Annals of Rehabilitation Medicine

"Deglutition"

Original Article

Dysphagia

Predictors for Failed Removal of Nasogastric Tube in Patients With Brain Insult: Shih-Ting Huang, Tyng-Guey Wang, Mei-Chih Peng, Wan-Ming Chen, An-Tzu Jao, Fuk Tan Tang, Yu-Ting Hsieh, Chun Sheng Ho, Shu-Ming Yeh; Ann Rehabil Med 2024;48(3):220-227. Published online June 4, 2024; DOI: https://doi.org/10.5535/arm.230011

Objective
To construct a prognostic model for unsuccessful removal of nasogastric tube (NGT) was the aim of our study.
Methods
This study examined patients with swallowing disorders receiving NGT feeding due to stroke or traumatic brain injury in a regional hospital. Clinical data was collected, such as age, sex, body mass index (BMI), level of activities of daily living (ADLs) dependence. Additionally, gather information regarding the enhancement in Functional Oral Intake Scale (FOIS) levels and the increase in food types according to the International Dysphagia Diet Standardization Initiative (IDDSI) after one month of swallowing training. A stepwise logistic regression analysis model was employed to predict NGT removal failure using these parameters.
Results
Out of 203 patients, 53 patients (26.1%) had experienced a failed removal of NGT after six months of follow-up. The strongest predictors for failed removal were age over 60 years, underweight BMI, total dependence in ADLs, and ischemic stroke. The admission prediction model categorized patients into high, moderate, and low-risk groups for removal failure. The failure rate of NGT removal was high not only in the high-risk group but also in the moderate-risk groups when there was no improvement in FOIS levels and IDDSI food types.
Conclusion
Our predictive model categorizes patients with brain insults into risk groups for swallowing disorders, enabling advanced interventions such as percutaneous endoscopic gastrostomy for high-risk patients struggling with NGT removal, while follow-up assessments using FOIS and IDDSI aid in guiding rehabilitation decisions for those at moderate risk.

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Review Article

Dysphagia

Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update: Shingo Kakehi, Eri Isono, Hidetaka Wakabayashi, Moeka Shioya, Junki Ninomiya, Yohei Aoyama, Ryoko Murai, Yuka Sato, Ryohei Takemura, Amami Mori, Kei Masumura, Bunta Suzuki; Ann Rehabil Med 2023;47(5):337-347. Published online October 31, 2023; DOI: https://doi.org/10.5535/arm.23101

Abstract
PDF

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient’s pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.

Citations

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Dual burden of sarcopenia and impaired oral status on activities of daily living, cognition and swallowing outcomes in post-stroke patients
Yoshihiro Yoshimura, Hidetaka Wakabayashi, Fumihiko Nagano, Ayaka Matsumoto, Sayuri Shimazu, Ai Shiraishi, Yoshifumi Kido, Takahiro Bise, Takenori Hamada, Kouki Yoneda
Archives of Gerontology and Geriatrics.2025; 129: 105648. CrossRef
Progress in dysphagia management in older patients
Gero Lueg, Maryam Pourhassan, Rainer Wirth
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Renata Marchewka, Tomasz Trzmiel, Katarzyna Hojan
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Malnutrition and cachexia may affect death but not functional improvement in patients with sarcopenic dysphagia
Mai Yamanaka, Hidetaka Wakabayashi, Shinta Nishioka, Ryo Momosaki
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Association between sarcopenia and urinary dysfunction in patients with dysphagia
Shingo Kakehi, Hidetaka Wakabayashi, Eri Isono, Ryohei Takemura, Yuka Sato, Yukiko Otsuka, Takako Nagai, Shinta Nishioka, Ryo Momosaki
Archives of Gerontology and Geriatrics.2024; 127: 105577. CrossRef
Treatment of Esophageal Achalasia With Sarcopenic Dysphagia by Rehabilitation and Nutritional Support: A Case Report
Fumiko Furukawa, Kiyohito Kakita
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Nutritional care in older adults: are we doing everything? An expert opinion review
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Age and sex differences in sarcopenic dysphagia: A secondary data analysis
Hidetaka Wakabayashi, Shingo Kakehi, Ayano Nagano, Masako Kishima, Masataka Itoda, Shinta Nishioka, Ryo Momosaki
Journal of General and Family Medicine.2024; 25(6): 343. CrossRef
Triad of rehabilitation, nutrition support, and oral management improves activities of daily living and muscle health in hospitalized patients after stroke
Yoshihiro Yoshimura, Sayuri Shimazu, Ai Shiraishi, Hidetaka Wakabayashi, Fumihiko Nagano, Ayaka Matsumoto, Yoshifumi Kido, Takahiro Bise, Aomi Kuzuhara, Takenori Hamada, Kouki Yoneda
Clinical Nutrition ESPEN.2024; 63: 837. CrossRef
The Prevalence and Prognosis of Cachexia in Patients with Non-Sarcopenic Dysphagia: A Retrospective Cohort Study
Shingo Kakehi, Hidetaka Wakabayashi, Takako Nagai, Shinta Nishioka, Eri Isono, Yukiko Otsuka, Junki Ninomiya, Ryo Momosaki
Nutrients.2024; 16(17): 2917. CrossRef

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Clinical Practice Guideline

Dysphagia

Clinical Practice Guidelines for Oropharyngeal Dysphagia: Seoyon Yang, Jin-Woo Park, Kyunghoon Min, Yoon Se Lee, Young-Jin Song, Seong Hee Choi, Doo Young Kim, Seung Hak Lee, Hee Seung Yang, Wonjae Cha, Ji Won Kim, Byung-Mo Oh, Han Gil Seo, Min-Wook Kim, Hee-Soon Woo, Sung-Jong Park, Sungju Jee, Ju Sun Oh, Ki Deok Park, Young Ju Jin, Sungjun Han, DooHan Yoo, Bo Hae Kim, Hyun Haeng Lee, Yeo Hyung Kim, Min-Gu Kang, Eun-Jae Chung, Bo Ryun Kim, Tae-Woo Kim, Eun Jae Ko, Young Min Park, Hanaro Park, Min-Su Kim, Jungirl Seok, Sun Im, Sung-Hwa Ko, Seong Hoon Lim, Kee Wook Jung, Tae Hee Lee, Bo Young Hong, Woojeong Kim, Weon-Sun Shin, Young Chan Lee, Sung Joon Park, Jeonghyun Lim, Youngkook Kim, Jung Hwan Lee, Kang-Min Ahn, Jun-Young Paeng, JeongYun Park, Young Ae Song, Kyung Cheon Seo, Chang Hwan Ryu, Jae-Keun Cho, Jee-Ho Lee, Kyoung Hyo Choi; Ann Rehabil Med 2023;47(Suppl 1):S1-S26. Published online July 30, 2023; DOI: https://doi.org/10.5535/arm.23069

Objective
Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia.
Methods
Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology.
Results
Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended.
Conclusion
This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Citations

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Using concept mapping to guide dysphagia service enhancements in Singapore: Recommendations from the speech-language pathology workforce
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International Journal of Speech-Language Pathology.2025; 27(1): 56. CrossRef
Cough Suppression Therapy in Patients With Chronic Refractory Cough and Oropharyngeal Dysphagia
ShengYing A. Chen, Jessica F. Kim, Priya Krishna, Ethan Simmons, Brianna K. Crawley, Thomas Murry
American Journal of Speech-Language Pathology.2025; 34(3): 1058. CrossRef
Characterization of Beverage Viscosity Based on the International Dysphagia Diet Standardisation Initiative and Its Correspondence to the Japanese Dysphagia Diet 2021
Mari Nakao-Kato, Aya Takahashi, Jin Magara
Nutrients.2025; 17(6): 1051. CrossRef
Factors influencing oropharyngeal dysphagia in individuals with chronic neurological disorders presenting to the outpatient swallowing disorder clinic
Güleser Güney Yılmaz, Müberra Tanrıverdi, Remzi Doğan, Orhan Özturan
Multiple Sclerosis and Related Disorders.2025; 97: 106387. CrossRef
The Efficacy of Outpatient Swallowing Therapy: A Retrospective Longitudinal Cohort Study
Tyler W. Crosby, Sonja Molfenter, Matina Balou, Uche C. Ezeh, Milan R. Amin
Dysphagia.2025;[Epub] CrossRef
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Špela Matko, Christina Knauseder, David Riedl, Vincent Grote, Michael J. Fischer, Samuel Moritz Vorbach, Karin Pfaller-Frank, Wilhelm Frank, Thomas Licht
Current Oncology.2025; 32(4): 220. CrossRef
The impact of physical therapy on dysphagia in neurological diseases: a review
Kun Li, Cuiyuan Fu, Zhen Xie, Jiajia Zhang, Chenchen Zhang, Rui Li, Caifeng Gao, Jiahui Wang, Chuang Xue, Yuebing Zhang, Wei Deng
Frontiers in Human Neuroscience.2024;[Epub] CrossRef
Clinical Characteristics and Evaluation of Dysphagia in Patients with Parkinson’s Disease
Seo Jung Yun, Han Gil Seo
Journal of the Korean Dysphagia Society.2024; 14(1): 10. CrossRef
Updated Clinical Practice Guidelines for the Diagnosis and Management of Long COVID
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Association between the C-reactive protein/albumin ratio and mortality in older Japanese patients with dysphagia
Chunhong Guo, Pingping Zheng, Shiyang Chen, Lin Wei, Xiuzhen Fu, Youyuan Fu, Tianhong Hu, Shaohua Chen
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Compensatory strategies of dysphagia after anterior cervical spinal surgery: A case report
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Dysphagia Screening in Residential Long-Term Care Settings in the Republic of Ireland: A Cross-Sectional Survey
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Effect of segmental tongue function training on tongue pressure attributes in individuals with dysphagia after receiving radiotherapy for nasopharyngeal carcinoma
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BMC Oral Health.2024;[Epub] CrossRef
Diagnosis and treatment of dysphagia
Kyoung Hyo Choi
Journal of the Korean Medical Association.2023; 66(10): 604. CrossRef

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Original Articles

Dysphagia

Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients: Back Min Oh, Hyun Seok, Sang-Hyun Kim, Seung Yeol Lee, Su Jung Park, Beom Jin Kim, Hyun Jung Kim; Ann Rehabil Med 2023;47(3):192-204. Published online June 12, 2023; DOI: https://doi.org/10.5535/arm.23018

Objective
To determine correlations of alternation motor rate (AMR), sequential motor rate (SMR), and maximum phonation time (MPT) with the severity of dysphagia in subacute stroke patients.
Methods
This was a retrospective chart review study. Data of 171 subacute stroke patients were analyzed. Patient’s AMR, SMR, and MPT data were collected from their language evaluations. Video fluoroscopic swallowing study (VFSS) was done. Data of dysphagia scales including penetration-aspiration scale (PAS), American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale, clinical dysphagia scale (CDS), and videofluoroscopic dysphagia scale (VDS) were obtained. AMR, SMR, and MPT were compared between a non-aspirator group and an aspirator group. Correlations of AMR, SMR, and MPT with dysphagia scales were analyzed.
Results
AMR ("ka"), SMR, and modified Rankin Scale were significant associated factors between non-aspirator group and aspirator group, while AMR ("pa"), AMR ("ta"), and MPT were not. AMR, SMR, and MPT showed significant correlations with PAS score, ASHA-NOMS scale, CDS, VDS oral, and VDS pharyngeal scores. The cut-off value for distinguishing non-aspirator group and aspiration group was 18.5 for AMR ("ka") (sensitivity of 74.4%, specificity of 70.8%) and 7.5 for SMR (sensitivity of 89.9%, specificity of 61.0%). AMR and SMR were significantly lower in before-swallow aspiration group.
Conclusion
Articulatory diadochokinetic tasks that can be easily performed at the bedside would be particularly helpful in determining the oral feeding possibility of subacute stroke patients who cannot undergo VFSS, which is the gold standard for dysphagia assessment.

