Effect of Swallowing Rehabilitation Protocol on Swallowing Function in Patients with Esophageal Atresia and/or Tracheoesophageal Fistula

2017 ◽  
Vol 27 (06) ◽  
pp. 526-532 ◽  
Author(s):  
Selen Serel Arslan ◽  
Numan Demir ◽  
Sule Yalcın ◽  
Ayşe Karaduman ◽  
Ibrahim Karnak ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Oral Intake ◽  
Control Group ◽  
Study Group ◽  
Start Time ◽  
Swallowing Function ◽  
Rehabilitation Protocol ◽  
Swallowing Rehabilitation ◽  
Pharyngeal Swallowing

Aim The aim of this study was to evaluate the results of Swallowing Rehabilitation Protocol (SRP) on swallowing function (SF) of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients with pharyngeal swallowing disorder. Materials and Methods In this study, 24 children with EA-TEF who had deglutitive and respiratory problems were grouped into either study (n = 12) or control group (n = 12) by basic randomization. Study group received the SRP including neuromuscular electrical stimulation, thermal tactile stimulation, and hyolaryngeal mobilization. The control group received nonnutritive stimulations. SF was evaluated with 3 mL liquid and pudding barium by videofluoroscopic swallowing study (VFSS) before and after 20 sessions of interventions. Results No statistical differences were found between groups in terms of descriptive characteristics including age, sex, weight, height, type of atresia, repair type, repair time, and start time of oral intake (p > 0.05). There were no statistical differences between groups in term of swallowing parameters (p > 0.05), except reflux (p = 0.004) according to VFSS findings. After 20 sessions of interventions, the study group showed improvement in penetration–aspiration scale scores, oral phase dysfunction, delay in swallowing reflex, and residue in valleculae and pyriform sinuses after pudding swallow. The control group showed improvement only in oral phase dysfunction. Conclusion SRP can be recommended to improve SF in patients with EA/TEF who have pharyngeal swallowing disorders.

Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy

2020 ◽  
Author(s):  
Jun Takatsu ◽  
Eiji Higaki ◽  
Takahiro Hosoi ◽  
Masahiro Yoshida ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Enhanced Recovery ◽  
Intervention Group ◽  
Oral Intake ◽  
Control Group ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Swallowing Function ◽  
Nerve Paralysis ◽  
Postoperative Stay

Summary Dysphagia after esophagectomy is the main cause of a prolonged postoperative stay. The present study investigated the effects of a swallowing intervention led by a speech–language–hearing therapist (SLHT) on postoperative dysphagia. We enrolled 276 consecutive esophageal cancer patients who underwent esophagectomy and cervical esophagogastric anastomosis between July 2015 and December 2018; 109 received standard care (control group) and 167 were treated by a swallowing intervention (intervention group). In the intervention group, swallowing function screening and rehabilitation based on each patient’s dysfunction were led by SLHT. The start of oral intake, length of oral intake rehabilitation, and length of the postoperative stay were compared in the two groups. The patient’s subgroups in the 276 patients were examined to clarify the more effectiveness of the intervention. The start of oral intake was significantly earlier in the intervention group (POD: 11 vs. 8 days; P = 0.009). In the subgroup analysis, the length of the postoperative stay was also significantly shortened by the swallowing intervention in patients without complications (POD: 18 vs. 14 days; P = 0.001) and with recurrent laryngeal nerve paralysis (RLNP) (POD: 30 vs. 21.5 days; P = 0.003). A multivariate regression analysis identified the swallowing intervention as a significant independent factor for the earlier start of oral intake and a shorter postoperative stay in patients without complications and with RLNP. Our proposed swallowing intervention is beneficial for the earlier start of oral intake and discharge after esophagectomy, particularly in patients without complications and with RLNP. This program may contribute to enhanced recovery after surgery.

scholarly journals A New Type of Balloon Catheter-Based Dilatation Intervention for Patients With Cricopharyngeus Achalasia After Stroke: A Randomized Study

