Citations
Effectiveness of Neuromuscular Electrical Stimulation on Post-Stroke Dysphagia: A Systematic Review of Randomized Controlled Trials
To investigate the feasibility of the use of the oropharyngeal airway (OPA) during intermittent oroesophageal tube (IOET) feeding.
Ten patients, who were evaluated using the videofluoroscopic swallowing study (VFSS), were enrolled. One patient withdrew from the study during the study period. Tube insertion time with and without OPA use was recorded in the same patients in a random order during the VFSS. Patients who could safely undergo IOET feeding were then randomly allocated to 2 groups (OPA and non-OPA). Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) scores and pneumonia incidence were assessed on the 3rd and 10th day after the VFSS. Non-parametric analysis was used for statistical analyses.
The IOET insertion time was significantly shorter in the OPA group than in the non-OPA group (17.72±5.79 vs. 25.41±10.41 seconds; p=0.017). Complications were not significantly different between the 2 groups (p=0.054). Furthermore, although there were no significant differences in the SAGA-8 scores (25.50±2.38 vs. 21.40±3.13; p=0.066), which reflect the patient/caregiver satisfaction and the ease of tube insertion, patients in the OPA group tended to be more satisfied with the feeding procedure.
Although the small size of the study cohort is a limitation of our study, the use of the OPA appears to be beneficial during IOET feeding in patients with dysphagia.
Citations
To investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis.
We retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined.
Among the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test).
Careful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.
Citations
Method: Thirty patients who complained of swallowing difficulty or had potential for dysphagia were evaluated using videofluoroscopy and bedside swallowing evaluation for dysphagia. The bedside swallowing evaluations included gag reflex, laryngeal elevation, water swallowing test and swallowing provocation test. We compared bedside swallowing evaluations with videofluoroscopy to determine the sensitivity and specificity in detecting tracheal aspiration.
Results: The comparison of the all combination of bedside swallowing evaluation and videofluoroscopic results suggested that the sensitivity and specificity in the detection of tracheal aspiration was 84.6%, 47.0% respectively.
Conclusion: Bedside swallowing evaluations are limited for screening test of tracheal aspiration, so videofluoroscopic swallowing studies would be necessary to evaluate swallowing difficulty. (J Korean Acad Rehab Med 2003; 27: 489-493)
Objective: To describe the videofluoroscopic findings of quadriplegic patients with dysphagia and to assess the predisposing factors of dysphagia in quadriplegic patients.
Method: Six quadriplegic patients with a dysphagia within 3 months from the injury were included in this study and videofluoroscopic evaluations for both lateral and AP views were performed and evaluated.
Result: A variety of swallowing deficits that involve both oral and pharyngeal phases were detected in the videofluoroscopic study.
The presumed predisposing factors of dysphagia were a surgical stabilization of cervial vertebrae, inadequate neck extension due to cervical orthosis, history of mechanical ventilation, cervical traction, tracheostomy state and cranial nerve injury.
Conclusion: When there are symptoms that suggest a swallowing problem such as a frequent reflex coughing and voice change in quadriplegic patients, videofluoroscopic study will help to prevent the pulmonary complications and to determine the successful swallowing strategies.
Objective: Our study was designed to evaluate the clinical value of pulse oximetry for the detection of aspiration in a stroke patient with dysphagia at bedside.
Methods: Thirty two acute stroke patients with dysphagia were devided into two groups according to the presence or absence of aspiration. And controls was selected among the inpatients without a neurological disease and an evidence of dysphagia. We assessed the dysphagia by a neurological examination, fiberoptic examination of vocal cord and videofluoroscopic swallowing study(VFSS). And the oxygen saturation of tissue blood flow(SpO2) was measured, while VFSS was performed by swallowing the barium sulfate fluid for three times.
Results: The clinical findings of dysphagia were not exactly correlated with the VFSS. There was no significant difference of the resting SpO2 among three groups, but the mean SpO2 fell more in the patients with aspirations(2.73%) than in the controls(0.11%) or the patients without aspirations(0.33%). Mean SpO2 fell more in the patients with aspiration of larger amount, but the change of SpO2 was not statistically significant.
Conclusions: We conclude that the pulse oximetric measurement of SpO2 is useful as a screening test for the assessment of aspiration and the efficacy of swallowing training.
The oropharyngeal swallow of 26 patients with dysphagia was studied quantitatively and qualitatively using videofluoroscope. Videofluoroscopic examination was done with head in neutral position, and with three different consistency of test meals; thin liquid, thick liquid, and solid. When aspiration or laryngeal penetration was noted in neutral position, the study was repeated with different head positions. We compared them with each other and with 25 normal subject(previously presented).
11/26(42%) patients revealed laryngeal penetration or aspiration at least with one consistency of test meal. Aspiration occurred more frequently in thin liquid than thick liquid or solid. Head position change successfully eliminated aspiration in 10/10 patient(100%). Other one patient could not change his head position.
9 numerical parameters were derived and calculated for quantitative examination. Liquid meal oral discharge time, pharyngeal delay time, and pharyngeal transit time were significantly increased in patients with aspiration than in patients without aspiration. Also significantly increased than those of normal controls.
Because different test meal consistency gave different values, direct comparison of values regardless of meal consistency was fruitless. And because all the process of swallowing cannot be expressed as numerical parameters, qualitative examination of videofluoroscopic result was essential.
In conclusion, liquid meal oral discharge time, pharyngeal delay time, and pharyngeal transit time were useful parameters in differentiating and quantifying dysphagia. Aspiration can be reduced when appropriate position assumed. Calculated values were different according to the consistency of the test meal. Quantitative analysis was helpful, but qualitative examination of videofluoroscopy was essential.
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