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ISSN (Print) 1432-0460 - ISSN (Online) 0179-051X
Published by Springer-Verlag Homepage  [2351 journals]
  • High-Resolution Pharyngeal Manometry and Impedance: Protocols and
           Metrics—Recommendations of a High-Resolution Pharyngeal Manometry
           International Working Group
    • Abstract: High-resolution manometry has traditionally been utilized in gastroenterology diagnostic clinical and research applications. Recently, it is also finding new and important applications in speech pathology and laryngology practices. A High-Resolution Pharyngeal Manometry International Working Group was formed as a grass roots effort to establish a consensus on methodology, protocol, and outcome metrics for high-resolution pharyngeal manometry (HRPM) with consideration of impedance as an adjunct modality. The Working Group undertook three tasks (1) survey what experts were currently doing in their clinical and/or research practice; (2) perform a review of the literature underpinning the value of particular HRPM metrics for understanding swallowing physiology and pathophysiology; and (3) establish a core outcomes set of HRPM metrics via a Delphi consensus process. Expert survey results were used to create a recommended HRPM protocol addressing system configuration, catheter insertion, and bolus administration. Ninety two articles were included in the final literature review resulting in categorization of 22 HRPM-impedance metrics into three classes: pharyngeal lumen occlusive pressures, hypopharyngeal intrabolus pressures, and upper esophageal sphincter (UES) function. A stable Delphi consensus was achieved for 8 HRPM-Impedance metrics: pharyngeal contractile integral (CI), velopharyngeal CI, hypopharyngeal CI, hypopharyngeal pressure at nadir impedance, UES integrated relaxation pressure, relaxation time, and maximum admittance. While some important unanswered questions remain, our work represents the first step in standardization of high-resolution pharyngeal manometry acquisition, measurement, and reporting. This could potentially inform future proposals for an HRPM-based classification system specifically for pharyngeal swallowing disorders.
      PubDate: 2019-06-05
  • Can We Reduce Frame Rate to 15 Images per Second in Pediatric
           Videofluoroscopic Swallow Studies'
    • Abstract: Videofluoroscopic Swallow studies (VFSS) are useful radiological examinations to explore swallowing disorders but which require ionizing radiation. The aim of our study was to evaluate the comparability of pediatric VFSS at 15 frames per second (fps) with 30 fps. Fifty-five loops including 190 swallowings of VFSS at 30 fps performed on 32 consecutive pediatric patients in a University Hospital Center were retrospectively modified by a software to delete one image out of two to obtain secondary loops with a frame rate of 15 fps. An otorhinolaryngologist-phonatrician and a radiologist reviewed all swallowings blindly and randomly using the penetration and aspiration scale (PAS). In case of discordance, they concluded a consensual interpretation. Fifteen girls and seventeen boys were included. The median age was 4 years and 8 months (range = 4 months–16 yr.). 144 swallowings were normal. Swallowing disorder was confirmed in 46 swallowings, (23 supraglottic penetrations and 23 aspirations). Considering each swallowing at 15 fps, sensitivity and specificity were, respectively, 93% (CI 0.82–0.98) and 98% (CI 0.94–0.99). The Cohen’Kappa coefficient between each interpretation at 15 and 30 fps was “almost perfect” (κ = 0.95; CI 0.88–0.99). Considering each loop, conclusion was identical. Reducing frame rate at 15 fps during pediatric VFSS seemed to be acceptable with comparable diagnostic performances without clinical impact compared to 30 fps, while being an efficient way to reduce the ionizing radiation exposition in children. We would suggest reconsidering the possibility of using VFSS with a 15 fps in a pediatric population.