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Application of B+M-Mode Ultrasound in Evaluating Dysphagia in Elderly Stroke Patients
Jiaying Shuai, Linping Pian, Li Tian, Linying Wang, Miaomiao Deng, Chen Cheng
Ultrasound in Medicine & Biology.2025; 51(2): 273. CrossRef
Laryngeal and swallowing characteristics in elderly after stroke: a preliminary study
Jonan Emi Valencia Cardenas, Cris Magna dos Santos Oliveira, Raquel Rodrigues Rosa, Gabriele Ramos de Luccas, Claudia Tiemi Mituuti, Kelly Cristina Alves Silverio, Alcione Ghedini Brasolotto, Giédre Berretin-Felix
Audiology - Communication Research.2025;[Epub] CrossRef
Características laríngeas e de deglutição em idosos pós-acidente vascular encefálico: um estudo preliminar
Jonan Emi Valencia Cardenas, Cris Magna dos Santos Oliveira, Raquel Rodrigues Rosa, Gabriele Ramos de Luccas, Claudia Tiemi Mituuti, Kelly Cristina Alves Silverio, Alcione Ghedini Brasolotto, Giédre Berretin-Felix
Audiology - Communication Research.2025;[Epub] CrossRef
Comparative analysis of speech assessment tools for individuals with dysarthria in Chile and worldwide
Marcela Sanhueza-Garrido, Virginia García-Flores, Carlos Rojas-Zepeda, Jaime Crisosto-Alarcón
Salud, Ciencia y Tecnología.2024; 4: 626. CrossRef
Rehabilitation of Patients with Post-Stroke Dysarthria in the Russia and Abroad: a Literature Review
Olga V. Loginova, Daria I. Bovtyuk
Bulletin of Rehabilitation Medicine.2023; 22(6): 100. CrossRef

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Dysphagia

Clinical and Swallowing Characteristics Related With Respiratory Infection in Parkinsonism Patients: Ji Su Jung, Heewon Jeon, Byung-Mo Oh, Han Gil Seo; Ann Rehabil Med 2023;47(2):138-146. Published online April 30, 2023; DOI: https://doi.org/10.5535/arm.22152

Objective
To investigate the clinical and swallowing characteristics related to respiratory infection in patients with parkinsonism.
Methods
One hundred and forty-two patients with parkinsonism who underwent videofluoroscopic swallowing studies (VFSS) were enrolled in this study. The initial clinical and VFSS characteristics were compared between patients with and without a history of respiratory infection in the past year. A multivariate logistic regression model was applied to identify clinical and swallowing characteristics related to respiratory infections.
Results
Patients with respiratory infections were older (74.75±10.20 years vs. 70.70±8.83 years, p=0.037), had a higher Hoehn and Yahr (H&Y) stage (stage IV–V, 67.9% vs. 49.1%; p=0.047), and were more likely to have a diagnosis of idiopathic Parkinson’s disease (IPD) (67.9% vs. 41.2%, p=0.011) than those without respiratory infections. Among VFSS findings, bolus formation, premature bolus loss, oral transit time, pyriform sinus residues, pharyngeal wall coatings, and penetration/aspiration were significantly worse in patients with respiratory infections (p<0.05). Regarding clinical characteristics, higher H&Y stage (odds ratio [OR], 3.174; 95% confidence interval [CI], 1.226–8.216; p=0.017) and diagnosis of IPD (OR, 0.280, 95% CI, 0.111–0.706; p=0.007) were significantly related to respiratory infections in the multivariate analysis. Among VFSS findings, pyriform sinus residue (OR, 14.615; 95% CI, 2.257–94.623; p=0.005) and premature bolus loss (OR, 5.151; 95% CI, 1.047–25.338; p=0.044) were also significantly associated with respiratory infection.
Conclusion
This study suggests that disease severity, diagnosis, pyriform sinus residue, and premature bolus loss observed in VFSS are associated with respiratory infection in patients with parkinsonism.

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Dysphagia

Esophageal Motility Disorders in Patients With Esophageal Barium Residue After Videofluoroscopic Swallowing Study: Jintae Park, Sora Baek, Gowun Kim, Seung-Joo Nam, Ji Hyun Kim; Ann Rehabil Med 2022;46(5):237-247. Published online October 31, 2022; DOI: https://doi.org/10.5535/arm.22039

Abstract
PDF

Objective
To investigate esophageal motility disorders in patients with esophageal residual barium on chest x-rays after videofluoroscopic swallowing studies (VFSS) through high-resolution esophageal manometry (HREM).
Methods
We reviewed the records of 432 patients who underwent VFSS from September 2019 to May 2021, and 85 patients (19.7%) with large residual barium (diameter ≥1 cm) were included. As a result of HREM, motility disorders were classified as major or minor motility disorders according. Esophagogastroduodenoscopy and chest computed tomography results available were also reviewed.
Results
Among 85 patients with large residual barium in the esophagus, 16 patients (18.8%) underwent HREM. Abnormal esophageal motilities were identified in 68.8% patient: three patients (18.8%) had major motility disorders—achalasia (n=1), esophagogastric junction (EGJ) outflow obstruction (n=2)—and eight patients (50%) had minor motility disorders—ineffective esophageal motility (n=7), fragmented peristalsis (n=1). In those with normal esophageal motility, three patients of esophageal structure disorders (18.8%)—esophageal cancer (n=1), cardiogenic dysphagia (n=1), slight narrowing without obstruction of EGJ (n=1)—and two patients (12.5%) with chronic atrophic gastritis (n=2) were confirmed.
Conclusion
Esophageal motility disorders were identified in 68.8% of 16 patients with large esophageal residual barium with three patients in the major and eight patients in the minor categories. Residual barium in the esophagus was not rare and can be a sign of significant esophageal motility disorders.

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Spinal cord injury

Utilizing Pulmonary Function Parameters to Predict Dysphagia in Individuals With Cervical Spinal Cord Injuries: So Jung Lee, Sungchul Huh, Sung-Hwa Ko, Ji Hong Min, Hyun-Yoon Ko; Ann Rehabil Med 2021;45(6):450-458. Published online December 31, 2021; DOI: https://doi.org/10.5535/arm.21161

Abstract
PDF

Objective
To utilize pulmonary function parameters as predictive factors for dysphagia in individuals with cervical spinal cord injuries (CSCIs).
Methods
Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2–8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group.
Results
The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively.
Conclusion
Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.

Citations

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Methods of diagnosis and rehabilitation of dysphagia in patients with spinal cord injury: a systematic review
Roberta ZUPO, Beatrice POGGI, Nicole CAGGIANO, Giulio VARRONE, Fabio CASTELLANA, Silvia NATOLI, Rodolfo SARDONE, Antonio NARDONE, Chiara PAVESE
European Journal of Physical and Rehabilitation Medicine.2025;[Epub] CrossRef
Pulmonary function and sarcopenia as predictors of dysphagia in cervical spinal cord injury
Su Ji Lee, Ji Cheol Shin
Spinal Cord.2024; 62(1): 42. CrossRef
Evaluation of clinical factors predicting dysphagia in patients with traumatic and non-traumatic cervical spinal cord injury: a retrospective study
Jin-Woo Choi, Dae Yeong Kim, Sun Young Joo, Donghwi Park, Min Cheol Chang
Frontiers in Neurology.2024;[Epub] CrossRef
Coordination Between Respiration and Swallowing in Patients With Dysphagia After Cervical Spinal Cord Injury: An Observational Case–Control Study
Xuluan Xu, Qingsu Zhang, Yongqi Xie, Degang Yang, Feng Gao, Yongxue Yuan, Yu Zhang, Jianjun Li
American Journal of Speech-Language Pathology.2024; 33(5): 2572. CrossRef
Flujo máximo de tos y evaluación de la deglución: Una revisión de literatura
Amalia Nanjarí R , María del Carmen Campos
Revista Científica Signos Fónicos.2024; 10(1): 7. CrossRef
Voluntary Cough Testing as a Clinical Indicator of Airway Protection in Cervical Spinal Cord Injury
Laura Pitts, Valerie K. Hamilton, Erin A. Walaszek, Stephanie Watts, Leora R. Cherney
The Laryngoscope.2023; 133(6): 1434. CrossRef
Association between Anterior Surgical Approach and Dysphagia Severity in Patients with Cervical Spinal Cord Injury
Min Cheol Chang, Dae Yeong Kim, Jin-Woo Choi, Ho Yong Choi, Jin-Sung Park, Donghwi Park
Journal of Clinical Medicine.2023; 12(9): 3227. CrossRef
Successful Continuation of Oral Intake in a Dysphagic and Tetraplegic Patient With Alternate Right and Left Complete Lateral Decubitus Positions in Rehabilitation
Yoshinori Maki, Mayumi Takagawa, Akio Goda, Junichi Katsura, Ken Yanagibashi
Cureus.2023;[Epub] CrossRef
Laryngeal and swallow dysregulation following acute cervical spinal cord injury
Teresa Pitts, Kimberly E. Iceman, Alyssa Huff, M. Nicholas Musselwhite, Michael L. Frazure, Kellyanna C. Young, Clinton L. Greene, Dena R. Howland
Journal of Neurophysiology.2022; 128(2): 405. CrossRef

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Dysphagia

Decreased Maximal Tongue Protrusion Length May Predict the Presence of Dysphagia in Stroke Patients: Hyunchul Cho, Jeong Se Noh, Junwon Park, Changwook Park, No Dam Park, Jun Young Ahn, Ji Woong Park, Yoon-Hee Choi, Seong-Min Chun; Ann Rehabil Med 2021;45(6):440-449. Published online December 31, 2021; DOI: https://doi.org/10.5535/arm.21126

Abstract
PDF

Objective
To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients.
Methods
Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS).
Results
The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%.
Conclusion
There is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.