2021 ◽  
Author(s):  
Tingting Hu ◽  
Yeyu Cai ◽  
Zhaohui Shen ◽  
Ailian Chen ◽  
Yacen Wu ◽  
...  
Keyword(s):  
Urinary Catheter ◽  
Randomized Study ◽  
Balloon Catheter ◽  
Oral Intake ◽  
Solid Food ◽  
Control Group ◽  
Liquid Food ◽  
Swallowing Rehabilitation ◽  
New Type ◽  
Experimental Group

Abstract Purpose To investigated the efficacy and safety of a new type of balloon catheter in dilatation intervention for patients with cricopharyngeus achalasia after stroke. Methods Fifty-two patients with cricopharyngeus achalasia after stroke received routinely swallowing rehabilitation trainings and were randomly assigned to: an experimental group (n = 26) that received dilatation therapy using this new balloon catheter one time per day for 5 days per week and a control group (n = 26) that received dilatation therapy with NO.14 ordinary urinary catheter one time per day for 5 days per week. Duration of intervention, EAT-10 and FOIS scores were recorded at baseline and every day during intervention. The time for FOIS score ≥ 3, the time for recovery of oral intake of water, liquid food, mushy food and solid food were recorded and estimated. Complications were recorded during intervention. Results The Exp group had shorter duration of intervention compared to the Con group (p < 0.001). Exp group improved faster than Con group with shorter recovery time for oral intake of liquid food (p < 0.001), mushy food (p = 0.001) and solid food (p < 0.001). At the termination of intervention, EAT-10 score was lower in Exp group than in Con group (p = 0.002). Compared to the Con group, Exp group had similar incidence of complications but better tolerability (p = 0.006). Conclusion Using this new balloon catheter for dilatation improves more and faster than using ordinary urinary catheter in patients with cricopharyngeus achalasia after stroke.

scholarly journals Efficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study

2017 ◽  
Vol 22 (03) ◽  
pp. 225-230 ◽  
Author(s):  
Bruno Fraga ◽  
Sheila Almeida ◽  
Márcia Santana ◽  
Mauriceia Cassol
Keyword(s):  
Pilot Study ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Control Group ◽  
Stroke Patients ◽  
Swallowing Rehabilitation ◽  
Significant Difference ◽  
Vocal Exercises ◽  
Experimental Group ◽  
Post Therapy

Introduction Dysphagia causes changes in the laryngeal and stomatognathic structures; however, the use of vocal exercises is poorly described. Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients. Methods This is a pilot study made up of two distinct groups: a control group, which performed only myofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS). Results The FOIS levels reveal that the pre-therapy median of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments (p = 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone (p = 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy (p = 0.126). Conclusion This pilot study showed indications that using vocal exercises in swallowing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.

scholarly journals Post-esophageal atresia repair double acquired tracheoesophageal fistulas treated successfully by gastric transposition: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Nobuhiro Takahashi ◽  
Yasushi Fuchimoto ◽  
Teizaburo Mori ◽  
Kiyotomo Abe ◽  
Yohei Yamada ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Lower Lobe ◽  
Oral Intake ◽  
Postoperative Recurrence ◽  
Lobe Bronchus ◽  
Gastric Transposition ◽  
The Right