      PubDate: 2019-06-05
  • Variations in Healthy Swallowing Mechanics During Various Bolus Conditions
           Using Computational Analysis of Swallowing Mechanics (CASM)
    • Abstract: Bolus properties such as volume, consistency, and density have been shown to influence swallowing through the analysis of kinematics and timing in both normal and disordered swallowing. However, inherent intra- and inter-person variability of swallowing cloud interpretation of group data. Computational analysis of swallow mechanics (CASM) is an established methodology that uses coordinate tracking to map structural movements during swallowing and yields statistically powerful analyses at both the group and individual levels. In this study, the CASM method was used to determine how different bolus properties (volume, consistency, and density) altered swallow mechanics in healthy young adults at the group and individual levels. Videofluoroscopic swallow studies of 10 (4 females) healthy young adults were analyzed using CASM. Five bolus types were administered in each study (3 × 5 ml 40% w/v nectar, 3 × 5 ml 22% w/v thin, 3 × 5 ml 40% w/v thin, 3 × 10 ml 22% w/v thin, and 3 × 20 ml 22% w/v thin). Canonical variate analyses demonstrated that bolus condition did not affect swallowing mechanics at the group level, but bolus condition did affect pharyngeal swallow mechanics at the individual level. Functional swallow adaptations (e.g., hyoid movement) to bolus conditions were not uniform across participants, consistent with the nonsignificant group finding. These results suggest that individual swallowing systems of healthy young individuals vary in how they respond to bolus different conditions, highlighting the intrinsic variability of the swallow mechanism and the importance of individually tailored evaluation and treatment of swallowing. Findings warrant further investigation with different bolus conditions and aging and disordered populations.
      PubDate: 2019-06-04
  • The Penetration–Aspiration Scale: Adaptation to Open Partial
           Laryngectomy and Reliability Analysis
    • Abstract: A standard for assessing swallowing function after open partial horizontal laryngectomy (OPHL) is still not established. The variability in the measures used to investigate swallowing functional outcomes after OPHL limits the communication among clinicians and the possibility to compare and combine results from different studies. The study aims to adapt the PAS to the altered anatomy after OPHLs using fiberoptic endoscopic evaluation of swallowing (FEES) and to test its reliability. To adapt the PAS, two landmarks were identified: the entry of the laryngeal vestibule and the neoglottis. Ninety patients who underwent an OPHL were recruited (27 type I, 31 type II and 32 type III). FEES was performed and video-recorded. Two speech and language therapists (SLTs) independently rated each FEES using the PAS adapted for OPHL (OPHL-PAS). FEES recordings were rated for a second time by both SLTs at least 15 days from the first video analysis. Inter- and intra-rater agreement was assessed using unweighted Cohen’s kappa. Overall, inter-rater agreement of the OPHL-PAS was k = 0.863, while intra-rater agreement was k = 0.854. Concerning different OPHL types, inter- and intra-rater agreement were k = 0.924 and k = 0.914 for type I, k = 0.865 and k = 0.790 for type II, and k = 0.808 and k = 0.858 for type III, respectively. The OPHL-PAS is a reliable scale to assess the invasion of lower airway during swallowing in patients with OPHL using FEES. The study represents the first attempt to define standard tools to assess swallowing functional outcome in this population.
      PubDate: 2019-06-03
  • Letter to the Editor
    • PubDate: 2019-06-01
  • Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load
           Matter' A Randomized Controlled Trial
    • Abstract: Tongue-strengthening exercises (TSE) are based on the principles of exercise and motor learning, including intensity. Intensity is manipulated by gradually adjusting the resistive load. This randomized controlled trial (RCT) investigates the effect of three different values resistive load during TSE in healthy older adults. Sixty subjects completed 8 weeks of TSE while exercising with Iowa Oral Performance Instrument (IOPI). They were randomly distributed to 4 different treatment arms: 3 exercise groups (EG1: n = 15; EG2: n = 16, EG3: n = 16) and 1 control group performing lip-strengthening exercises (CG: n = 13). Values of resistive load for EG1, EG2, and EG3 were 100, 80, and 60% 1RM, respectively. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, after 4 and 8 weeks of training and 4 weeks post-training. MIPA and MIPP in the EG were significantly higher than in the CG at all time points, except baseline. No significant differences between EG were found, but some trends were observable. Anteriorly, the higher the resistive load, the higher the increase in MIP. Posteriorly, 100% 1RM caused the highest values, followed by 60% and 80% 1RM. No detraining effects were measured. The degree of exercise load had a significant negative effect on the registered success rate. This RCT confirms the efficacy of TSE in healthy older adults. For MIPA and MIPP, TSE at a resistive load of 100% 1RM are the most efficient choice in this population, while lowering the resistive load will lead to an increased success rate. No detraining effects were registered.