Citations

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Inter-rater and Intra-rater Reliability of the Videofluoroscopic Dysphagia Scale with the Standardized Protocol
Ingi Min, Hyeonseong Woo, Jae Yoon Kim, Tae-Lim Kim, Yookyung Lee, Won Kee Chang, Se Hee Jung, Woo Hyung Lee, Byung-Mo Oh, Tai Ryoon Han, Han Gil Seo
Dysphagia.2024; 39(1): 43. CrossRef
Tongue diagnostic parameters-based diagnostic signature in coronary artery disease patients with clopidogrel resistance after percutaneous coronary intervention
Bo Liang, Rui Li, Jia Lu, Xiao-Jie Tian, Ning Gu
EXPLORE.2023; 19(4): 528. CrossRef
Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients
Back Min Oh, Hyun Seok, Sang-Hyun Kim, Seung Yeol Lee, Su Jung Park, Beom Jin Kim, Hyun Jung Kim
Annals of Rehabilitation Medicine.2023; 47(3): 192. CrossRef

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Dysphagia

Peak Voluntary Cough Flow and Oropharyngeal Dysphagia as Risk Factors for Pneumonia: Jayoon Choi, Sora Baek, Gowun Kim, Hee-won Park; Ann Rehabil Med 2021;45(6):431-439. Published online December 31, 2021; DOI: https://doi.org/10.5535/arm.21068

Abstract
PDF

Objective
To investigate the relationship between voluntary peak cough flow (PCF), oropharyngeal dysphagia, and pneumonia in patients who were evaluated with videofluoroscopic swallowing study (VFSS).
Methods
Patients who underwent both VFSS and PCF measurement on the same day were enrolled retrospectively (n=821). Pneumonia (n=138) and control (n=683) groups were assigned based on presence of pneumonia within 1 month from the date of VFSS assessment. In addition, sex, age (<65 and ≥65 years), preceding conditions, modified Barthel Index (MBI), Mini-Mental State Examination (MMSE), PCF value (<160, ≥160 and <270, and ≥270 L/min), and presence of aspiration/penetration on VFSS were reviewed.
Results
Pneumonia group was more likely to be male (n=108; 78.3%), ≥65 years (n=121; 87.7%), with neurodegenerative (n=25; 18.1%) or other miscellaneous diseases (n=50; 36.2%), and in poor functional level with lower value of MBI (39.1±26.59). However, MMSE was not significantly different in comparison to that of the control group. The pneumonia group was also more likely to have dysphagia (82.6%) and lower value of PCF (<160 L/min, 70.3%). In multivariable logistic regression analysis, male sex (odd ratio [OR]=6.62; 95% confidence interval [CI], 2.70–16.26), other miscellaneous diseases as preceding conditions (OR=2.52; 95% CI, 1.14–5.58), dysphagia (OR=3.82; 95% CI, 1.42–10.23), and PCF <160 L/min (OR=14.34; 95% CI, 1.84–111.60) were factors significantly related with pneumonia.
Conclusion
Impaired swallowing and coughing function showed an independent association with the development of pneumonia. Patients with PCF <160 L/min require more attention with lung care and should be encouraged with voluntary coughing strategy to prevent possible pulmonary complications.

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Predictors of Pneumonia in Patients With Penetration-Aspirations Detected on Fiberoptic Endoscopic Evaluation of Swallowing
Raviv Allon, Elad Babayof, Yonatan Lahav, Yael Shapira-Galitz
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Sound‐based cough peak flow estimation in patients with neuromuscular disorders
Bernat Bertran Recasens, Ana Balañá Corberó, Juana María Martínez Llorens, Anna Guillen‐Sola, Montserrat Villatoro Moreno, Greta García Escobar, Yasutaka Umayahara, Zu Soh, Toshio Tsuji, Miguel Ángel Rubio
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Mónica Zapata-Soria, Irene Cabrera-Martos, Alejandro Heredia-Ciuró, Esther Prados-Román, Javier Martín-Nuñez, Marie Carmen Valenza
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Yoji Yamada, Yuji Mitani, Akio Yamamoto, Kazumo Miura, Kanji Yamada, Yukari Oki, Yutaro Oki, Yasumichi Maejima, Yoko Kurumatani, Akira Ishikawa
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Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients
Back Min Oh, Hyun Seok, Sang-Hyun Kim, Seung Yeol Lee, Su Jung Park, Beom Jin Kim, Hyun Jung Kim
Annals of Rehabilitation Medicine.2023; 47(3): 192. CrossRef
Deterioration of Cough, Respiratory, and Vocal Cord Functions in Patients with Multiple System Atrophy
Takashi Asakawa, Mieko Ogino, Naomi Tominaga, Naoto Ozaki, Jin Kubo, Wataru Kakuda
Neurology International.2023; 15(4): 1227. CrossRef

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Brain disorders

Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients: Ga Yang Shim, Ju Sun Oh, Seunghee Han, Kyungyeul Choi, Son Mi Lee, Min Woo Kim; Ann Rehabil Med 2021;45(2):108-115. Published online April 21, 2021; DOI: https://doi.org/10.5535/arm.20171

Objective
To investigate the correlation between videofluoroscopic swallowing study (VFSS) and radionuclide salivagram findings in chronic brain-injured patients with dysphagia.
Methods
Medical records of chronic brain-injured patients who underwent radionuclide salivagram and VFSS were retrospectively analyzed. Patients were divided into two groups according to salivagram findings. Differences in patient characteristics and clinical factors, including Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulatory Category (FAC), feeding method, tracheostomy state, and VFSS findings between the two groups were investigated.
Results
A total of 124 patients were included in this study. There were no significant differences in MMSE, MBI, FAC, feeding method, and presence of tracheostomy between the two groups. However, the incidence of aspiration pneumonia history was significantly higher in the positive salivagram group. The Functional Dysphagia Scale (FDS) was significantly associated with positive salivagram findings, especially in the pharyngeal phase. A multivariate logistic regression analysis showed that laryngeal elevation and epiglottic closure was statistically significant FDS parameter in predicting salivary aspiration on a salivagram (odds ratio=1.100; 95% confidence interval, 1.017–1.190; p=0.018). The receiver operating characteristic (ROC) curve of FDS in the pharyngeal phase showed that an optimum sensitivity and specificity of 55.1% and 65.4%, respectively, when the cut-off value was 39.
Conclusion
In chronic brain-injured patients, inappropriate laryngeal elevation and epiglottic closure is predictive variable for salivary aspiration. Therefore, performing a radionuclide salivagram in patients with FDS of 39 or less in the pharyngeal phase for prevents aspiration pneumonia from salivary aspiration.

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Yun Liu, Xue Wang, Li-bo Wang, Xin-rong Sun
Journal of Voice.2023;[Epub] CrossRef
Understanding the Drooling Evaluation
Kyoung-chul Min, Sang-min Seo, Hee-soon Woo
Journal of the Korean Dysphagia Society.2022; 12(2): 85. CrossRef

4,886 View
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Dysphagia

Predictors of Aspiration Pneumonia in the Elderly With Swallowing Dysfunction: Videofluoroscopic Swallowing Study: Joo Young Ko, Dae Youp Shin, Tae Uk Kim, Seo Young Kim, Jung Keun Hyun, Seong Jae Lee; Ann Rehabil Med 2021;45(2):99-107. Published online April 14, 2021; DOI: https://doi.org/10.5535/arm.20180

Abstract
PDF

Objective
To identify the variables of videofluoroscopic swallowing study (VFSS) that are useful for predicting the risk of aspiration pneumonia in elderly patients with dysphagia.
Methods
A total of 251 patients (aged 65 years or more) were included and divided into a pneumonia group (n=133) and a non-pneumonia group (n=118). The pneumonia group included patients who had been diagnosed with aspiration pneumonia, and individuals in the non-pneumonia group did not have pneumonia but were referred for VFSS. The medical records and results of VFSS were reviewed and compared between the groups retrospectively.
Results
The pneumonia group exhibited a male preponderance and a higher 8-point Penetration-Aspiration Scale (8PPAS) score. The mean values of 8PPAS score for swallowing thick liquid and rice porridge was significantly higher in the pneumonia group. The pharyngeal delay time (PDT) and pharyngeal transit time (PTT) were significantly longer in the pneumonia group. The amounts of vallecular and pyriform sinus residue were increased in the pneumonia group. The delay in swallowing reflex and the decrease in laryngeal elevation were more frequently observed in the pneumonia group. Among those variables, PDT and PTT were identified as significant predictors of aspiration pneumonia based on logistic regression analysis.
Conclusion
The present study delineated the findings of VFSS, suggesting an increased risk of aspiration pneumonia in elderly patients with dysphagia. The results demonstrate that prolonged PDT and PTT are significant predictors of aspiration pneumonia.

Citations

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Association Between Masticatory Difficulty and Chronic Cough in a Korean Population
Chang Wan Kim, Tae Sic Lee, Chun Sung Byun, Yon Chul Park
International Dental Journal.2025; 75(2): 496. CrossRef
Research on Intelligent Diagnosis Method of Swallowing Signal Based on Complex Electrical Impedance Myography
Xu Chu, Shaoshuai Yu, Fu Zhang, Yuxiang Yang, Letian Fu, Qi Liu
IEEE Sensors Journal.2025; 25(4): 5969. CrossRef
The Brain Lesion Affecting Dysphagia in Patient with Supratentorial Stroke
Jeon-Woong Kang, Seong-Hoon Lim, Dae-Hyun Jang, Min-Wook Kim, Jaewon Kim
NeuroRehabilitation: An International, Interdisciplinary Journal.2025; 56(3): 340. CrossRef
Predictors of Pneumonia in Patients With Penetration-Aspirations Detected on Fiberoptic Endoscopic Evaluation of Swallowing
Raviv Allon, Elad Babayof, Yonatan Lahav, Yael Shapira-Galitz
Dysphagia.2025;[Epub] CrossRef
Collaboration Between Acute Care Hospitals and Nursing Homes for Dysphagia Management: A Comparative Study of Patients With and Without Pneumonia-Related Hospitalization
Takafumi Yamano, Shoichi Kimura, Fumitaka Omori, Kaori Wada, Miho Tanaka, Takashi Tsutsumi
Cureus.2025;[Epub] CrossRef
Tongue pressure during swallowing is an independent risk factor for aspiration pneumonia in middle‐aged and older hospitalized patients: An observational study
Yen‐Chin Chen, En‐Ni Ku, Che‐Wei Lin, Pei‐Fang Tsai, Jiun‐Ling Wang, Yu‐Fen Yen, Nai‐Ying Ko, Wen‐Chieh Ko, Nan‐Yao Lee
Geriatrics & Gerontology International.2024; 24(S1): 351. CrossRef
Swallowing dysfunction between the community-living older adults with and without comorbid conditions using Patient-Reported Outcome Measures (PROM)
Himanshu Verma, Sourabh Kumar, Atul Sharma, Roshani Mishra, Banumathy Nagamani
Geriatric Nursing.2024; 56: 64. CrossRef
Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency
José Vergara, Anna Miles, Juliana Lopes de Moraes, Carlos Takahiro Chone
Journal of Speech, Language, and Hearing Research.2024; 67(3): 821. CrossRef
Oral and pharyngeal phases of swallowing in removable complete denture wearers
Marina Rodrigues Montaldi, Cláudia Helena Lovato da Silva, Adriana Barbosa Ribeiro, Camila Borba de Araujo, Caroline Vieira Fortes, Roberto Oliveira Dantas
RGO - Revista Gaúcha de Odontologia.2024;[Epub] CrossRef
Short-term cortical activation changes associated with postural compensation in swallowing
Kelsey L. Murray, Seng Mun Wong, Erin Kamarunas
Experimental Brain Research.2024; 242(11): 2623. CrossRef
Quantitative prediction of aspiration risk in head and neck cancer patients treated with radiation therapy
Hannah C. Liu, Casey W. Williamson, Jingjing Zou, Jacob R. Todd, Tyler J. Nelson, Lindsay M. Hill, Kristen E. Linnemeyer, Gerald Henderson, Puja Madgula, Brian Faung, Assuntina G. Sacco, Lucas K. Vitzthum, Philip A. Weissbrod, Liza S. Blumenfeld, Loren K.
Oral Oncology.2023; 136: 106247. CrossRef
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Back Min Oh, Hyun Seok, Sang-Hyun Kim, Seung Yeol Lee, Su Jung Park, Beom Jin Kim, Hyun Jung Kim
Annals of Rehabilitation Medicine.2023; 47(3): 192. CrossRef
Effects of Carbonated Thickened Drinks on Pharyngeal Swallowing with a Flexible Endoscopic Evaluation of Swallowing in Older Patients with Oropharyngeal Dysphagia
Motoyoshi Morishita, Masahiko Okubo, Tatsuro Sekine
Healthcare.2022; 10(9): 1769. CrossRef
Aspiration pneumonia after cerebrovascular stroke: a comparison between patients with and without dysphagia
N. A. Moulaei, N Ramroodi, S. M. N. A. Tabatabaie, H. A. Danesh, H. A. Khazaie
Anesteziologie a intenzivní medicína.2022; 33(3-4): 148. CrossRef

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Case Report

Dysphagia

Unusual Pharyngo-Esophageal Dysphagia Caused by a High-Riding Right Brachiocephalic Artery: Ki Hoon Park, Sora Baek, Eun Kyoung Kang; Ann Rehabil Med 2021;45(1):79-82. Published online February 9, 2021; DOI: https://doi.org/10.5535/arm.20057

Abstract
PDF

High-riding right brachiocephalic and subclavian arteries are often asymptomatic and rare vascular variations. We present a patient with high-riding right brachiocephalic and subclavian arteries that caused compressive pharyngeal and cervical esophageal dysphagia. An 82-year-old woman presented to our hospital with dysphagia that worsened with solid food. A pulsatile lump was observed on the right neck side. A videofluoroscopic swallowing study showed a deviated food bolus movement anterolaterally from the normal vertical pharyngoesophageal transition, with a filling defect in the lower pharynx through the upper esophagus. Neck computed tomography (CT) showed high-riding right brachiocephalic and subclavian arteries and a tortuous right common carotid artery located adjacent to the trachea in the cervical area. The cervical midline structures were deviated to the left neck side. A neck mass with vascular variation should be considered as a cause of dysphagia that worsens with solid food; CT should be considered to determine its cause.

