyographic biofeedback (EMG-biofeedback) therapy in improving swallowing function of Alzheimer's disease patients with dysphagia.A series of 103 Alzheimer's disease patients with dysphagia were divided into 2 groups, among which the control group (n = 50) received swallowing function training and the treatment group (n = 53) received neuromuscular electrical stimulation plus EMG-biofeedback therapy. The mini-mental state scale score was performed in all patients along the treatment period. Twelve weeks after the treatment, the swallowing function was assessed by the water swallow test. The nutritional status was evaluated by Mini Nutritional Assessment (MNA) as well as the levels of hemoglobin and serum albumin. The frequency and course of aspiration pneumonia were also recorded.No significant difference on mini-mental state scale score was noted between 2 groups. More improvement of swallowing function, better nutritional status, and less frequency and shorter course of aspiration pneumonia were presented in treatment group when compared with the control group.Neuromuscular electrical stimulation and EMG-biofeedback treatment can improve swallowing function in patients with Alzheimer's disease and significantly reduce the incidence of adverse outcomes. Thus, they should be promoted in clinical practice.

  12. Psychometric properties of questionnaires on functional health status in oropharyngeal dysphagia: a systematic literature review.

    Science.gov (United States)

    Speyer, Renée; Cordier, Reinie; Kertscher, Berit; Heijnen, Bas J

    2014-01-01

    Questionnaires on Functional Health Status (FHS) are part of the assessment of oropharyngeal dysphagia. To conduct a systematic review of the literature on the psychometric properties of English-language FHS questionnaires in adults with oropharyngeal dysphagia. A systematic search was performed using the electronic databases Pubmed and Embase. The psychometric properties of the questionnaires were determined based on the COSMIN taxonomy of measurement properties and definitions for health-related patient-reported outcomes and the COSMIN checklist using preset psychometric criteria. Three questionnaires were included: the Eating Assessment Tool (EAT-10), the Swallowing Outcome after Laryngectomy (SOAL), and the Self-report Symptom Inventory. The Sydney Swallow Questionnaire (SSQ) proved to be identical to the Modified Self-report Symptom Inventory. All FHS questionnaires obtained poor overall methodological quality scores for most measurement properties. The retrieved FHS questionnaires need psychometric reevaluation; if the overall methodological quality shows satisfactory improvement on most measurement properties, the use of the questionnaires in daily clinic and research can be justified. However, in case of insufficient validity and/or reliability scores, new FHS questionnaires need to be developed using and reporting on preestablished psychometric criteria as recommended in literature.

  13. Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

    Science.gov (United States)

    2009-01-01

    Introduction The low incidence of tetanus in developed countries has resulted in a decreased vigilance of this disease. This raises concern, as the prodromal stadium of a generalized tetanus infection may lack the characteristic paroxysmal muscle spasms. Tetanus can rapidly progress into life-threatening muscle spasms accompanied by respiratory insufficiency and/or autonomic dysfunction. This emphasizes the need for early diagnosis and treatment. Case presentation A 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration. Due to parental concerns about the boy's refusal of fluids, a pediatrician was consulted. At that time of presentation he showed signs of trismus and muscle rigidity. Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection. After sedation, endotracheal intubation and ventilation, passive immunization and initiation of antimicrobial treatment, he was immediately transferred to a pediatric intensive care unit (PICU) for further treatment. The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved. Conclusion Tetanus infection remains a rare but potentially lethal disease in developed countries. As the full scope of classical symptoms may be absent at first presentation, tetanus should always be considered in non-immunized patients with an acute onset of dysphagia and trismus. PMID:19829891

  14. Rehabilitative management of oropharyngeal dysphagia in acute care settings: data from a large Italian teaching hospital.

