Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia

Objective: The aim of this study to determine the therapeutic effect of Neuromuscular Electrical Stimulation (NMES) on pharyngeal phase of swallowing for stroke patients with neurogenic dysphagia,and to see the effect of NMES in reducing the incidence of standing secretion, residue, penetration and aspiration.Methods: It is a quasi-experimental study design. 10 stroke patients with neurogenic dysphagia in Cipto Mangunkusumo hospital, Jakarta, 40-80 years old with hemodynamically stable, cooperative and will be get NMES therapy for 4 weeks. Pre and Post treatment assessment caompared using a modified MASA test (The Mann Assessment of Swallowing Ability) and FEES examination (Flexible Endoscophic Evaluation of Swallowing). Analysis of change scores using Wilcoxon test.Results:The obtain average age of patients 59.80+9.705 years. Significant difference seen in the pharyngeal phase of swallowing increased score of gag reflex, velum elevation, cough reflex, voluntary cough, voice quality, pharynx response, pharyngeal constrictor contraction and vocal cord adduction (p<0.005).Also seen significant reduction in the incidence of standing secretion, residue and penetration (p<0.005), but not significantly in the incidence of aspiration (p=0083).Conclusions: NMES increased the pharyngeal phase of swallowing, reduced the incidence of standing secretion, residue and penetration of stroke patients with neurogenic dysphagia, but have not able to reduced aspiration.Keywords :Neuromuscular Electrical Stimulation (NEMS), neurogenic dysphagia, MASA test (The Mann Assessment of Swallow ing Ability), FEES examination (Flexible Endoscophic Evaluation of Swallowing), swallowing process.

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Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology

Neurological Research and Practice ◽

10.1186/s42466-021-00122-3 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Rainer Dziewas ◽

Hans-Dieter Allescher ◽

Ilia Aroyo ◽

Gudrun Bartolome ◽

Ulrike Beilenhoff ◽

...

Keyword(s):

Neurological Diseases ◽

Treatment Options ◽

German Society ◽

Diagnosis And Treatment ◽

Dietary Interventions ◽

Neurogenic Dysphagia ◽

Treatment Interventions ◽

Term Care ◽

High Resolution Manometry ◽

Clinical Scenarios

Abstract Introduction Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. Recommendations This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. Conclusions The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf).

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Functional endoscopy in neurogenic dysphagia: a feasibility study focusing on the esophageal phase of swallowing

Endoscopy International Open ◽

10.1055/a-1380-3224 ◽

2021 ◽

Vol 09 (04) ◽

pp. E646-E652

Author(s):

Jan Rückert ◽

Philipp Lenz ◽

Hauke Heinzow ◽

Johannes Wessling ◽

Tobias Warnecke ◽

...

Keyword(s):

Primary Outcome Measure ◽

Interdisciplinary Cooperation ◽

Upper Esophageal Sphincter ◽

Secondary Outcome ◽

Diagnostic Tools ◽

Control Group ◽

Special Focus ◽

Neurogenic Dysphagia ◽

High Resolution Manometry ◽

Multidisciplinary Study

Abstract Background and study aims Due to demographic transition, neurogenic dysphagia has become an increasingly recognized problem. Patients suffering from dysphagia often get caught between different clinical disciplines. In this study, we implemented a defined examination protocol for evaluating the whole swallowing process by functional endoscopy. Special focus was put on the esophageal phase of swallowing. Patients and methods This prospective observational multidisciplinary study evaluated 31 consecutive patients with suspected neurogenic dysphagia by transnasal access applying an ultrathin video endoscope. Thirty-one patients with gastroesophageal reflux symptoms were used as a control group. We applied a modified approach including standardized endoscopic positions to compare our findings with fiberoptic endoscopic evaluation of swallowing and high-resolution manometry. The primary outcome measure was feasibility of functional endoscopy. Secondary outcome measures were adverse events (AEs), tolerability, and pathologic endoscopic findings. Results Functional endoscopy was successfully performed in all patients. No AEs were recorded. A variety of disorders were documented by functional endoscopy: incomplete or delayed closure of the upper esophageal sphincter in retroflex view, clearance disturbance of tubular esophagus, esophageal hyperperistalsis, and hypomotility. Analysis of results obtained with the diagnostic tools showed some discrepancies. Conclusions By interdisciplinary cooperation with additional assessment of the esophageal phase of deglutition using the innovative method of functional endoscopy, the diagnosis of neurogenic disorders including dysphagia may be significantly improved, leading to a better clinical understanding of complex dysfunctional patterns. To the best of our knowledge, this is the first study to show that a retroflex view of the ultrathin video endoscope within the esophagus can be safely performed. [NCT01995929]

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The treatment effi cacy of disturbed swallowing function in patients with ischemic stroke and neurogenic dysphagia

Russian neurological Journal ◽

10.30629/2658-7947-2021-26-3-51-57 ◽

2021 ◽

Vol 26 (3) ◽

pp. 51-57

Author(s):

V. I. Ershov ◽

A. A. Borzdyko ◽

V. V. Silkin

Keyword(s):

Ischemic Stroke ◽

Combination Therapy ◽

Comparison Group ◽

Dynamic Assessment ◽

Control Group ◽

Training Method ◽

Severity Scale ◽

Neurogenic Dysphagia ◽

Swallowing Function ◽

Penetration Aspiration Scale

The aim. To evaluate the effi cacy of swallowing recovery of patients with ischemic stroke carried out with the use of training rehabilitation method using special nutrient mixtures as part of combination therapy. Material and methods. The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients (control group) were treated with special binding compounds as part of a combination therapy. Thirty fi ve patients (comparison group) did not use the mixture. The dynamics of the recovery function of swallowing using the Penetration–Aspiration Scale (PAS) and the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), as well as the transition from tube to independent feeding were studied. Results. The training method of rehabilitation using special nutritional mixtures is eff ective assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia (p < 0.05). The most pronounced eff ect was achieved in the group of patients with pseudobulbar syndrome. In patients with bulbar syndrome no statistically signifi cant diff erences were observed in the dynamic assessment of the severity of dysphagia on the PAS and FEDSS scales. The application of the training method leads to a signifi cantly better transition from tube to independent feeding. Conclusion. The training method of rehabilitation using special nutritional mixtures is eff ective in patients with ischemic stroke and neurogenic dysphagia and leads to a signifi cantly better transition from tube to independent feeding.

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