Citations

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High-Riding Inominate Artery: Challenge During Tracheostomy
E-Ting Wannitta Wong, Jeyasakthy Saniasiaya, Anas Tharek, Nur Syazwani Sallehuddin
Indian Journal of Otolaryngology and Head & Neck Surgery.2023; 75(4): 3878. CrossRef

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Original Articles

Effects of Chin-Down Maneuver on Pharyngeal Pressure Generation According to Dysphagia and Viscosity: Sun Myoung Lee, Ban Hyung Lee, Jung Woo Kim, Joon Young Jang, Eun Gyeong Jang, Ju Seok Ryu; Ann Rehabil Med 2020;44(6):493-501. Published online December 31, 2020; DOI: https://doi.org/10.5535/arm.20016

Abstract
PDF

Objective
To demonstrate the effects of chin-down maneuver on swallowing by using high-resolution manometry (HRM).
Methods
HRM data of 20 healthy subjects and 64 dysphagic patients were analyzed. Participants swallowed 5 mL of thin and honey-like liquids in neutral and chin-down positions. HRM was used to evaluate maximal velopharyngeal pressure/area, maximal tongue base pressure/area, maximal pharyngeal constrictor pressure, pre-/post-swallow upper esophageal sphincter (UES) peak pressure, minimal UES pressure, UES activity time, and nadir duration.
Results
Compared to the neutral position, the chin-down maneuver significantly increased tongue base pressure in both normal and dysphagic groups as well as for both honey-like and thin viscosities, although the honey-like liquid did not reach statistical significance in the dysphagic group. Regarding pharyngeal constrictors and pre-swallow peak UES pressure, the healthy group showed a significant decrease in thin liquid swallowing and decreasing tendency in honeylike liquid swallowing. UES nadir duration was significantly decreased for honey-like liquid swallowing in the dysphagic group and for both thin and honey-like liquids in the healthy group. UES nadir duration of honey-like and thin flow swallowing in the dysphagia group was 0.26 seconds after the chin-down maneuver, which was severely limited.
Conclusion
This study showed a different kinetic effect of the chin-down maneuver between the healthy and dysphagic groups, as well as between thin and honey-like viscosities. The chin-down maneuver increased tongue base pressure and decreased UES nadir duration, which the latter was severely limited in dysphagic patients. Therefore, appropriate application of the chin-down maneuver in clinical practice is required.

Citations

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The effectiveness of chin‐down manoeuvre in patients with dysphagia: A systematic review and meta‐analysis
Mengchao Li, Shaochun Huang, Yaping Ding, Xianwen Li, Yan Cui, Shen Chen
Journal of Oral Rehabilitation.2024; 51(4): 762. CrossRef
Normative High-Resolution Pharyngeal Manometry: Impact of Age, Size of System, and Sex on Primary Metrics and Pressure Stability
Corinne A. Jones, Jilliane F. Lagus, Suzan M. Abdelhalim, Caroline M. Osborn, Sophia M. Colevas, Timothy M. McCulloch
Dysphagia.2024; 39(4): 648. CrossRef
Physiology and Execution of Swallowing Maneuvers in 3D Videos: Integrating the Technology into Patient Care
Marina Gatti, Chao Lung Wen, Renata Lígia Vieira Guedes, Giédre Berretin-Felix
Dysphagia.2024;[Epub] CrossRef
Short-term cortical activation changes associated with postural compensation in swallowing
Kelsey L. Murray, Seng Mun Wong, Erin Kamarunas
Experimental Brain Research.2024; 242(11): 2623. CrossRef
Correlation Between Articulatory Diadochokinetic Parameters and Dysphagia Parameters in Subacute Stroke Patients
Back Min Oh, Hyun Seok, Sang-Hyun Kim, Seung Yeol Lee, Su Jung Park, Beom Jin Kim, Hyun Jung Kim
Annals of Rehabilitation Medicine.2023; 47(3): 192. CrossRef
A Comparative Assessment of the Diagnosis of Swallowing Impairment and Gastroesophageal Reflux in Canines and Humans
Tarini V. Ullal, Stanley L. Marks, Peter C. Belafsky, Jeffrey L. Conklin, John E. Pandolfino
Frontiers in Veterinary Science.2022;[Epub] CrossRef
Recent Kinetic and Kinematic Findings of Swallowing Maneuvers and Posture Techniques
Yoko Inamoto
The Japanese Journal of Rehabilitation Medicine.2022; 59(9): 903. CrossRef
The upper esophageal sphincter in the high-resolution manometry era
Pedro Norton, Fernando A. M. Herbella, Francisco Schlottmann, Marco G. Patti
Langenbeck's Archives of Surgery.2021; 406(8): 2611. CrossRef

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Changes in Pharyngeal Width Over Time as an Indicator of Dysphagia in Stroke Patients: Seungki Baek, Il Hwan Jung, Ho Young Lee, Jimin Song, Eunsil Cha, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn; Ann Rehabil Med 2020;44(3):203-209. Published online May 29, 2020; DOI: https://doi.org/10.5535/arm.19140

Abstract
PDF

Objective
To verify the pharyngeal width at rest as a measurement that could be used to assess changes in the degree of dysphagia over time in stroke patients.
Methods
In a cohort of stroke patients, we performed serial measurements of the pharyngeal width at the midpoints of the second (C2) and third (C3) cervical vertebral bodies using lateral neck X-rays while the patients were at rest. The JOSCYL width, a parameter named after the first initial of each developers’ surname and defined as the average value of the upper and lower pharyngeal widths, was used to formulate the JOSCYL scale, which was calculated as the JOSCYL width × 100/neck circumference. All patients also underwent serial videofluoroscopic swallowing studies (VFSSs). The Spearman correlation analysis was used to detect correlations between the serial VFSS results, JOSCYL widths, and JOSCYL scale values.
Results
Over time, we observed significant positive and negative correlations of change in the JOSCYL width and scale with changes in the Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale scores, respectively.
Conclusion
The JOSCYL width and JOSCYL scale clearly reflected changes in dysphagia in stroke patients over time. These parameters may provide an easier method for evaluating whether post-stroke dysphagia has been alleviated.

Citations

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Pharyngeal Structure and Dysphagia in Patients with Parkinson’s Disease and Related Disorders
Eunjee Lee, Gyu Jin Kim, Hyewon Ryu, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn
Dysphagia.2024; 39(3): 468. CrossRef
Prediction of Pharyngeal 3D Volume Using 2D Lateral Area Measurements During Swallowing
Howell Henrian G. Bayona, Yoko Inamoto, Eichii Saitoh, Keiko Aihara, Masanao Kobayashi, Yohei Otaka
Dysphagia.2024; 39(5): 783. CrossRef
The influence of pharyngeal width on post-stroke laryngeal aspiration
Wonil Kang, Jane Chung, Jeongeun Lee, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn
NeuroRehabilitation.2021; 49(3): 435. CrossRef

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Characteristics of Patients With Esophageal Dysphagia Assessed by Chest X-Ray Imaging After Videofluoroscopic Swallowing Study: Young-Kee Min, Sora Baek, Eun Kyoung Kang, Seung-Joo Nam; Ann Rehabil Med 2020;44(1):38-47. Published online February 29, 2020; DOI: https://doi.org/10.5535/arm.2020.44.1.38

Abstract
PDF

Objective
To evaluate the prevalence rate, types, characteristics, and associated factors of esophageal dysphagia detected on chest X-ray images after videofluoroscopic swallowing study (VFSS).
Methods
The medical records of 535 adults were reviewed retrospectively. Chest X-ray images taken after barium swallow study were analyzed and presence of any residual barium in the esophagus was considered as esophageal dysphagia. Esophageal dysphagia was classified based on the largest width of barium deposit (mild, <2 cm; severe ≥2 cm) and the anatomic level at which it was located (upper and lower esophagus).
Results
Esophageal residual barium on chest X-ray images was identified in 40 patients (7.5%, 40/535). Esophageal dysphagia was more frequent in individuals aged 65–79 years (odds ratio=4.78, p<0.05) than in those aged <65 years. Mild esophageal dysphagia was more frequent (n=32) than its severe form (n=8). Lower esophageal dysphagia was more frequent (n=31) than upper esophageal dysphagia (n=9). Esophageal residual barium in patients diagnosed with esophageal cancer or lung cancer was significantly associated with severe esophageal dysphagia (p<0.05) and at the upper esophagus level (p<0.01).
Conclusion
Esophageal residual barium was observed on chest X-ray imaging after VFSS. Esophageal barium in the upper esophagus with a diameter of ≥2 cm is an important indicator of malignancy, and chest X-ray image taken after VFSS is an important step to evaluate the presence of esophageal disorder.

Citations

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Extremely Severe Dysphagia Secondary to Tracheostomy: A Case Report
Daham Kim, Bum-Seok Lee, Si-Woon Park, Hyung-Wook Han, Namo Jeon, Hyeon-Woo Jeon, Doo Young Kim
Journal of the Korean Dysphagia Society.2023; 13(1): 65. CrossRef
Esophageal dysphagia in neuromuscular disorder patients with validity and reliability study of the brief esophageal dysphagia questionnaire
Ebru Umay, Yusuf Serdar Sakin, Mehlika Panpallı Ates, Sibel Alicura, Ibrahim Gundogdu, Erhan Arif Ozturk, Guray Koc
Acta Neurologica Belgica.2022; 122(2): 315. CrossRef
Application Value of Gastroenterography Combined With CT in the Evaluation of Short-Term Efficacy and Prognosis in Patients With Esophageal Cancer Radiotherapy
Liangliang Xue, Linning E, Zhifeng Wu, Dongqiang Guo
Frontiers in Surgery.2022;[Epub] CrossRef
Dysphagia Secondary to Esophageal Compression in a Patient with Decompensated Heart Failure
Jintae Park, Sora Baek, Gowun Kim, Seung-Joo Nam, Byung-Ryul Cho
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(2): 146. CrossRef
Esophageal Motility Disorders in Patients With Esophageal Barium Residue After Videofluoroscopic Swallowing Study
Jintae Park, Sora Baek, Gowun Kim, Seung-Joo Nam, Ji Hyun Kim
Annals of Rehabilitation Medicine.2022; 46(5): 237. CrossRef

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Epiglottic Retroflexion is a Key Indicator of Functional Recovery of Post-stroke Dysphagia: Ji Soo Choi, Hyun Bang, Goo Joo Lee, Han Gil Seo, Byung-Mo Oh, Tai Ryoon Han; Ann Rehabil Med 2020;44(1):1-10. Published online February 29, 2020; DOI: https://doi.org/10.5535/arm.2020.44.1.1

Abstract
PDF

Objective
To evaluate the longitudinal changes of swallowing kinematics based on videofluoroscopic swallowing studies (VFSSs) in subacute stroke patients grouped according to the method of dietary intake.
Methods
Sixty-nine subacute stroke patients who had taken at least 2 successive VFSSs were included. Subjects were allocated into 3 groups according to the degree of swallowing function recovery—not improved group (tube feeding recommended to patients at both studies), improved group (tube feedings recommended initially to patients and oral feeding recommended at follow-up study), and well-maintained group (oral feeding at both studies recommended to patients). Initial VFSS was performed during the subacute stage of stroke, 1 to 12 weeks after the onset of stroke, and follow-up VFSS was performed at least once. Kinematic variables were calculated by two-dimensional motion analysis of multiple structures, including the hyoid bone, epiglottis, and vocal cord. Changes of kinematic variables were analyzed in serial VFSSs.
Results
At the initial VFSS, the well-maintained group showed significantly larger angles of epiglottic folding than the not improved group, while at the follow-up VFSS, the improved and the well-maintained groups showed significantly larger epiglottic folding angles than the not improved group. The distribution of epiglottic folding angles was in a dichotomous pattern, and each cluster was related to the swallowing function.
Conclusion
This study showed that improved epiglottic folding angles are associated with the recovery of the swallowing process and suitability for oral feeding among various kinematic variables in subacute stroke patients.

