Which swallowing difficulty of food consistency is best predictor for oropharyngeal dysphagia risk in older person?

Purpose: To document the nutritional risk in adults with oculopharyngeal muscular dystrophy (OPMD) and its association with oropharyngeal dysphagia. Methods: In this cross-sectional study, 33 adults with molecular confirmation of OPMD between 50 and 75 years old were recruited from the registry of a university-affiliated neuromuscular clinic. Nutritional risk was assessed with the French version of Seniors in the Community: Risk Evaluation for Eating and Nutrition II (SCREEN II), whereas the severity of dysphagia was assessed using the French-Canadian version of the Sydney Swallow Questionnaire. Anthropometric measurements were performed with standardized procedures. Results: SCREEN II scores showed high nutritional risk for 81.8% of OPMD participants with 6 factors contributing to nutritional risk in at least 50% of the sample. Pearson’s correlational analysis showed a significant moderate relationship between dysphagia and nutritional risk (r = −0.470; P = 0.006). Conclusion: To our knowledge, this study is the first to investigate the nutritional risk of adults with OPMD. Our results indicate that individuals with OPMD may be at high nutritional risk mostly associated with swallowing difficulty, in the absence of a low body mass index. The present study highlights the need for dietary counseling in OPMD.

Download Full-text

Experimental Injury Rodent Models for Oropharyngeal Dysphagia

Biology ◽

10.3390/biology10050360 ◽

2021 ◽

Vol 10 (5) ◽

pp. 360

Author(s):

Ji-Youn Kim

Keyword(s):

Animal Models ◽

Nerve Injury ◽

Screening Method ◽

Oropharyngeal Dysphagia ◽

Comprehensive Treatment ◽

Rodent Models ◽

Animal System ◽

Number Of Patients ◽

Tongue Dysfunction ◽

Swallowing Difficulty

Oropharyngeal dysphagia is a disorder that can make swallowing difficult and reduce the quality of life. Recently, the number of patients with swallowing difficulty has been increasing; however, no comprehensive treatment for such patients has been developed. Various experimental animal models that mimic oropharyngeal dysphagia have been developed to identify appropriate treatments. This review aims to summarize the experimentally induced oropharyngeal dysphagia rodent models that can be used to provide a pathological basis for dysphagia. The selected studies were classified into those reporting dysphagia rodent models showing lingual paralysis by hypoglossal nerve injury, facial muscle paralysis by facial nerve injury, laryngeal paralysis by laryngeal and vagus nerve injury, and tongue dysfunction by irradiation of the head and neck regions. The animals used in each injury model, the injury method that induced dysphagia, the screening method for dysphagia, and the results are summarized. The use of appropriate animal models of dysphagia may provide adequate answers to biological questions. This review can help in selecting a dysphagia animal system tailored for the purpose of providing a possible solution to overcome dysphagia.

Download Full-text

Abstract TP157: Functional Oral Intake Scale is Associated With Poorer Outcomes Following Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp157 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Juli T De Souza ◽

Sérgio Paiva ◽

Priscila Ribeiro ◽

Suzana Tanni ◽

Marcos Minicucci ◽

...

Keyword(s):