      PubDate: 2019-06-01
  • Does the Hebrew Eating Assessment Tool-10 Correlate with Pharyngeal
           Residue, Penetration and Aspiration on Fiberoptic Endoscopic Examination
           of Swallowing'
    • Abstract: The Eating Assessment Tool-10 (EAT-10) is a 10-item patient-reported outcome measure (PROM) for dysphagia patients. The objective of this study was to translate and validate the EAT-10Heb and to test for a correlation between its score and residue, penetration and aspiration on Fiberoptic Endoscopic Examination of Swallowing (FEES). 136 patients visiting two specialized dysphagia clinics and undergoing FEES between April 2015 and August 2017, filled the EAT-10Heb. 23 patients refilled the EAT-10Heb during a 2-week period following their first visit. FEES were scored for residue (1 point per consistency, maximum 3 points) and penetration and aspiration (1 point for penetration, 2 points for aspiration per consistency, maximum 6 points). 51 healthy volunteers also filled the EAT-10Heb. Internal consistency and test–retest reproducibility were examined for reliability testing. Validity was established by comparing EAT-10Heb scores of dysphagia patients to healthy controls. The EAT-10Heb score was then correlated with the FEES score. Internal consistency of the EAT-10Heb was high (Cronbach’s alpha = 0.925) as was the test–retest reproducibility (Spearman’s correlation coefficient = 0.82, p < 0.0001). The median EAT-10Heb score was significantly higher in the dysphagia group compared to healthy controls (13, IQR 7–22 points for dysphagia patients compared to 0, IQR 0–0 points for healthy controls, p < 0.0001). A weak correlation was found between the EAT-10Heb scores and the FEES score (Pearson’s correlation coefficient = 0.376, p < 0.0001). While the EAT-10Heb was found to be a reliable and valid PROM, it only weakly correlates with the pathological findings on FEES examination.
      PubDate: 2019-06-01
  • Effects of Tongue-Hold Swallows on Suprahyoid Muscle Activation According
           to the Relative Tongue Protrusion Length in the Elderly Individuals
    • Abstract: This study investigated differences in suprahyoid muscle activity in elderly adults during tongue-hold swallowing (THS) according to tongue protrusion length to determine the most effective tongue protrusion length during THS. A total of 52 healthy participants (34 females and 18 males) aged 69–92 years were included. Changes in suprahyoid muscle activation during normal swallowing and THS with 1/3rd and 2/3rd tongue protrusions using surface electromyography were observed. Suprahyoid muscle activation significantly increased with the increasing tongue protrusion length (p < 0.05). Depending on the responses of the participants based on tongue protrusion length, participants were categorized into the increase group [increased suprahyoid muscle activity with tongue protrusion, n = 36 (1/3rd THS compared to normal swallowing) or 38 (2/3rd THS compared to normal swallowing)] or decrease group [decreased suprahyoid muscle activity with tongue protrusion, n = 16 (1/3rd THS compared to normal swallowing) or 14 (2/3rd THS compared to normal swallowing)]. The functional reserve of the increase group was significantly higher than that of the decrease group (p < 0.05). Many elderly people were found to have increased activation of the suprahyoid muscle during THS; however, others showed the opposite. Therefore, it is necessary to confirm the degree of suprahyoid muscle activation during THS so that the patient can perform the exercise at the tongue protrusion length that can maximize the effect of the exercise. For individuals who cannot overcome even a small amount of tongue protrusion (e.g., 1/3rd MTPL), replacing THS with another exercise may be considered.
      PubDate: 2019-06-01
  • The Relationship Between Hiatal Hernia and Cricopharyngeus Muscle
    • Abstract: Although the precise etiology of cricopharyngeus muscle (CPM) dysfunction (CPMD) is uncertain, many have hypothesized that a hypertrophied CPM may develop as a protective compensation against gastroesophageal reflux disease (GERD). The purpose of this investigation was to evaluate the association between CPMD and the presence of hiatal hernia (HH) in an attempt to elucidate the potential etiology of CPMD. The charts of individuals who underwent video fluoroscopic esophagrams between 01/01/14 and 10/30/16 were reviewed from an electronic database. A group of 50 subjects with reported HH were identified and age- and gender-matched to an individual without HH. The prevalence of CPMD was compared between groups. The mean (± SD) age of the HH cohort was 64 (± 13.4) years and 64 (± 12.8) years for the group without HH (p > 0.05). Thirty-eight percent was male. The frequency of CPMD in the HH group was 78% versus 58% in the non-HH group (p < 0.05). Individuals with a HH were 2.57 times more likely to have evidence of CPMD (95% CI 1.07– 6.15). Although these data suggest an association between GERD and CPMD, further research is required before a causal relationship can be presumed.