Citations

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Predictors of recovery from dysphagia after stroke: A systematic review and meta-analysis
Xiaoyan Jin, Shaomei Shang, HoiYee Tong, Ming Liu, Dan Li, Ying Xiao
International Journal of Nursing Sciences.2025; 12(2): 184. CrossRef
Timing of True Vocal Cords Closure for Safe Swallowing: A Review of 5 Studies Using 3D Analysis Using Computerized Tomography (CT)
Yoko Inamoto, Marlís González-Fernández, Eiichi Saitoh
Dysphagia.2024; 39(3): 313. CrossRef
A Large Cohort Analysis of Epiglottic Phenotypes and Pharyngeal Residue
Adam Kravietz, Tyler Crosby, Jackie Yang, Stamatela Balou, Gregory R. Dion, Ashley Logan, Milan R. Amin
Annals of Otology, Rhinology & Laryngology.2024; 133(4): 375. CrossRef
Predicting Swallowing Recovery in Subacute Stroke Patients via Temporal and Spatial Parameters of Videofluoroscopy
Lian Wang, Zhenhai Wei, Wei Xin, Zulin Dou
Brain and Behavior.2024;[Epub] CrossRef
Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review
Pamela D’Netto, Anna Rumbach, Katrina Dunn, Emma Finch
Dysphagia.2023; 38(1): 1. CrossRef
Risk factors of dysphagia in patients with ischemic stroke: A meta-analysis and systematic review
Cui Yang, Yun Pan, Massimiliano Toscano
PLOS ONE.2022; 17(6): e0270096. CrossRef
Correlation of Videofluoroscopic Swallowing Study Findings With Radionuclide Salivagram in Chronic Brain-Injured Patients
Ga Yang Shim, Ju Sun Oh, Seunghee Han, Kyungyeul Choi, Son Mi Lee, Min Woo Kim
Annals of Rehabilitation Medicine.2021; 45(2): 108. CrossRef
Effects of percutaneous injection laryngoplasty on voice and swallowing problems in cancer‐related unilateral vocal cord paralysis
Min‐Gu Kang, Han Gil Seo, Eun‐Jae Chung, Hyun Haeng Lee, Seo Jung Yun, Bhumsuk Keam, Tae Min Kim, Seong Keun Kwon, Byung‐Mo Oh
Laryngoscope Investigative Otolaryngology.2021; 6(4): 800. CrossRef
Correlation Between Maximal Tongue Pressure and Swallowing Function in Spinal and Bulbar Muscular Atrophy
Dae-Won Gwak, Seung-Hwan Jung, Yu-Sun Min, Jin-Sung Park, Hee-Jin Cho, Donghwi Park, Min Woo Hong, Min-Gu Kang
Frontiers in Neurology.2021;[Epub] CrossRef

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Case Report

Pharyngeal Dystonia Misdiagnosed as Cricopharyngeal Dysphagia Successfully Treated by Pharmacotherapy: Ho Eun Park, Myung Jun Shin, Je-Sang Lee, Yong Beom Shin; Ann Rehabil Med 2019;43(6):720-724. Published online December 31, 2019; DOI: https://doi.org/10.5535/arm.2019.43.6.720

Abstract
PDF

A 43-year-old woman suffered from drooling and dysphagia after a stroke in the left posterior inferior cerebellar artery territory. Videofluoroscopic swallowing study showed compatible findings of cricopharyngeal dysphagia. Despite the injection of botulinum neurotoxin, no symptom improvement was achieved and pharyngeal dystonia was considered as the cause. Medications for dystonia dramatically helped with saliva control and resulted in a small improvement in the progression of food from the pharyngeal to esophageal phase. After adjusting the drug dose, the patient was able to perform social activities without drooling. Moreover, she could consume food orally; however, this was limited to small amounts of liquid, and the main method of nutrition support was via an orogastric tube. Therefore, we suggest that physicians should make a differential diagnosis of combined dystonia in patients complaining of dysphagia by esophageal manometry and electromyography.

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Original Articles

Predictive Value of Pharyngeal Width at Rest (JOSCYL Width) for Aspiration in Elderly People: Ho Young Lee, Il Hwan Jung, Eunsil Cha, Jimin Song, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn; Ann Rehabil Med 2019;43(2):187-194. Published online April 30, 2019; DOI: https://doi.org/10.5535/arm.2019.43.2.187

Abstract
PDF

Objective
To develop a new tool for aspiration risk prediction based on pharyngeal width at rest in older adults with symptoms of aspiration.
Methods
Lateral cervical spine roentgenograms were obtained from 33 older adult patients who complained of dysphagia and from 33 healthy, age-matched controls. Pharyngeal width at rest was measured at two points. We named the average of these two pharyngeal widths ‘JOSCYL Width’, calculated ‘JOSCYL Scale’, and compared these parameters between dysphagia and control groups. Correlations of individual JOSCYL Width and JOSCYL Scale, with Penetration Aspiration Scale (PAS) and Dysphagia Outcome and Severity Scale (DOSS) scores were analyzed for the dysphagia group. To determine optimal cutoff points for predicting aspiration, a receiver operating characteristic curve analysis was performed on JOSCYL Width and JOSCYL Scale.
Results
Both JOSCYL Width and JOSCYL Scale of the dysphagia group were larger than those of the control group (p<0.001). The correlation between JOSCYL Width and severity of dysphagia was significant for the dysphagia group (PAS p=0.007; DOSS p=0.012). The correlation between JOSCYL Scale and the severity of dysphagia was also significant for the dysphagia group (PAS p=0.009; DOSS p=0.011). Optimal cutoffs for JOSCYL Width and JOSCYL Scale for predicting aspiration were 20.0 mm and 5.9, respectively.
Conclusion
JOSCYL Width and JOSCYL Scale can be new indicators for predicting aspiration in older adults. They are both precise and easy to use.

Citations

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Pharyngeal Structure and Dysphagia in Patients with Parkinson’s Disease and Related Disorders
Eunjee Lee, Gyu Jin Kim, Hyewon Ryu, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn
Dysphagia.2024; 39(3): 468. CrossRef
Prediction of Pharyngeal 3D Volume Using 2D Lateral Area Measurements During Swallowing
Howell Henrian G. Bayona, Yoko Inamoto, Eichii Saitoh, Keiko Aihara, Masanao Kobayashi, Yohei Otaka
Dysphagia.2024; 39(5): 783. CrossRef
The influence of pharyngeal width on post-stroke laryngeal aspiration
Wonil Kang, Jane Chung, Jeongeun Lee, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn
NeuroRehabilitation.2021; 49(3): 435. CrossRef
Changes in Pharyngeal Width Over Time as an Indicator of Dysphagia in Stroke Patients
Seungki Baek, Il Hwan Jung, Ho Young Lee, Jimin Song, Eunsil Cha, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn
Annals of Rehabilitation Medicine.2020; 44(3): 203. CrossRef

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Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients: Ra Yu Yun, Ho Eun Park, Ji Won Hong, Yong Beom Shin, Jin A Yoon; Ann Rehabil Med 2019;43(2):156-162. Published online April 30, 2019; DOI: https://doi.org/10.5535/arm.2019.43.2.156

Abstract
PDF

Objective
To investigate difference in bilateral diaphragm movement of patients with tracheal aspiration according to post stroke residue severity and determine correlations of Penetration-Aspiration Scale (PAS), residue scale, and bilateral diaphragm movement.
Methods
A total of 47 patients diagnosed with hemiplegic stroke were enrolled in this study. PAS, severity of valleculae, and pyriform sinus retention during videofluoroscopic swallowing study (VFSS) were assessed. Bilateral fluoroscopic diaphragm movements during spontaneous breathing and forced breathing were measured.
Results
Patients with tracheal aspiration (PAS≥6) had significantly (p=0.035) lower ipsilateral diaphragm movement during spontaneous breathing. Post-swallow residue severity showed statistically significant (p=0.028) difference in patients with ipsilateral diaphragm movement during forced breathing. In linear regression analysis, PAS showed weak correlations with ipsilateral spontaneous diaphragm movement (r=0.397, p=0.006), ipsilateral forced diaphragm movement (r=0.384, p=0.008), and contralateral forced diaphragm movement (r=0.323, p=0.027). Weak correlation was also observed between post swallow residue severity and ipsilateral diaphragm movement during spontaneous breathing (r=0.331, p=0.023) and forced breathing (r=0.343, p=0.018).
Conclusion
We confirmed the relationship between swallowing function and bilateral diaphragm movement in this study. The severity of dysphagia after hemiplegic stroke was correlated with bilateral diaphragm movement. Further longitudinal studies are needed to assess the effect of breathing exercise on post-stroke dysphagia.