Protective Factor ◽

Oropharyngeal Dysphagia ◽

Tube Feeding ◽

Adult Life ◽

Oral Intake ◽

Oral Feeding ◽

Early Evaluation ◽

Food Consistency ◽

Specific Protocol ◽

Functional Oral Intake Scale

Background: Stroke is the leading cause of disability in adult life. Oropharyngeal dysphagia occurs in 65-90% of patients, and its identification in the acute phase of stroke can prevent complications. Objective: Verify whether Functional Oral Intake Scale (FOIS) score during stroke hospitalization is associated with functional capacity, as assessed by the modified Rankin Scale (mRs), and mortality 90 days after stroke. Methods: A prospective cohort study evaluating 201 patients hospitalized in the Stroke Unit was carried out. Dysphagia was evaluated during hospitalization using both a specific protocol to evaluate swallowing biomechanics and FOIS, in which FOIS 1-3 - tube feeding, 4-5 - oral feeding requiring food consistency changes, and 6-7 - oral feeding with no changes in food consistency. mRs≥3 90 days after discharge was considered disability. The data were adjusted for the NIHSS score, sex, age, type of stroke, and presence of thrombolysis. Significance level of 5%. Results: Of the 201 patients evaluated, 42.8% (86) who had dysphagia were older, had a higher severity of stroke, and pneumonia rate . A FOIS score of 6-7 may be a protective factor against disability (mRs≥3) (OR:0.17; CI:0.005-0.56; p=0.004), and FOIS 1-3 at hospital discharge increased the risk of mRs≥3 (OR:14.97; CI: 2.68-83.65; p=0.002) and mortality (OR:9.79; CI:2.21-43.4; p=0.003) within 90 days after stroke. Pneumonia was the leading cause of death, however dysphagia and FOIS 1-3 at discharge were associated with death from any cause. Important to highlight that the interaction of FOIS 1-3 at discharge and pneumonia further enhanced mortality chance (OR:113; CI:1.40-9.097; p=0.035). Conclusion: Dysphagia or FOIS 1-3 at discharge are markers of poor prognosis after stroke. Our data suggest the importance of early evaluation of dysphagia and closely monitoring the tube fed patients following stroke.

Download Full-text

Impact of Oral and Swallowing Function on the Feeding Status of Older Adults in Nursing Homes

Gerontology ◽

10.1159/000511912 ◽

2021 ◽

pp. 1-9

Author(s):

Sirima Kulvanich ◽

Kayoko Ito ◽

Eri Takei ◽

Haruka Sakai ◽

Risa Suzumi ◽

...

Keyword(s):

Older Adults ◽

Nursing Homes ◽

Significant Relationship ◽

Test Score ◽

Swallowing Function ◽

Cooked Rice ◽

Food Consistency ◽

Swallowing Difficulty ◽

Side Dishes ◽

Dietary Food

Background: To date, there have been few guidelines proposed for adjustment of the food consistency, particularly to match the oral function of older adults, which will guide clinicians and caregivers in appropriately modifying food. Objective: We investigated how oral, swallowing, and cognitive conditions of older adults who required daily nursing care in a nursing home were associated with different dietary food consistencies. Methods: Clinical examinations to record dentition status, swallowing, and cognitive functions were performed, and the feeding status, including the food consistencies and need for assistance at lunchtime, was evaluated in 37 older residents in nursing homes. The swallowing function was assessed by performing a modified water-swallowing test, and food swallowing was tested using pudding and rice crackers. The χ2 test was used to determine the relationships among the parameters. Results: No participants were able to take cooked rice, nor regular and soft side dishes. There was no significant relationship between dentition status and feeding status. Of the participants, 95% ate pudding without any problems and 49% ate rice crackers without any signs of swallowing difficulty such as coughing or stopping chewing. There was a significant relationship between the food test score using a rice cracker and the level of food consistencies, and between the same test score and the level of mealtime assistance, whereby the better the score of the food test using a rice cracker, the better was the level of food consistencies including use of a thickening agent and the better was the level of mealtime assistance. Conclusion: The results strongly suggest that the food test using a rice cracker was associated with the level of food consistency and mealtime assistance for older adults in nursing homes.

Download Full-text

Dysphagia: implications for older people

Reviews in Clinical Gerontology ◽

10.1017/s095925980201242x ◽

2002 ◽

Vol 12 (4) ◽

pp. 283-294 ◽

Cited By ~ 2

Author(s):

Ranjit N Ratnaike

Keyword(s):

Older People ◽

Older Persons ◽

Oropharyngeal Dysphagia ◽

Older Person

Dysphagia is defined as difficulty in swallowing solids or liquids and is distinct from odynophagia, which is pain on swallowing. Dysphagia occurs in a range of conditions that affect the oral, pharyngeal and oesophageal phase of swallowing. The problem of dysphagia assumes greater importance in older persons. Some people may not be able to communicate that a problem exists. In others the lack of nutrition due to dysphagia compounds existing undernutrition, a common problem in institutionalized older persons. This paper discusses dysphagia in the context of the older person and outlines the normal mechanism of swallowing, the important clinical distinction between oropharyngeal dysphagia and oesophageal dysphagia, the aetiology of dysphagia and issues of management.