      PubDate: 2019-06-01
  • Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to
           Palpation at the Bedside and Visualization During Videofluoroscopy
    • Abstract: Purpose Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). Minimal evidence exists to support the use of these perceptual methods for judging HE. We investigated whether binary judgment of HE differentiates quantitative measures of hyoid movement, using frame-by-frame VFSS analysis to measure anatomically scaled peak hyoid positions. Methods Medical records of patients who received a CSE and VFSS within a 24-h period were reviewed. Clinician ratings of HE (‘reduced’ or ‘normal’) were collected from CSE and VFSS reports, along with rater experience. Five ml puree swallows were extracted from each VFSS for randomized, blinded analysis. Peak hyoid position from C4 was captured in anterior, superior, and hypotenuse positions and expressed relative to C2–C4 length. T-test comparisons of hyoid positions between patients judged to have reduced versus normal HE on palpation and VFSS were conducted. Results Eighty-seven patients (56 male, mean age 61) met criteria. Peak anterior hyoid position was significantly different between patients judged to have reduced (mean = 89.2% C2–C4) and normal (mean = 110.6% C2–C4) HE on palpation (p = 0.001). Further analysis revealed no effect of clinician experience on differentiation of objective measures based on palpation. No differences were found across any objective measures when compared to clinician VFSS ratings. Conclusions Clinicians appeared to be able to differentiate peak anterior hyoid movement but not superior or hypotenuse movement on palpation. On VFSS visualization, no significant differences were found between swallows judged to have reduced versus normal HE in any directional dimension. While perceptual methods may contribute to clinical decision-making, clinicians should remain cautious when making judgments about HE using these methods.
      PubDate: 2019-06-01
  • Is the Location of White Matter Lesions Important in the Swallowing
           Function of Older Patients with Mild Stroke'
    • Abstract: Older patients with stroke have poor functional prognosis compared to younger patients. Patients with stroke who have severe white matter (WM) lesions have been reported to have swallowing problems. The aim of this study was to determine whether the location of WM lesions affects swallowing function in older patients with mild stroke. We conducted a retrospective analysis of 88 patients aged > 65 years who had a National Institutes of Health Stroke Scale score  of ≤ 5 and who underwent videofluoroscopic swallowing examination after their first stroke. Participants were divided into three groups according to the involvement of corticobulbar tract (CBT) as follows: group I, no involvement of CBT; group II, involvement of CBT in one hemisphere; and group III, involvement of CBT in both hemispheres. Linear regression analysis showed that pharyngeal transit time tended to increase according to the involvement of CBT in WM lesion (p = 0.043). In addition, inadequate laryngeal elevation was related to the involvement of CBT (p = 0.016). Early spillage, inadequate laryngeal elevation, and penetration could also be predicted by Fazekas grade. Accordingly, the location of WM lesions can be regarded as a potential predictive factor for dysphagia. Moreover, in patients with WM lesions involving CBT, detailed evaluation of dysphagia is required.
      PubDate: 2019-06-01
  • A Novel Three-Dimensional Analysis of Tongue Movement During Water and
           Saliva Deglutition: A Preliminary Study on Swallowing Patterns
    • Abstract: Deglutition is a complex oral function, and the study of the whole process requires a precise analysis of the elements involved, especially of the tongue biomechanics. We described a three-dimensional analysis of tongue movements during both saliva and water deglutition in participants with normal occlusion. Fourteen participants (25.36 ± 4.85 years) were evaluated, and the movements of anterior, middle, and posterior portions of the tongue were recorded using AG501 3D-electromagnetic articulograph. An average volume (AVS) for water deglutition was determined for each participant. Saliva deglutition was classified according to Bourdiol et al. 35.71% was type I, 14.29% type II, and 50% type III. The greatest displacement on the inferior–superior axis was in the posterior portion, followed by the middle and anterior portions. In the posterior–anterior axis, smallest movement was in the anterior portion. During water deglutition, on the inferior–superior axis, there were statistical differences for 1-AVS between the anterior/middle and anterior/posterior portions of the tongue. There were statistical differences for both ½-AVS and ¼-AVS between the anterior/posterior portions of the tongue. On the posterior–anterior axis, there were no statistical differences among any volume–portion relations. On the medial–lateral axis, there was statistical difference for the ½-AVS between middle and posterior portions. The movement of the tongue portions was influenced by the volume and the element to be swallowed. The amplitude of the movement was directly proportional to the volume of water swallowed.