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The Impact of Ageing on Diaphragm Function and Maximal Inspiratory Pressure: A Cross-Sectional Ultrasound Study
Toru Yamada, Taro Minami, Takahiro Shinohara, Shuji Ouchi, Suguru Mabuchi, Shunpei Yoshino, Ken Emoto, Kazuharu Nakagawa, Kanako Yoshimi, Mitsuko Saito, Ayane Horike, Kenji Toyoshima, Yoshiaki Tamura, Atsushi Araki, Ryoichi Hanazawa, Akihiro Hirakawa, Tak
Diagnostics.2025; 15(2): 163. CrossRef
Methods for Diagnosing and Predicting Diaphragm Dysfunction in the Recovery Period of a Stroke: a Narrative Review
Ekaterina A. Melnikova, Elena Yu. Starkova, Nadezhda N. Vladimirova, Evgeniya M. Tsvetkova, Vladislav Yu. Litau
Bulletin of Rehabilitation Medicine.2023; 22(4): 138. CrossRef
Assessment of Diaphragm in Hemiplegic Patients after Stroke with Ultrasound and Its Correlation of Extremity Motor and Balance Function
Xiaoman Liu, Qingming Qu, Panmo Deng, Yuehua Zhao, Chenghong Liu, Conghui Fu, Jie Jia
Brain Sciences.2022; 12(7): 882. CrossRef
Respiratory‐swallow coordination in a rat model of chemoradiation
Linda M. Rowe, Nadine P. Connor, John A. Russell
Head & Neck.2021; 43(10): 2954. CrossRef
Neck Stabilization Exercises Enhance Respiratory Function after Stroke: Respiratory Function Index Change Trajectory Analyzed Using a Hierarchical Linear Model
So-Hyun Kim, Sung-Hyoun Cho
Medicina.2021; 57(12): 1312. CrossRef
Guidelines for the Evaluation of Cardiorespiratory Physiotherapy in Stroke Patients
Sung-Hyoun Cho, Ki-Bok Choi
Healthcare.2020; 8(3): 222. CrossRef

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Comparison of Dysphagia Between Infratentorial and Supratentorial Stroke Patients: Yong Kyun Kim, Jung Hyun Cha, Kyun Yeon Lee; Ann Rehabil Med 2019;43(2):149-155. Published online April 30, 2019; DOI: https://doi.org/10.5535/arm.2019.43.2.149

Abstract
PDF

Objective
To compare dysphagia between infratentorial stroke patients and supratentorial stroke patients.
Methods
Subjects of this study were patients with post-stroke dysphagia (PSD) who were admitted to our medical institution between May 2014 and June 2017. We evaluated a total of 64 patients with PSD. A videofluoroscopic swallowing study (VFSS) was performed to determine dysphagia severity. We measured the following parameters: pharyngeal transit time (PTT), post-swallow pharyngeal remnant, Penetration Aspiration Scale (PAS) scores, and Functional Dysphagia Scale (FDS). We analyzed patient’s results from VFSS performed at admission. All VFSS images were recorded using a camcorder running at 30 frames per second. An AutoCAD 2D screen was used to measure post-swallow pharyngeal remnant.
Results
In this study, PTT and FDS were similar (p>0.05) between infratentorial stroke patients and supratentorial stroke patients. However, there were significant differences in pharyngeal remnant and PAS scores between the two groups (p<0.01 and p<0.05, respectively).
Conclusion
Both pharyngeal remnant and PAS score registered higher levels from VFSS test for infratentorial stroke patients than those for supratentorial stroke patients. This suggests greater chances of problems occurring with swallowing, the major functions of pons. Thus, clinicians should pay particular attention to active dysphagia evaluation and treatment in PSD of infratentorial stroke patients.

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Investigation of neurogenic dysphagia in commonly seen neurological diseases
Müberra Tanrıverdi, Senanur Düzenli, Merve Sevinç Gündüz, Ayça Arslantürk, Ayşenur Erekdağ
Anadolu Kliniği Tıp Bilimleri Dergisi.2025; 30(1): 150. CrossRef
Post-stroke dysphagia: identifying the evidence missing
Zicong Wang, Ran Shi, Paulo Moreira
Frontiers in Medicine.2025;[Epub] CrossRef
Temporal Characteristics of Penetration and Aspiration in Patients with Severe Dysphagia Associated with Lateral Medullary Syndrome
Meng Dai, Jiao Qiao, Huayu Chen, Zhonghui Shi, Binbin Liu, Zu-Lin Dou
Dysphagia.2024; 39(2): 255. CrossRef
Correlation between lesion location and dysphagia characteristics in post-stroke patients
Qing-lu Yang, Yang Chen, Xue-jie Wang, Hui-ying Qiu, Meng-ting Chen, Xu-hui Zhou, Chu-yao Jian, Shao-feng Zhao
Journal of Stroke and Cerebrovascular Diseases.2024; 33(6): 107682. CrossRef
Factors Influencing Early Diagnosis and Poor Prognosis of Dysphagia After Senile Ischemic Stroke
Qingxian Fan, Yan Zhao, Jianrong Zhang, Yu’e Wu, Qingping Huang, Ying Gao, Jingqin Wang, Changqiong Guo, Shuqing Zhang
Journal of Molecular Neuroscience.2024;[Epub] CrossRef
Effects of Cerebellar Repetitive Transcranial Magnetic Stimulation in the Treatment of Post-Stroke Dysphagia: A Meta-Analysis and Systematic Review of Randomized Controlled Trials
Ying Liu, Shao Yin, Xinwei Yang, Shanshan Luo, Fengya Zhu, Zijian Zeng, Qian Hu, Li Xu, Qian Yu
European Neurology.2024; 87(2): 67. CrossRef
The Respiratory-Swallow Coordination may be Related to Aspiration in Infratentorial Stroke Patients
Jia Qiao, Meng Dai, Fang Sun, Zhi-Min Wu, Lian Wang, Qiu-Pin Ye, Yong Dai, Hong-Mei Wen, Zu-Lin Dou
Dysphagia.2024;[Epub] CrossRef
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Journal of NeuroInterventional Surgery.2023; 15(e2): e270. CrossRef
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Jeong Min Kim, Ji Eun Park, Seung Jun Baek, Seung Nam Yang
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Effect of cerebellar transcranial magnetic stimulation with double-cone coil on dysphagia after subacute infratentorial stroke: A randomized, single-blinded, controlled trial
Meng Dai, Jia Qiao, Zhonghui Shi, Xiaomei Wei, Huayu Chen, Luxi Shen, Hongmei Wen, Zulin Dou
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Postoperative Dysphagia Aortica: Comparison with Other Dysphagia
Jong Keun Kim, Sangpil Son, InHyuk Suh, Jin Seok Bae, Jong Youb Lim
Dysphagia.2022; 37(5): 1112. CrossRef
Predictive value of the videofluoroscopic swallowing study for long-term mortality in patients with subacute stroke
Daham Kim, Jae-Hyung Kim, Si-Woon Park, Hyung-Wook Han, Sang Joon An, Yeong In Kim, Hyo Jin Ju, YoonHee Choi, Doo Young Kim
Medicine.2022; 101(4): e28623. CrossRef
Increased cortical-medulla functional connectivity is correlated with swallowing in dysphagia patients with subacute infratentorial stroke
Meng Dai, Jia Qiao, Xiaomei Wei, Huayu Chen, Zhonghui Shi, Zulin Dou
NeuroImage: Clinical.2022; 35: 103104. CrossRef
Characteristics of dysphagia among different lesion sites of stroke: A retrospective study
Jia Qiao, Zhi-min Wu, Qiu-ping Ye, Meng Dai, Yong Dai, Zi-tong He, Zu-lin Dou
Frontiers in Neuroscience.2022;[Epub] CrossRef
Increased Cortical–Medulla Functional Connectivity is Correlated with Swallowing in Dysphagia Patients with Sub-Acute Infratentorial Stroke
Meng Dai, Jia Qiao, Xiaomei Wei, Huayu Chen, Zhonghui Shi, Zulin Dou
SSRN Electronic Journal .2022;[Epub] CrossRef
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Alessandro De Stefano, Francesco Dispenza, Gautham Kulamarva, Giuseppina Lamarca, Antonio Faita, Antonio Merico, Giuseppe Sardanelli, Salvatore Gabellone, Antonio Antonaci
European Archives of Oto-Rhino-Laryngology.2021; 278(3): 741. CrossRef
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Byung Joo Lee, Hyoshin Eo, Changbae Lee, Donghwi Park
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The influence of pharyngeal width on post-stroke laryngeal aspiration
Wonil Kang, Jane Chung, Jeongeun Lee, Kwang-Ik Jung, Woo-Kyoung Yoo, Suk Hoon Ohn
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Use of the maximal phonation test for the screening of dysphagia in stroke patients: a preliminary study
Ju-Young Lim, Young-Hwan Yoo, Chan-Hyuk Park, Kyung-Lim Joa, Han-Young Jung
European Journal of Physical and Rehabilitation Medicine.2020;[Epub] CrossRef

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Characteristics and Clinical Course of Dysphagia Caused by Anterior Cervical Osteophyte: Hee Eun Choi, Geun Yeol Jo, Woo Jin Kim, Hwan Kwon Do, Jun Koo Kwon, Se Heum Park; Ann Rehabil Med 2019;43(1):27-37. Published online February 28, 2019; DOI: https://doi.org/10.5535/arm.2019.43.1.27

Abstract
PDF

Objective
To investigate swallowing characteristics of patients with dysphagia caused by anterior cervical osteophytes (ACOs) and compare clinical courses according to treatment options.
Methods
A retrospective analysis of 1,866 videofluoroscopic swallowing studies (VFSS) of patients with ACOs from electronic medical records was performed. Patients with other diseases that could explain the dysphagia were excluded. Dysphagia characteristics and severity and clinical and radiological characteristics of subjects with ACOs were evaluated. Dysphagia characteristics and clinical course were compared among three treatment groups: surgical treatment, swallowing rehabilitation, and conservative treatment.
Results
Subjects were 22 men and 1 woman with a mean age of 78.69±8.01 years. The mean osteophyte thickness was 9.07±3.84 mm. It was significantly thicker in the surgical group than that in other groups (p=0.01). ACOs were most frequently found at C5 level. This level also had the thickest osteophytes. However, videofluoroscopic dysphagia scales (VDS) were not significantly different among the three treatment groups. The pharyngeal phase score of the VDS was significantly higher in the surgical group (p=0.041). Dysphagia severity was decreased significantly in the surgical group at 3 months after the initial VFSS (p=0.004).
Conclusion
The main swallowing characteristics in patients with ACOs were dysphagia features of the pharyngeal phase, including inappropriate airway protection, decreased laryngeal elevation, and reduced epiglottis inversion. When determining treatment options, it may be helpful to consider dysphagia severity at pharyngeal phase and osteophyte thickness.

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Dysphagia as the main symptom in anterior cervical spine osteophytes (Forestier disease and cervical spondylosis deformans). Case reports and literature review
A.V. Trashin, N.V. Vikherev, E.M. Belov, V.A. Shamanin, V.V. Stepanenko
Burdenko's Journal of Neurosurgery.2024; 88(2): 69. CrossRef
A Case of Dysphagia Due to Large Osteophytic Lesions in the Cervical Spine: A Conservative Approach
Christos Lyrtzis, Alexandros Poutoglidis, Athina Stamati, Nikolaos Lazaridis, George Paraskevas
Cureus.2024;[Epub] CrossRef
Diagnosis and Management of Anatomical Causes of Dysphagia: From Hypopharynx to Upper Esophagus
Min Woo Park
Journal of the Korean Dysphagia Society.2023; 13(1): 8. CrossRef
The Impact of Cervical Spinal Disease on Pharyngeal Swallowing Function
Rameen K. Walters, Rachana Gudipudi, Kate Davidson, Melissa Cooke, Jenna Barengo, Drasti Smyre, Kendrea L. Garand, Bonnie Martin-Harris, Maria G. Matheus, Shaun A. Nguyen, Ashli K. O'Rourke
American Journal of Speech-Language Pathology.2023; 32(2): 565. CrossRef
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Liu Wei, Li Sulian, Li Tonglian, Zhang Yan, Liu Zongchao
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Andreia De Matos, Cristiane Macedo, Patrícia Afonso Mendes
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Mateus Morais Aires, Gabriela Marie Fukumoto, Sarah Lima Ribeiro, Leonardo Haddad, Eliézia Helena de Lima Alvarenga
CoDAS.2022;[Epub] CrossRef
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Zihan Peng, Hao Liu, Ying Hong, Yang Meng
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Giant Anterior Cervical Osteophyte Causing Dysphagia
Sang Joon Kang, Hoe Jong Jeong, Won Cheol Jeong, Sang-Won Ha, Seung Min Kim
Journal of the Korean Neurological Association.2022; 40(3): 267. CrossRef
Aggravation of dysphagia after surgical removal of anterior cervical osteophytes: a case report
Young-In Go, Gi-Wook Kim, Yu-Hui Won, Sung-Hee Park, Myoung-Hwan Ko, Jeong-Hwan Seo, Da-Sol Kim
Journal of International Medical Research.2022;[Epub] CrossRef
Anterior Cervical Osteophyte Resection for Treatment of Dysphagia
Joshua M. Kolz, Mohammed A. Alvi, Atiq R. Bhatti, Marko N. Tomov, Mohamad Bydon, Arjun S. Sebastian, Benjamin D. Elder, Ahmad N. Nassr, Jeremy L. Fogelson, Bradford L. Currier, Brett A. Freedman
Global Spine Journal.2021; 11(4): 488. CrossRef
Hypertrophic anterior cervical osteophyte
Takaomi Kobayashi, Alan Kawarai Lefor, Tadatsugu Morimoto
Reumatología Clínica.2021; 17(9): 552. CrossRef
Hypertrophic anterior cervical osteophyte
Takaomi Kobayashi, Alan Kawarai Lefor, Tadatsugu Morimoto
Reumatología Clínica (English Edition).2021; 17(9): 552. CrossRef
Ostéophytes vertébraux : une cause rare de dysphagie chez le sujet jeune
M. Le Guen, G. Lahlou, S. Le Burel, T. Chaara, H. Nielly, H. Vanquaethem, L. Gilardin
La Revue de Médecine Interne.2019; 40: A112. CrossRef