Download Full-text

A Systematic Review of Oropharyngeal Dysphagia Models in Rodents

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094987 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4987

Author(s):

Han-Na Kim ◽

Ji-Youn Kim

Keyword(s):

Animal Models ◽

Oropharyngeal Dysphagia ◽

Cochrane Library ◽

Screening Methods ◽

Rodent Models ◽

Important Data ◽

Swallowing Difficulty ◽

Effect Of Treatment ◽

The Cochrane Library ◽

Specific Symptoms

Oropharyngeal dysphagia is a condition characterized by swallowing difficulty in the mouth and pharynx, which can be due to various factors. Animal models of oropharyngeal dysphagia are essential to confirm the cause-specific symptoms, pathological findings, and the effect of treatment. Recently, various animal models of dysphagia have been reported. The purpose of this review is to organize the rodent models of oropharyngeal dysphagia reported to date. The articles were obtained from Medline, Embase, and the Cochrane library, and selected following the PRISMA guideline. The animal models in which oropharyngeal dysphagia was induced in rats or mice were selected and classified based on the diseases causing oropharyngeal dysphagia. The animal used, method of inducing dysphagia, and screening methods and results were collected from the selected 37 articles. Various rodent models of oropharyngeal dysphagia provide distinctive information on atypical swallowing. Applying and analyzing the treatment in rodent models of dysphagia induced from various causes is an essential process to develop symptom-specific treatments. Therefore, the results of this study provide fundamental and important data for selecting appropriate animal models to study dysphagia.

Download Full-text

Lingual Strengthening: Success in an Outpatient Setting

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd24.2.71 ◽

2015 ◽

Vol 24 (2) ◽

pp. 71-74

Author(s):

Ali Meier

Keyword(s):

Oropharyngeal Dysphagia ◽

Patient Discharge ◽

Outpatient Setting ◽

Oral Performance ◽

Exercise Protocol ◽

Anterior Position ◽

Tongue Position ◽

Bolus Propulsion ◽

Posterior Position

In the last decade or more, dysphagia research has investigated the effect of lingual strengthening on oropharyngeal dysphagia with promising results. Much of this research has utilized strengthening devices such as the Iowa Oral Performance Instrument (IOPI) or the Madison Oral Strengthening Therapeutic (MOST) Device. Patients are often given a device to use, and are able to complete an exercise protocol daily or multiple times per day. This case study was completed to determine the effectiveness of using the IOPI in an outpatient clinic where therapy was conducted two to three times per week. The patient was seen post tongue resection due to oropharyngeal cancer. From initiation of IOPI use to patient discharge, the patient demonstrated a 71% increase in lingual strength at the anterior position, a 61% increase at the posterior position, and a 314% increase at the base of tongue position. His diet advanced from NPO to general based on gains in lingual strength and bolus propulsion.

Download Full-text

Research Consumerism 101: Evaluating External Evidence of Treatment Effectiveness

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd17.2.43 ◽

2008 ◽

Vol 17 (2) ◽

pp. 43-49

Author(s):

James L. Coyle

Keyword(s):

Treatment Effectiveness ◽

Code Of Ethics ◽

Oropharyngeal Dysphagia ◽

Clinical Importance ◽

Professional Services ◽

Adverse Outcomes ◽

Professional Judgment ◽

Evidence Based ◽

Intervention Selection ◽

Published Research

Abstract The modern clinician is a research consumer. Rehabilitation of oropharyngeal impairments, and prevention of the adverse outcomes of dysphagia, requires the clinician to select interventions for which evidence of a reasonable likelihood of a successful, important outcome exists. The purpose of this paper is to provide strategies for evaluation of published research regarding treatment of oropharyngeal dysphagia. This article utilizes tutorial and examples to inform and educate practitioners in methods of appraising published research. It provides and encourages the use of methods of efficiently evaluating the validity and clinical importance of published research. Additionally, it discusses the importance of the ethical obligation we, as practitioners, have to use evidence-based treatment selection methods and measurement of patient performance during therapy. The reader is provided with tactics for evaluating treatment studies to establish a study's validity and, thereby, objectively select interventions. The importance of avoiding subjective or unsubstantiated claims and using objective methods of generating empirical clinical evidence is emphasized. The ability to evaluate the quality of research provides clinicians with objective intervention selection as an important, essential component of evidence-based clinical practice. ASHA Code of Ethics (2003): Principle I, Rule F: “Individuals shall fully inform the persons they serve of the nature and possible effects of services rendered and products dispensed…” (p. 2) Principle I, Rule G: “Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.” (p. 2) Principle IV, Rule G: “Individuals shall not provide professional services without exercising independent professional judgment, regardless of referral source or prescription.” (p. 4)

Download Full-text