Update on Exercise-Based Rehabilitation Approaches for Neurogenic Dysphagia

2021 ◽  
Author(s):  
Cecilia C. Félix-Lusterman ◽  
Megan E. Joseph ◽  
Stephanie K. Daniels
Keyword(s):  
Neurogenic Dysphagia

Effect of Neuromuscular Electrical Stimulation on Swallowing Process in Stroke Patient with Neurogenic Dysphagia

1970 ◽  
Vol 1 (1) ◽  
pp. 44-53
Author(s):  
Ruth Ariyani ◽  
Widjajalaksmi ◽  
Luh K Wahyuni ◽  
Susyana Tamin ◽  
Saptawati Bardosono
Keyword(s):  
Electrical Stimulation ◽  
Voice Quality ◽  
Neuromuscular Electrical Stimulation ◽  
Neurogenic Dysphagia ◽  
Stroke Patients ◽  
Cough Reflex ◽  
Voluntary Cough ◽  
Pharyngeal Phase ◽  
Significant Difference ◽  
Quasi Experimental

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.

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

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).

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

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]

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

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.

Impaired oropharyngeal reconfiguration and bolus propulsion in neurogenic dysphagia

2006 ◽  
Vol 40 (Supplement 4) ◽  
pp. S174
Author(s):  
Pere Clav?? ◽  
Marleen de Kraa ◽  
Viridiana Arreola ◽  
Meritxell Girvent ◽  
Ricard Farr?? ◽  
...  
Keyword(s):  
Neurogenic Dysphagia ◽  
Bolus Propulsion

scholarly journals The correlation between pharyngeal residue, penetration/aspiration and nutritional modality: a cross-sectional study in patients with neurogenic dysphagia

2020 ◽  
Vol 40 (1) ◽  
pp. 38-43 ◽  
Author(s):  
Sara Nordio ◽  
Arianna Di Stadio ◽  
Isabella Koch ◽  
Paola Stritoni ◽  
Francesca Meneghello ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Sectional Study ◽  
Neurogenic Dysphagia ◽  
Cross Sectional ◽  
Pharyngeal Residue

scholarly journals THE ASSOCIATION BETWEEN LOCATION OF BRAIN LESION AND FINDINGS OF FLEXIBLE ENDOSCOPIC EVALUATION OF SWALLOWING (FEES) IN STROKE PATIENTS: WHICH EXERCISE IS BENEFICIAL?

2019 ◽  
Author(s):  
Widjajalaksmi Kusumaningsih ◽  
Nur Indah Lestari ◽  
Herdiman Purba
Keyword(s):  
Brain Stem ◽  
Right Hemisphere ◽  
Brain Lesion ◽  
Retrospective Chart Review ◽  
Brain Regions ◽  
Cortical Lesion ◽  
Neurogenic Dysphagia ◽  
Stroke Patients ◽  
Subcortical Lesion ◽  
Strengthening Exercise

Abstract Background: Dysphagia is a frequent occurrence following stroke. Various brain regions have been shown to control deglutition. However, it is still controversial as to which of the two hemispheres plays more important role in deglutition, and which injured hemisphere is more likely to cause the specific patterns of dysphagia seen in stroke patients. An accurate estimate of the incidence of dysphagia will be critical to assess benefits of dysphagia interventions. Objective: To investigate whether patterns of dysphagia are associated with the location of brain lesion in stroke patients and to examine whether pharyngeal strengthening exercise and hyolaryngeal exercise are proper for patients, based on the findings of FEES and location of brain lesion. Methods: The subjects were stroke outpatients who visited our clinic from January 2016 to April 2018. To localize brain lesion, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) have been employed. The locations of brain lesions were classified into cortical, subcortical, and brain stem. FEES was conducted to assess the patterns of deglutition disorders. These data were collected via retrospective chart review. Results: Of the 11 subjects, mean age (SD) was 62.73 (8.67) years and seven (63.64%) subjects were male. All subjects got ischemic stroke, eight (72.73%) had right hemispheric lesion and three (27.27%) had left hemispheric lesion. By brain lesion, there were nine subcortical, five cortical, and four brain stem lesions. All FEES findings, especially standing secretion, penetration, residue, and reduced hypopharynx sensitivity were higher in subcortical lesion, followed by brain stem and cortical lesion successively. Conclusion: Right hemisphere was involved more than left hemisphere in dysphagia patients. Standing secretion, penetration, residue, and reduced hypopharynx sensitivity occurs more often in subcortical lesion. Further studies on big samples in a perspective structure are needed. Based on this result, there is a place for pharyngeal strengthening exercise and hyolaryngeal complex range of motion and strengthening exercise to be implemented to the patients with neurogenic dysphagia after stroke.

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