    Science.gov (United States)

    Schindler, Antonio; Vincon, Elena; Grosso, Elena; Miletto, Anna Maria; Di Rosa, Rosalba; Schindler, Oskar

    2008-09-01

    A high incidence of oropharyngeal dysphagia (OD) in acute-care settings has been reported; however, no data on its management are found in the literature. Here we report the experience with rehabilitative management of OD in a large Italian hospital. The characteristics of inpatients with OD during 2004 have been studied prospectively. For each patient, demographic data, the department referring the patient, the disease causing OD, and the presence of a communication disorder were registered. The swallowing level at the beginning and at the end of rehabilitation were recorded. Of the 35,590 inpatients admitted to San Giovanni Battista Hospital of Turin during 2004, 222 of them were referred for the assessment and rehabilitation of OD. The inpatients with OD came from different departments and mainly had a neurologic disease. In 110 patients a communication disorder was present. The swallowing impairment was moderate to severe at the moment of referral, while on average patients were able to eat by mouth after swallowing therapy. Dysphagia rehabilitation in an acute care setting is requested from different departments because of its prevalence and severity; skilled specialists are needed for early assessment and the best management.

  15. Chemical and structural effects of base modifications in messenger RNA

    Science.gov (United States)

    Harcourt, Emily M.; Kietrys, Anna M.; Kool, Eric T.

    2017-01-01

    A growing number of nucleobase modifications in messenger RNA have been revealed through advances in detection and RNA sequencing. Although some of the biochemical pathways that involve modified bases have been identified, research into the world of RNA modification -- the epitranscriptome -- is still in an early phase. A variety of chemical tools are being used to characterize base modifications, and the structural effects of known base modifications on RNA pairing, thermodynamics and folding are being determined in relation to their putative biological roles.

  16. [The effectiveness of fiberoptic endoscopic swallow study and modified barium swallow study techniques in diagnosis of dysphagia].

    Science.gov (United States)

    Gerek, Mustafa; Atalay, Altan; Cekin, Engin; Ciyiltepe, Müzeyyen; Ozkaptan, Yalçin

    2005-01-01

    The purpose of this study was to evaluate the effectiveness of fiberoptic endoscopic evaluation of swallowing (FEES) and the modified barium swallow test (MBST) in patients with dysphagia. Eighty patients with dysphagia were evaluated in three groups consisting of 27 patients with oral, pharyngeal, or esophageal masses; 26 patients with neurogenic dysphagia; and 27 patients with no distinct pathology. All the patients underwent FEES and MBST to examine elevation of the soft palate, nasal regurgitation, pharyngeal residue, penetration, aspiration, and pooling of secretions in the pyriform sinus and vallecula. In neurogenic dysphagia, MBST was more efficacious in detecting aspiration and pooling in the vallecula (p<0.05). Evaluation of the internal anatomy, visualization of masses, and laryngopharyngeal sensory discrimination were only possible with the FEES. On the other hand, evaluation of the elevation of the larynx and the hyoid, the relaxation of the upper esophageal sphincter, and the oral phase of swallowing, and the detection of esophageal pathologies were only possible with the MBST. The leading advantages of the two evaluation techniques seem to lie in the detection of aspiration for the FEES, and dynamic evaluation of the oral and esophageal phases of swallowing for the MBST.

  17. Endoscopic gastrostomy for enteral nutrition in neurogenic dysphagia: Application of a nasogastric tube or percutaneous endoscopic gastrostomy.

    Science.gov (United States)

    Maitines, Gennaro; Ugenti, Ippazio; Memeo, Riccardo; Clemente, Nicola; Iambrenghi, Onofrio Caputi

    2009-01-01

    Enteral nutrition can be administered via a nasogastric tube or, in selected patients, via a percutaneous endoscopic gastrostomy. In patients with neurogenic dysphagia, the choice of nutritional administration, and above all the timing, are crucial. Our aim was to retrospectively assess the impact of new guidelines for percutaneous endoscopic gastrostomy insertion adopted since January 2002 and compare them with our previous experience. From January 1992 to June 2007, 285 gastrostomies (168 M, 117 F) were positioned in our institute. We analysed 232 patients (139 M, 93 F) in whom a percutaneous endoscopic gastrostomy was applied for neurogenic dysphagia: Group A (from January 1992 to December 2001) consisting of 174 patients; Group B (from January 2002 to June 2007) consisting of 58 patients. The percutaneous endoscopic gastrostomy was positioned in all the cases with neurogenic dysphagia after a period of not less than 3 weeks of nutrition by nasogastric tube. A total of 6 major complications (2.3 %) occurred, almost all in group A. The mortality rate (3 patients, 2%) correlated with the complications in group A. In cases of neurogenic dysphagia we believe that greater methodological rigour in the multidisciplinary decision-making process, and a period of about 6-8 weeks' nutrition by nasogastric tube after the acute neurological damage may be useful to ensure a better prognostic evaluation of the patient and hence of the indications for percutaneous endoscopic gastrostomy.