Abstract Background Postoperative recurrence of tracheoesophageal fistula (TEF) is a frequent complication in the repair of esophageal atresia (EA). Based on the recent etiologic classification, a TEF that develops in a different new pathway from the original one is categorized as an acquired TEF. The TEFs that fall into this category have been reported to be refractory and their mechanisms have not been fully understood. Here, we report the complicated case of an acquired TEF derived from mediastinitis after the original TEF repair developed an anastomotic stricture. The TEF contained double fistulas, both towards the right lobe bronchi, and was repaired by gastric transposition through a retrosternal route. Case presentation The patient was diagnosed with Gross C esophageal atresia after birth and underwent tracheoesophageal fistula banding during the neonatal period. He experienced an intractable anastomotic stenosis after surgery which was treated with repeated balloon dilation therapy. By the age of 11 months, he developed a mediastinal abscess that improved with conservative treatment. At 18 months old, a fistula from the esophagus to the right superior lobe bronchus was identified. The patient underwent a right upper lobectomy to resect the fistula. However, at 21 months old, another fistula to the right lower lobe was revealed. An esophageal banding was done to relieve the respiratory symptoms. This was followed by esophagectomy and gastric transposition through the retrosternal route at 26 months old. The patient started rehabilitation and oral intake gradually after surgery. By 3 years after gastric transposition, he could already take blended food orally with the support of small amounts of enteral feeding. Conclusion Cases of TEF derived from severe inflammation have the potential to form a complicated network and lead to recurrence. Surgeons should consider the possibility of multiple tiny fistulas in cases of severe acquired TEF. These may be repaired successfully by gastric transposition through the retrosternal route.

Association of preoperative sarcopenia with postoperative dysphagia in patients with thoracic esophageal cancer

2020 ◽  
Author(s):  
Shuhei Mayanagi ◽  
Aiko Ishikawa ◽  
Kazuaki Matsui ◽  
Satoru Matsuda ◽  
Tomoyuki Irino ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Oral Intake ◽  
Psoas Muscle ◽  
Postoperative Dysphagia ◽  
Thoracic Esophageal Cancer ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Swallowing Rehabilitation ◽  
Significant Difference

Summary Background The purpose of the current study was to clarify the relationship between clinical features of dysphagia after esophagectomy and preoperative sarcopenia. Methods A total of 187 cases were included in the current study. The psoas cross-sectional area on pre-treatment computed tomography was measured in thoracic esophageal cancer patients who underwent curative resection. The psoas muscle index (PMI) cut-off levels for sarcopenia were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Swallowing function was evaluated using videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) at postoperative days 7–15, and classified according to the food intake level scale (FILS). Perioperative swallowing rehabilitation was performed in all cases. Results In the 187 included patients, the median PMI was 5.42 cm2/m2 for men and 3.43 cm2/m2 for women, and 133 cases (71%) met the sarcopenia criteria. The FILS &lt;4 (no oral intake) was 15% in the non-sarcopenia group, and 38% in the sarcopenia group (P = 0.003). There was no significant difference in the incidence of postoperative complications, including pneumonia and re-admission due to pneumonia, between the two groups. Preoperative sarcopenia and recurrent laryngeal nerve palsy were be independent risk factors for postoperative dysphagia. Conclusions Sarcopenic patients with esophageal cancer develop postoperative dysphagia more often than non-sarcopenic patients. Prehabilitation and nutritional support for patients with preoperative sarcopenia could play an important role to mitigate postoperative dysphagia.

The Effect of Capacity Assessment Combined with Staged Target Nursing Intervention on Swallowing Functional Disturbance and Pulmonary Infection in Elderly Stroke Patients

2021 ◽  
Vol 7 (5) ◽  
pp. 2492-2500
Author(s):  
Li Huang ◽  
Chenchen Zhang ◽  
Li Li ◽  
Min Pang ◽  
Li Liu
Keyword(s):  
Pulmonary Infection ◽  
Life Quality ◽  
Nursing Intervention ◽  
Capacity Assessment ◽  
Control Group ◽  
Efficacy Rate ◽  
Study Group ◽  
Stroke Patients ◽  
Swallowing Function ◽  
Functional Disturbance