      PubDate: 2019-06-01
  • Correlates of Early Pharyngeal High-Resolution Manometry Adoption in
           Expert Speech-Language Pathologists
    • Abstract: Pharyngeal high-resolution manometry (HRM) is at a point of entry into speech-language pathologist (SLP) clinical practice. However, the demographic characteristics of SLPs who are early adopters of HRM are unclear; perspectives of early adopters may shape how the technology is received by the field at large. We hypothesized that younger SLPs, those working in outpatient settings, those with a strong knowledge base in HRM, and those with experience in other types of instrumentation are more likely to have interest in adopting HRM. We surveyed the population of board-certified SLPs (BCS-S; n = 262) with a 33% response rate (n = 78). Firth logistic regression was used to determine differences in those expressing interest in adopting HRM into future practice (n = 28) and those who did not (n = 45) from the analytic sample of 73 respondents. The best fitting model predicted that SLPs: (1) with training in more types of instrumentation; and (2) believing they could explain the HRM procedure to a patient were more likely to plan to adopt pharyngeal HRM into regular clinical practice. Experience with a variety of instrumentation techniques may encourage SLPs to use new forms of technology. Knowledge of early adopter demographics will allow for development of targeted trainings and determination of HRM implementation barriers. Identification of a clinician sub-group more likely to adopt other new technologies in the future may also be possible.
      PubDate: 2019-06-01
  • 18 F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term
           Feeding Tube Use in Head and Neck IMRT
    • Abstract: The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.
      PubDate: 2019-06-01
  • A Pilot Study on the Efficacy of Continuous Positive Airway Pressure on
           the Manifestations of Dysphagia in Patients with Obstructive Sleep Apnea
    • Abstract: There is evidence in the literature demonstrating that patients with obstructive sleep apnea (OSA) may present with dysphagia, but few studies have evaluated whether this complaint can be reversed with treatment of OSA. To assess whether findings of dysphagia in patients with OSA can be reversed with the use of continuous positive airway pressure (CPAP) devices. Seventy adult patients (age 18–70 years) with moderate or severe OSA were included in the study. All patients underwent fiberoptic endoscopic evaluation of swallowing (FEES) and completed the SWAL-QOL questionnaire on quality of life in dysphagia. Patients with visible abnormalities on FEES were treated with CPAP and reassessed after 3 months. The prevalence of dysphagia was 27.3% (18 patients). Premature spillage was the main finding. On comparison of groups with and without dysphagia, the SWAL-QOL score was significantly worse in the dysphagia group in domain 2 (eating duration and eating desire, p = 0.015), with no impact on overall score (p = 0.107). Of the 18 patients with dysphagia, 12 were started on CPAP; 11 exhibited satisfactory adherence and remained in the study. Abnormal FEES findings resolved in 81% (n = 9/11) of patients who started CPAP (p = 0.004), and dysphagia-specific quality of life also improved significantly (overall SWAL-QOL score, p = 0.028). In this sample of patients with OSA, the overall prevalence of dysphagia (as demonstrated by premature spillage on FEES) was 27.3%. Treatment of OSA with CPAP was able to reverse the endoscopic findings of swallowing dysfunction and to improve quality of life as measured by the SWAL-QOL.
      PubDate: 2019-06-01
  • “Hidden in Plain Sight”: A Descriptive Review of Laryngeal
           Vestibule Closure
    • Abstract: A major emphasis in the evaluation of swallowing is to identify physiological abnormalities in swallowing that contribute to or explain unsafe swallowing (i.e., ingested material enters the trachea; post-swallow residue in the pharynx). Impairments in laryngeal vestibule closure are widely recognized as one of the major causes of unsafe swallowing, as it is the primary mechanism and first line of defense for preventing material from penetrating the airway during swallowing. However, this complex mechanism is often overlooked and understudied in swallowing research and dysphagia management. The purpose of this review is to promote a better understanding of the mechanism of laryngeal vestibule closure. We discuss where gaps in research exist and propose future directions for incorporating laryngeal vestibule closure as a primary outcome measure in swallowing research. Additionally, we propose that an increased knowledge of the mechanism of laryngeal vestibule closure will increase diagnostic accuracy and optimize dysphagia management for patients with dysphagia.