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Clinical Importance of Peak Cough Flow in Dysphagia Evaluation of Patients Diagnosed With Ischemic Stroke: Sang Won Min, Se Hyun Oh, Ghi Chan Kim, Young Joo Sim, Dong Kyu Kim, Ho Joong Jeong; Ann Rehabil Med 2018;42(6):798-803. Published online December 28, 2018; DOI: https://doi.org/10.5535/arm.2018.42.6.798

Abstract
PDF

Objective
To investigate the relationship between peak cough flow (PCF), pulmonary function tests (PFT), and severity of dysphagia in patients with ischemic stroke.
Methods
This study included patients diagnosed with ischemic stroke, who underwent videofluoroscopic swallowing study (VFSS), PCF and PFT from March 2016 to February 2017. The dysphagia severity was assessed using the videofluoroscopic dysphagia scale (VDS). Correlation analysis of VDS, PFT and PCF was performed. Patients were divided into three groups based on VDS score. One-way ANOVA of VDS was performed to analyze PCF, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and age among the different groups.
Results
The correlation coefficients of VDS and PCF, VDS and FVC, and VDS and FEV1 were -0.836, -0.508, and -0.430, respectively, all of which were statistically significant at the level of p<0.001. The one-way ANOVA indicated statistically significant differences in PCF, FVC, FEV1, and age among the VDS groups. Statistically significant differences in VDS and age were observed between aspiration pneumoia and non-aspiration pneumonia groups.
Conclusion
Coughing is a useful factor in evaluating the risk of aspiration in dysphagia patients. Evaluation of respiratory and coughing function should be conducted during the swallowing assessment of patients with ischemic stroke.

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Shan Liu, Zhenfeng Fan, Minke FU, Keling Cheng, Xin Zhang, Jun Ni, ZhiYong Wang
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Usefulness of Maximal Expiratory Pressure in Evaluating Dysphagia after Ischemic Stroke
Bo Seong Jang, Ho Joong Jeong, Han Eum Choi, Jae Hyun Lee, Young Joo Sim, Ghi Chan Kim
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Association of Brain Lesions and Videofluoroscopic Dysphagia Scale Parameters on Patients With Acute Cerebral Infarctions: Sang Jun Mo, Ho Joong Jeong, Yong Hyun Han, Kihun Hwang, Jong Kyoung Choi; Ann Rehabil Med 2018;42(4):560-568. Published online August 31, 2018; DOI: https://doi.org/10.5535/arm.2018.42.4.560

Abstract
PDF

Objective
To investigate the characteristics and risk factors of dysphagia using the videofluoroscopic dysphagia scale (VDS) with a videofluoroscopic swallowing study (VFSS) in patients with acute cerebral infarctions.
Methods
In this retrospective study, the baseline VFSS in 275 stroke patients was analyzed. We divided patients into 8 groups according to lesion areas commonly observed on brain magnetic resonance imaging. Dysphagia characteristics and severity were evaluated using the VDS. We also analyzed the relationship between clinical and functional parameters based on medical records and VDS scores.
Results
In comparison studies of lesions associated with swallowing dysfunction, several groups with significant differences were identified. Apraxia was more closely associated with cortical middle cerebral artery territory lesions. Vallecular and pyriform sinus residue was more common with lesions in the medulla or pons. In addition, the results for the Korean version of the Modified Barthel Index (K-MBI), a functional assessment tool, corresponded to those in the quantitative evaluation of swallowing dysfunctions.
Conclusion
A large cohort of patients with cerebral infarction was evaluated to determine the association between brain lesions and swallowing dysfunction. The results can be used to establish a specific treatment plan. In addition, the characteristic factors associated with swallowing dysfunctions were also confirmed.

Citations

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Post-stroke dysphagia: identifying the evidence missing
Zicong Wang, Ran Shi, Paulo Moreira
Frontiers in Medicine.2025;[Epub] CrossRef
Correlation between lesion location and dysphagia characteristics in post-stroke patients
Qing-lu Yang, Yang Chen, Xue-jie Wang, Hui-ying Qiu, Meng-ting Chen, Xu-hui Zhou, Chu-yao Jian, Shao-feng Zhao
Journal of Stroke and Cerebrovascular Diseases.2024; 33(6): 107682. CrossRef
Prevalence, recovery and phenotype of dysphagia in patients with ischaemic cerebellar stroke
Jan Hendrik Schaefer, Felix Luft, Alexander Seiler, Elena Harborth, Sara Kaffenberger, Christoph Polkowski, Christian Foerch, Sriramya Lapa
European Journal of Neurology.2024;[Epub] CrossRef
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Masoume Hajipour, Davood Sobhani-Rad, Shahryar Zainaee, Mohammad Taghi Farzadfar, Saeedeh Hajebi Khaniki
Frontiers in Neurology.2023;[Epub] CrossRef
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Jun Yup Kim, Seo Yeon Yoon, Jinna Kim, Yong Wook Kim
International Journal of Stroke.2022; 17(2): 207. CrossRef
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Hyun Im Moon, Yoon Jeong Jeong, Ji Hyun Suh
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Usefulness of the Modified Videofluoroscopic Dysphagia Scale in Choosing the Feeding Method for Stroke Patients with Dysphagia
Byung Joo Lee, Hyoshin Eo, Changbae Lee, Donghwi Park
Healthcare.2021; 9(6): 632. CrossRef
Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients
Ra Yu Yun, Ho Eun Park, Ji Won Hong, Yong Beom Shin, Jin A Yoon
Annals of Rehabilitation Medicine.2019; 43(2): 156. CrossRef

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Efficacy of a 4-Week Swallowing Rehabilitation Program Combined With Pyriform Sinus Ballooning in Patients With Post-stroke Dysphagia: Yong Kyun Kim, Kyun Yeon Lee, Sang-Heon Lee; Ann Rehabil Med 2018;42(4):542-550. Published online August 31, 2018; DOI: https://doi.org/10.5535/arm.2018.42.4.542

Abstract
PDF

Objective
To assess the efficacy of a 4-week swallowing rehabilitation program combined with pyriform sinus ballooning in patients with post-stroke dysphagia (PSD).
Methods
We evaluated a total of 30 patients (n=30) with PSD who were admitted to our medical institution between May of 2014 and October of 2016. These patients were randomly assigned to either the trial group (n=15; a 20-minute conventional rehabilitation followed by a 10-minute pyriform sinus ballooning) or the control group (n=15; a 30-minute conventional rehabilitation). In these patients, the efficacy outcome measures were pharyngeal remnant, the pharyngeal transit time, the Penetration Aspiration Scale (PAS) scores and the Videofluoroscopic Dysphagia Scale (VDS) scores. We compared the differences in efficacy outcome measures at 4 weeks from baseline between the two groups.
Results
There were significant changes in the pharyngeal remnant, the pharyngeal transit time, the PAS scores and the VDS scores at 4 weeks from baseline between the two groups (p<0.0001, p=0.0001, p<0.0001, and p=0.0048, respectively). There were no treatment-emergent adverse events in our series.
Conclusion
Our 4-week rehabilitation program combined with pyriform sinus ballooning is an effective and safe modality in patients with PSD. However, further large-scale, long-term, and multi-center studies are needed to corroborate our results.

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Clinical signs to predict the severity of dysphagia in Acute Ischemic Stroke patients
Huijun Zhou, Shengyan Huang, Kinji Arikawa, Jun Zhu, Ting Ye, Qiang Dong
Clinical Neurology and Neurosurgery.2024; 236: 108091. CrossRef
Research hotspots and frontiers in post-stroke dysphagia: a bibliometric analysis study
Bilian Guo, Mengwei Liu, Zhiyong Wang, Zhipeng Yan
Frontiers in Neurology.2024;[Epub] CrossRef
Therapeutic effects of deep pharyngeal electrical stimulation combined with modified masako maneuver on aspiration in patients with stroke
Bo-Ye Ni, Hua-Ping Jin, Wei Wu
NeuroRehabilitation.2024; 54(3): 391. CrossRef
Clinical study on swallowing function of brainstem stroke by tDCS
Huiwen Mao, Yi Lyu, Yan Li, Lin Gan, Jiawei Ni, Liang Liu, Zhengguang Xiao
Neurological Sciences.2022; 43(1): 477. CrossRef
European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia
Rainer Dziewas, Emilia Michou, Michaela Trapl-Grundschober, Avtar Lal, Ethem Murat Arsava, Philip M Bath, Pere Clavé, Jörg Glahn, Shaheen Hamdy, Sue Pownall, Antonio Schindler, Margaret Walshe, Rainer Wirth, David Wright, Eric Verin
European Stroke Journal.2021; 6(3): LXXXIX. CrossRef
Fonoaudiología En Salas De Urgencias: Perspectiva Desde Una Revisión Documental
Johanna Rodríguez Riaño, DANIELA MARCELA QUECHO RODRIGUEZ, MARIA PAULA RINCON PINILLA, PAULA VANESSA GARAVITO HERNÁNDEZ, DANIELA MARCELA QUECHO RODRIGUEZ, MARIA PAULA RINCON PINILLA, PAULA VANESSA GARAVITO HERNÁNDEZ
Areté.2021;[Epub] CrossRef
Fonoaudiología En Salas De Urgencias: Perspectiva Desde Una Revisión Documental
Johanna Rodríguez Riaño, DANIELA MARCELA QUECHO RODRIGUEZ, MARIA PAULA RINCON PINILLA, PAULA VANESSA GARAVITO HERNÁNDEZ, DANIELA MARCELA QUECHO RODRIGUEZ, MARIA PAULA RINCON PINILLA, PAULA VANESSA GARAVITO HERNÁNDEZ
Areté.2021; 21(1): 125. CrossRef
Diagnosis and treatments for oropharyngeal dysphagia: effects of capsaicin evaluated by newly developed ultrasonographic method
Rui Nakato, Noriaki Manabe, Kozo Hanayama, Hiroaki Kusunoki, Jiro Hata, Ken Haruma
Journal of Smooth Muscle Research.2020; 56: 46. CrossRef

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Relationship Between Swallowing Function and Maximum Phonation Time in Patients With Parkinsonism: Eu Jeong Ko, Minji Chae, Sung-Rae Cho; Ann Rehabil Med 2018;42(3):425-432. Published online June 27, 2018; DOI: https://doi.org/10.5535/arm.2018.42.3.425