To investigate the effect of capacity assessment combined with staged target nursing intervention on swallowing functional disturbance (SFD) and pulmonary infection in elderly stroke patients. 82 elderly stroke patients treated in the neurological department of our hospital (June 2019-February 2021) were chosen as the study subjects and randomly split into study group (n=41) and control group (n=41). Both groups received basic treatment for cerebrovascular diseases. After that, control group received routine clinical nursing, while study group underwent capacity assessment combined with staged target nursing intervention. The scores of the Burke Lateropulsion scale in both groups after 3-month nursing intervention were obviously lower (P < 0.001), and after 3-month nursing intervention the scores of the Burke Lateropulsion scale in study group were obviously lower compared with control group (P < 0.001). The NIHSS scores in both groups after 3-month nursing intervention were obviously lower (P < 0.001), and the NIHSS scores in study group after 3-month nursing intervention were obviously lower compared with control group (P < 0.001). The total clinical efficacy rate in study group was obviously higher compared with control group (P < 0.05). The SWAL-QOL scores in both groups after 3-month nursing intervention were obviously higher (P < 0.001), and the SWAL-QOL scores in study group after 3-month nursing intervention were obviously higher compared with control group (P < 0.001). The levels of FVC, FEV1 and PEF in both groups after 3-month nursing intervention were obviously higher (P < 0.001), and those after 3-month nursing intervention in study group were obviously higher compared with control group (P < 0.001). Plus, the total incidence of complications in study group was obviously lower compared with control group (P < 0.05). The capacity assessment combined with staged target nursing intervention can effectively improve patients’ swallowing function, neurological function, pulmonary function and life quality, with obvious therapeutic effect, deserving promotion and popularization.

scholarly journals Effect of Respiratory Muscle Training on Dysphagia in Stroke Patients - A Retrospective Pilot Study

2020 ◽  
Author(s):  
Robert J. Arnold ◽  
Nina Bausek
Keyword(s):  
Respiratory Muscle ◽  
Intervention Group ◽  
Oral Intake ◽  
Respiratory Muscle Training ◽  
Control Group ◽  
Muscle Training ◽  
Stroke Patients ◽  
Post Intervention ◽  
Swallowing Function ◽  
Expiratory Muscle

AbstractBackgroundDysphagia is prevalent with cerebrovascular accidents and contributes to the burden of disease and mortality. Strengthening of the dysfunctional swallow muscles through respiratory muscle training (RMT) has proven effective in improving swallow effectiveness and safety. However, approaches to strengthen only the expiratory muscle groups (EMST) dominate the clinical study literature, with variable outcomes. This study investigated the effect of a simultaneous inspiratory and expiratory muscle strengthening strategy to improve swallowing function in stroke patients.MethodsTwenty post-stroke patients were randomly assigned to either intervention group (IG) or control group (CG). The intervention group was treated with three 5-minute sessions of resistive respiratory muscle training every day for 28 days, while the control group received no RMT. Respiratory and swallow outcomes were assessed pre- and post-intervention and included Mann Assessment of Swallowing Ability (MASA), Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with Penetration/Aspiration Scale (PAS), Functional Oral Intake Scale (FOIS), patient visual analogue scale (VAS), and peak expiratory flow (PEF).ResultsAfter 28 days, the intervention group demonstrated greater improvements (pVal < 0.05) in PEF (IG: 168.03% vs CG: 17.47%), VAS (IG: 103.85% vs CG: 27.54%), MASA (IG: 37.28% vs CG: 6.92%), PAS (IG: 69.84% vs CG: 12.12%), and FOIS (IG: 93.75% vs CG: 21.21%).ConclusionCombined resistive inspiratory and expiratory muscle training is a feasible and effective method to improve signs and symptoms of dysphagia in stroke patients.

scholarly journals Application of Cluster Nursing Among Post-Stroke Patients with Dysphagia

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Zhu Lin ◽  
Min Sun ◽  
Yang Peng ◽  
Sun Weiqing
Keyword(s):  
Aspiration Pneumonia ◽  
Nursing Care ◽  
Control Group ◽  
Stroke Patients ◽  
Swallowing Function ◽  
Post Stroke ◽  
Satisfactory Level ◽  
Swallowing Rehabilitation ◽  
Before And After ◽  
Experimental Group