      PubDate: 2019-06-01
  • Validation of the German Version of the Yale Pharyngeal Residue Severity
           Rating Scale
    • Abstract: The aim of this study was to validate the German Version of the Yale Pharyngeal Residue Severity Rating Scale and to investigate the impact of rater experience and training. The English original scale was translated into German language using a forward–backward method. For the validation, 30 images of different pharyngeal residue amounts have been selected and assigned to the scales’ severity levels by two experts. 28 raters rated the images in randomized order in two passes. To investigate the impact of experience and training, raters were grouped into subgroups. Statistical analysis was carried out using kappa statistics. The results demonstrate excellent residue ratings for construct validity, inter-rater reliability and intra-rater reliability regarding overall group and all subgroups (Kappa > 0.90). No significant differences were found between groups by experience and inconstant differences were found between groups by training. The German version of the Yale Pharyngeal Residue Severity Rating Scale is a valid, reliable instrument for scoring location and severity of pharyngeal residue in the context of flexible endoscopic evaluations of swallowing.
      PubDate: 2019-06-01
  • Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on
           Swallowing Function and Quality of Life of Post-stroke Patients
    • Abstract: Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive techniques, which is used to modulate cortical regions in patients with stroke. The aim of this single blind, controlled study was to investigate the effect of rTMS on swallowing function and quality of life of mono-hemispheric post-stroke patients with dysphagia. Twenty-eight patients were randomized and split between study and control group. Each group received conventional dysphagia rehabilitation 3 days a week for 4 weeks, and study group also received 1 Hz rTMS to unaffected hemisphere in the final week. The descriptive information was noted. The clinical and radiological swallowing evaluation and quality of life assessment have been performed at four different times including before and after the treatment, 1 month and 3 months after the treatment. At baseline, no significant differences were observed between groups in terms of demographic and clinical features (p > 0.05). Swallowing function and quality of life of the patients were statistically improved in both groups towards the third month (p < 0.05). Swallowing function was comparable between two groups. However, a significant improvement was observed on appetite, fear of eating, and mental health parameters of quality of life assessment in the study group compared to the control group (p < 0.05). In conclusion, despite positive changes in some aspects of quality of life, rTMS did not enhance the swallowing function when compared conventional dysphagia rehabilitation. Therefore, the application of 1 Hz rTMS should be reconsidered to improve swallowing function in the chronic period.
      PubDate: 2019-06-01
  • Evaluating the Feasibility and Validity of Using Trained Allied Health
           Assistants to Assist in Mealtime Monitoring of Dysphagic Patients
    • Abstract: Growing patient numbers, within a context of finite resources, has placed increased demands on dysphagia services in acute settings. Delegating some aspects of dysphagia management to other trained professional groups, such as allied health assistants (AHA), may help speech-language pathology (SLP) service efficiencies. The primary aim of this study was to explore the feasibility and initial validity of using trained AHAs to complete structured mealtime observations of patients. The secondary aims were to explore costs and user perceptions. The study used a mixed methods design. All AHAs who participated worked in the adult acute inpatient setting and were agreeable to participate; they successfully completed training and were deemed competent to use the observation tool. To explore validity, trained AHAs (n = 7) and SLPs (n = 5) conducted independent, simultaneous mealtime observations of 50 adult inpatients, using a structured observation form. Costs of AHA versus SLP time per average assessment were compared. Consumer perceptions were examined in semi-structured interviews with the AHA (n = 5) and SLP participants (n = 3). Exact agreement between AHA and SLPs on the overall pass/fail criteria was high (94%). Where exact agreement was not achieved, the AHA had made a more conservative decision. Salary costs and time savings for the SLP were identified. Interviews identified that both SLPs and AHAs perceived multiple positive personal and service benefits. High levels of agreement in clinical decisions and positive staff perceptions support feasibility and initial clinical validity. This model may assist SP efficiencies in services with high patient demand.
      PubDate: 2019-06-01
  • Dysphagia Research Society 26th Anniversary Annual Meeting March 15–17,
           2018 Renaissance Baltimore Harborplace Hotel, Baltimore, Maryland
    • PubDate: 2019-05-15
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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