Abstract
PDF

Objective
To identify the relationship between maximum phonation time (MPT) and swallowing function, as well as the elements of swallowing, in order to provide a rationale for speech therapy in patients with Parkinsonism manifesting dysphagia.
Methods
Thirty patients with Parkinsonism who underwent speech evaluation and videofluoroscopic swallowing study (VFSS) were recruited. The MPT, the longest periods of sustained pronunciation of /aa/, was evaluated. The VFSS was evaluated using Penetration Aspiration Scale (PAS), National Institutes of Health-Swallowing Safety Scale (NIH-SSS), and Videofluoroscopic Dysphagia Scale (VDS). The relationship between dysphagia scales and MPT was analyzed using Pearson correlation. The difference in VDS variables between subgroups (Parkinson disease or Parkinsonian syndrome, independent or dependent ambulation, and normal or abnormal MPT) and the difference in MPT between subgroups based on the VDS variables were analyzed using the independent t-test.
Results
Bolus formation and laryngeal elevation functions were significantly higher in the normal MPT group compared with the impaired group. In the VDS variables, patients with intact bolus formation, oral transit time, pharyngeal swallow triggering, and laryngeal elevation showed significantly longer MPTs compared with the impaired groups. In addition, MPT was significantly correlated with the VDS and modestly correlated with the NIH-SSS, but not the PAS, suggesting that phonatory function is related to the oropharyngeal swallowing function, but not directly to the aspiration itself.
Conclusion
The correlation between MPT and several swallowing-related elements was identified, indicating an interactive correlation between swallowing and phonation. This result justifies voice therapy as a treatment for dysphagia in patients with Parkinsonism.

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Suguru Maruyama, Yoshihiko Kawaguchi, Kyoko Nitta, Hidenori Akaike, Katsutoshi Shoda, Yudai Higuchi, Takashi Nakayama, Ryo Saito, Wataru Izumo, Koichi Takiguchi, Kensuke Shiraishi, Shinji Furuya, Yuki Nakata, Hidetake Amemiya, Hiromichi Kawaida, Daisuke I
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Changes in Hyolaryngeal Movement During Swallowing in the Lateral Decubitus Posture: Byung-Mo Oh, Jae Hyun Lee, Han Gil Seo, Woo Hyung Lee, Tai Ryoon Han, Seoung Uk Jeong, Ho Joong Jeong, Young-Joo Sim; Ann Rehabil Med 2018;42(3):416-424. Published online June 27, 2018; DOI: https://doi.org/10.5535/arm.2018.42.3.416

Abstract
PDF

Objective
To investigate the differences in hyolaryngeal kinematics at rest and during swallowing in the upright sitting (UP) and the lateral decubitus (LD) postures in healthy adults, and delineating any potential advantages of swallowing while in the LD posture.
Methods
Swallowing was videofluoroscopically evaluated in 20 healthy volunteers in UP and LD postures, based on the movements of hyoid bone, vocal folds, and the bolus head. Parameters included the Penetration-Aspiration Scale (PAS), horizontal and vertical displacement, horizontal and vertical initial position, horizontal and vertical peak position, time to peak position of the hyoid bone and vocal folds, and pharyngeal transit time (PTT).
Results
Nine participants were rated PAS 2 in the UP and 1 was rated PAS 2 in the LD (p=0.003) at least 1 out of 3 swallows each posture. The hyoid and vocal folds showed more anterior and superior peak and initial positions in the LD. In addition, swallowing resulted in greater vertical and smaller horizontal displacement of the hyoid in LD posture compared with UP. Time to peak position of the hyoid was shorter in LD. The maximal vertical and horizontal displacement of the vocal folds, and PTT were comparable between postures.
Conclusion
The results showed that the peak and initial positions of the hyoid and larynx and the pattern of hyoid movement varied significantly depending on the body postures. This study suggests that the LD posture was one of the safe feeding postures without any increased risk compared with UP posture.

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Location of the upper oesophageal sphincter during swallowing: Analysis using swallowing CT
Minxing Gao, Yoko Inamoto, Eiichi Saitoh, Keiko Aihara, Seiko Shibata, Marlis Gonzalez‐Fernandez, Yohei Otaka
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Successful Continuation of Oral Intake in a Dysphagic and Tetraplegic Patient With Alternate Right and Left Complete Lateral Decubitus Positions in Rehabilitation
Yoshinori Maki, Mayumi Takagawa, Akio Goda, Junichi Katsura, Ken Yanagibashi
Cureus.2023;[Epub] CrossRef
Subjective and objective evaluation of swallowing in lateral decubitus positions examined in healthy volunteers
Mayumi Takagawa, Akio Goda, Yoshinori Maki, Ryota Ishibashi, Takumi Morita, Junichi Katsura, Ken Yanagibashi
European Archives of Oto-Rhino-Laryngology.2022; 279(2): 1071. CrossRef
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Virginie Woisard, Mireille Costes, Hélène Colineaux, Benoit Lepage
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Online Learning for the Hyoid Bone Tracking During Swallowing With Neck Movement Adjustment Using Semantic Segmentation
Dongheon Lee, Woo Hyung Lee, Han Gil Seo, Byung-Mo Oh, Jung Chan Lee, Hee Chan Kim
IEEE Access.2020; 8: 157451. CrossRef
Proportion of Aspiration Pneumonia Cases Among Patients With Community-Acquired Pneumonia: A Single-Center Study in Korea
Inpyo Jeon, Gwang Pyo Jung, Han Gil Seo, Ju Seok Ryu, Tai Ryoon Han, Byung-Mo Oh
Annals of Rehabilitation Medicine.2019; 43(2): 121. CrossRef

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Case Reports

Botulinum Toxin Injection in the Treatment of Postextubation Dysphagia: A Case Report: Byung Wook Kim, Hee-Ju Kim, Jung Keun Hyun, Seo Young Kim, Tae Uk Kim; Ann Rehabil Med 2018;42(2):358-362. Published online April 30, 2018; DOI: https://doi.org/10.5535/arm.2018.42.2.358

Abstract
PDF

Prolonged intubation is known to bring on postextubation dysphagia (PED) in some patients. We have noted that there were some studies to investigate specific type and pattern of PED, which showed large variety of different swallowing abnormalities as mechanisms of PED that are multifactorial. There are several options of treatment in accordance with the management of these abnormalities. A botulinum toxin (BoT) injection into the upper esophageal sphincter (UES) can improve swallowing functions for patients with this disorder, by working to help the muscle relax. In this case, the conventional treatment was not effective in patients with PED, whereas the BoT injection made a great improvement for these patients. This study suggests that the UES pathology could be the main cause of PED.

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Botulinum Toxin Injection for the Treatment of Upper Esophageal Sphincter Dysfunction
Pengxu Wei
Toxins.2022; 14(5): 321. CrossRef
[Retracted] Clinical Observation of Botulinum Toxin Injection in the Treatment of Focal Dystonia and Muscle Spasm
Zhen Zhang, Sandip K Mishra
BioMed Research International.2022;[Epub] CrossRef
Ultrasound, electromyography, and balloon guidance for injecting botulinum toxin for cricopharyngeal achalasia
Jian-Min Chen, Yang-Jia Chen, Jun Ni, Zhi-Yong Wang
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Muhammad Ubaid Hafeez, Michael Moore, Komal Hafeez, Joseph Jankovic
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Effectiveness of Combining Behavioral Treatment With Valproic Acid for Dysphagia Caused by Palatal Myoclonus in Patients With Stroke: Two Case Reports: Bo-Ram Kim, Yejin Lee, Soo Jin Kim, Hyuntae Kim, Jong Won Lee, Seunghwan Lee, Jongmin Lee; Ann Rehabil Med 2018;42(1):180-183. Published online February 28, 2018; DOI: https://doi.org/10.5535/arm.2018.42.1.180

Abstract
PDF

Palatal myoclonus (PM) is a rare disease that may induce dysphagia. Since dysphagia related to PM is unique and is characterized by myoclonic movements of the involved muscles, specific treatments are needed for rehabilitation. However, no study has investigated the treatment effectiveness for this condition. Therefore, the aim of this case report was to describe the benefit of combining behavioral treatment with valproic acid administration in patients with dysphagia triggered by PM. The two cases were treated with combined treatment. The outcomes evaluated by videofluoroscopic swallowing studies before and after the treatment showed significant decreases in myoclonic movements and improved swallowing function. We conclude that the combined treatment was effective against dysphagia related to PM.

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Cheng‐Chuan Chiang, Ryan Masterson, Eric T Nguyen, Alba Azola
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Kenta Uemura, Toru Miwa, Takashi Ono, Kishiko Sunami
Practica Oto-Rhino-Laryngologica.2024; 117(9): 789. CrossRef
Palato-pharyngo-laryngeal myoclonus with recurrent retrograde feeding tube migration after cerebellar hemorrhagic stroke: a case report and review of hypertrophic olivary degeneration
Jamie L. Fleet, Ronelle Calver, Gihan C. Perera, Zhihui Deng
BMC Neurology.2020;[Epub] CrossRef

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Original Articles

Association of Post-extubation Dysphagia With Tongue Weakness and Somatosensory Disturbance in Non-neurologic Critically Ill Patients: Hee Seon Park, Jung Hoi Koo, Sun Hong Song; Ann Rehabil Med 2017;41(6):961-968. Published online December 28, 2017; DOI: https://doi.org/10.5535/arm.2017.41.6.961

Abstract
PDF

Objective

To prospectively assess the association between impoverished sensorimotor integration of the tongue and lips and post-extubation dysphagia (PED).

Methods

This cross-sectional study included non-neurologic critically ill adult patients who required endotracheal intubation and underwent videofluoroscopic swallowing study (VFSS) between October and December 2016. Participants underwent evaluation for tongue and lip performance, and oral somatosensory function. Demographic and clinical data were retrieved from medical records.

Results

Nineteen patients without a definite cause of dysphagia were divided into the non-dysphagia (n=6) and the PED (n=13) groups based on VFSS findings. Patients with PED exhibited greater mean duration of intubation (11.85±3.72 days) and length of stay in the intensive care unit (LOS-ICU; 13.69±3.40 days) than those without PED (6.83±5.12 days and 9.50±5.96 days; p=0.02 and p=0.04, respectively). The PED group exhibited greater incidence of pneumonia, higher videofluoroscopy swallow study dysphagia scale score, higher oral transit time, and lower tongue power and endurance and lip strength than the non-dysphagia groups. The differences in two-point discrimination and sensations of light touch and taste among the two groups were insignificant. Patients intubated for more than 7 days exhibited lower maximal tongue power and tongue endurance than those intubated for less than a week.

Conclusion

Duration of endotracheal intubation, LOS-ICU, and oromotor degradation were associated with PED development. Oromotor degradation was associated with the severity of dysphagia. Bedside oral performance evaluation might help identify patients who might experience post-extubation swallowing difficulty.

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The Correlation Between Clinical Characteristics and Radionuclide Salivagram Findings in Patients With Brain Lesions: A Preliminary Study: Donghwi Park, Seung Beom Woo, Dae Hee Lee, Kwang Jae Yu, Ju Young Cho, Jong Min Kim, Zeeihn Lee; Ann Rehabil Med 2017;41(6):915-923. Published online December 28, 2017; DOI: https://doi.org/10.5535/arm.2017.41.6.915

Abstract
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Objective

To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions.

Methods

The medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed.

Results

Eleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625–0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689–0.953; p<0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%).

Conclusion

In patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.

Citations

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