Objective: To explore the effect of cluster nursing care among post-stroke patients. Methods: Post-stroke patients with dysphagia (n=72) were randomly divided into two groups: experimental (or intervention) (n=36) the control (n=36). Patients in the experimental group were given cluster care, including swallowing assessment, safe eating guide, swallowing rehabilitation, the establishment of cluster prevention strategy and health education to patients and caregivers. Patients in the control group were given conventional nursing care, and the score of swallowing function, the prevalence of aspiration pneumonia and nursing care satisfactory level in both groups were assessed before and after the intervention. Results: The swallowing function of patients in the two groups were improved after intervention, but patients in the experimental group showed significantly higher improvement than the control group (P<0.05). The incidence of aspiration pneumonia was significantly lower in the experimental group compared to the control group (P<0.05). Moreover, the satisfactory level of nursing management was higher in the experimental group than the control group (P<0.05). Conclusion: Cluster nursing (CN) practice has significantly improved the swallowing function of stroke patients with dysphagia, reduced the incidence of aspiration pneumonia and enhanced the satisfaction of nursing care.

Pretreatment with Methylprednisolone Improves Myocardial Protection during On-Pump Coronary Artery Bypass Surgery

2015 ◽  
Vol 18 (4) ◽  
pp. 171 ◽  
Author(s):  
Tolga Demir ◽  
Mehmet Umit Ergenoglu ◽  
Hale Bolgi Demir ◽  
Nursen Tanrikulu ◽  
Mazlum Sahin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Myocardial Protection ◽  
Troponin T ◽  
Artery Bypass ◽  
Control Group ◽  
Study Group ◽  
Cabg Surgery ◽  
Anti Inflammatory ◽  
Pump Coronary Artery Bypass

<strong>Background</strong>: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB).<br /><strong>Methods</strong>: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. <br /><strong>Results</strong>: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P &lt; .001; T3: <br />P &lt; .001; T4: P &lt; .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group <br />(P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001).<br /><strong>Conclusions</strong>: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.<br /><br />

CARDIOVASCULAR RISK FACTORS PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY LUNG DISEASES

2020 ◽  
pp. 21-25
Author(s):  
Tupitsyn V.V. ◽  
Bataev Kh.M. ◽  
Men’shikova A.N. ◽  
Godina Z.N.
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Digestive System ◽  
Control Group ◽  
Study Group ◽  
Type I ◽  
Internal Organs ◽  
History Of

Relevance. Information about the cardiovascular diseases risk factors (CVD RF) for in men with chronic lung inflam-matory pathology (CLID) is contradictory and requires clarification. Aim. To evaluate the peculiarities of CVD RF in men under 60 years of age with CLID in myocardial infarction (MI) to improve prevention. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with CLID - 142 patients; II - control, without it - 424 patients. A comparative analysis of the frequency of observation of the main and additional cardiovascular risk fac-tors in groups was performed. Results. In patients of the study group, more often than in the control group we observed: hereditary burden of is-chemic heart disease (40.8 and 31.6%, respectively; p = 0.0461) and arterial hypertension (54.2 and 44.6%; p = 0.0461), frequent colds (24.6 and 12.0%; p = 0.0003), a history of extrasystoles (19.7 and 12.7%; p = 0.04); chronic foci of infections of internal organs (75.4 and 29.5%; p˂0.0001), non-ulcer lesions of the digestive system (26.1 and 14.6%; p = 0.007), smoking (95.1 and 66.3%; p˂0.0001), MI in winter (40.8 and 25.9%; p = 0.006). Less commonly were observed: oral cavity infections (9.2 and 23.6%; p˂0.0001); hypodynamia (74.5 and 82.5%; p = 0.0358), over-weight (44.4 and 55.2%; p = 0.0136), a subjective relationship between the worsening of the course of coronary heart disease and the season of the year (43.7 and 55.2%; p = 0.0173) and MI - in the autumn (14.1 and 21.9%; p = 0.006) period. Conclusions. The structure of CVD RF in men under 60 years of age with CLID with MI is characterized by the pre-dominance of smoking, non-ulcer pathology of the digestive system, frequent pro-student diseases, meteorological dependence, a history of cardiac arrhythmias and foci of internal organ infections. It is advisable to use the listed factors when planning preventive measures in such patients.

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