  18. Dysphagia, malnutrition and gastrointestinal problems in patients with mitochondrial disease caused by the m3243A>G mutation

    NARCIS (Netherlands)

    Laat, P. de; Zweers, H.E.; Knuijt, S.; Smeitink, J.A.M.; Wanten, G.J.A.; Janssen, M.C.H.

    2015-01-01

    BACKGROUND: Previous research has shown that dysphagia and gastrointestinal problems occur frequently in carriers of the m.3243A>G mutation; however, the exact frequency and severity have not been determined. We hypothesise that adult carriers have an increased risk for malnutrition. METHODS: In

  19. Rehabilitation of oropharyngeal dysphagia in children with cerebral palsy: A systematic review of the speech therapy approach

    Science.gov (United States)

    Hirata, Gisela Carmona; Santos, Rosane Sampaio

    2012-01-01

    Summary Introduction: There are an estimated 30,000–40,000 new cases of cerebral palsy per year in Brazil. Motor disorders caused by cerebral palsy can lead to dysphagia as they may alter the preparatory, oral, pharyngeal, and esophageal phases. Aim: To identify existing rehabilitation methods of swallowing disorders in cerebral palsy, with emphasis on the pursuit of research using the Bobath concept, the Castillo Morales concept, oral sensorimotor therapy, and continuing education. Summary of the findings: We performed a systematic review of the medical and speech therapy literature on the rehabilitation of oropharyngeal dysphagia in children with cerebral palsy spanning 1977–2010 and from all languages and nations. Among the 310 articles retrieved, only 22 (7.09%) addressed therapeutic rehabilitation of oropharyngeal dysphagia in children with cerebral palsy. Of the 22 reports, 12 (54.5%) were from Canada, 3 (13.6%) were from Japan, 2 (9%) were from Brazil, 2 (9%) were from Germany, 1 (4.5%) was from the USA, 1 (4.5%) was from the United Kingdom, and 1 (4.5%) was from Poland. Of these reports, 63.6% used oral sensorimotor therapy as a therapeutic method, 36.3% reported continuing education as a therapeutic approach, and only 18.1% and 9% used the Bobath concept and Castillo Morales concept, respectively. Conclusion: Even with a constantly increasing cerebral palsy population, few studies include (re)habilitation in the treatment of oropharyngeal dysphagia in these children. PMID:25991964

  20. Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice.

    Science.gov (United States)

    Serrano Santos, Jose Manuel; Poland, Fiona; Wright, David; Longmore, Timothy

    2016-10-30

    In the UK, 69.5% of residents in care homes are exposed to one or more medication errors and 50% have some form of dysphagia. Hospital research identified that nurses frequently crush tablets to facilitate swallowing but this has not been explored in care homes. This project aimed to observe the administration of medicines to patients with dysphagia (PWD) and without in care homes. A convenient sample of general practitioners in North Yorkshire invited care homes with nursing, to participate in the study. A pharmacist specialised in dysphagia observed nurses during drug rounds and compared these practices with national guidelines. Deviations were classified as types of medication administration errors (MAEs). Overall, 738 administrations were observed from 166 patients of which 38 patients (22.9%) had dysphagia. MAE rates were 57.3% and 30.8% for PWD and those without respectively (pdysphagia and need to communicate its presence to the resident's GP. Further research should explore the design of an effective training for nurses. Copyright © 2016 Elsevier B.V. All rights reserved.