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

Stroke ◽  
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.

scholarly journals Dysphagia in Perry Syndrome: Pharyngeal Pressure in Two Cases

2017 ◽  
Vol 9 (2) ◽  
pp. 161-167 ◽  
Author(s):  
George Umemoto ◽  
Yoshio Tsuboi ◽  
Hirokazu Furuya ◽  
Takayasu Mishima ◽  
Shinsuke Fujioka ◽  
...  
Keyword(s):  
Tube Feeding ◽  
Oral Intake ◽  
Normal Diet ◽  
Oral Feeding ◽  
Tongue Pressure ◽  
Normal Range ◽  
Swallowing Function ◽  
Pharyngeal Pressure ◽  
Swallowing Dysfunction ◽  
The Impact

Background: To investigate the impact of dysphagia in Perry syndrome (PS), an autosomal dominant parkinsonism caused by mutation of DCTN1, which is associated with hypoventilation, depression, and weight loss. Case Presentation: We used tongue pressure measurements and manofluorography to investigate swallowing function in 2 patients with PS. Case 1, a 60-year-old male showing parkinsonism, and case 2, a 49-year-old male admitted with pneumonia, were diagnosed as having PS based on the DCTN1 gene analysis. Case 1 showed a pharyngeal retention of the bolus on videofluorography (VF) and a few swallows were required for its passage into the esophagus. However, tongue pressure and manometry were within the normal range. This patient could eat a normal diet under supervision. Case 2 required artificial ventilation and tube feeding on admission. The VF image showed a slow transfer of the bolus, delayed swallow reflex, and pharyngeal retention of the bolus that required several swallows for its passage into the esophagus. The tongue pressure was within the normal range, but manometry showed a significant decrease in pressure at the hypopharynx and upper esophageal sphincter. The oral intake of the patients was limited to 2 cups of jelly per day. Conclusions: The investigation of swallowing dysfunction of 2 cases of PS showed that maintaining pharyngeal pressure within the normal range was very important for oral feeding success and prognosis.

scholarly journals Swallowing muscle training for oropharyngeal dysphagia: A non-inferiority study of online versus face-to-face therapy

2021 ◽  
pp. 1357633X2110350
Author(s):  
Helena Bascuñana-Ambrós ◽  
Marta Renom-Guiteras ◽  
Maria Josep Nadal-Castells ◽  
Marta Beranuy-Rodríguez ◽  
Jean Claude Perrot-González ◽  
...  
Keyword(s):  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Total Sample ◽  
Face To Face ◽  
Treatment Groups ◽  
Online Treatment ◽  
The Face ◽  
The Difference ◽  
Functional Oral Intake Scale ◽  
Dysphagia Treatment

Introduction The purpose of this study is to show the non-inferiority of the telemedicine therapy versus face-to-face using the exercise therapy of oropharyngeal muscles in 183 patients treated consecutively from 2010 to 2020. Method We conducted a retrospective study comparing two dysphagia treatment groups: online versus face-to-face. Patients were distributed in a non-random way but according to patient's preferences. All patients followed the same pathway and were evaluated at the beginning and at the end of the study using the dysphagia outcome and severity scale and the functional oral intake scale. A non-inferiority analysis approximation was done with delta = 1 in both variables. Results Within a total of 183 patients, 114 (62.3%) used the online treatment and 69 (37.7%) the face-to-face one. The main cause of dysphagia was neurological in the total sample (60.7%) and within both groups. When we evaluate the clinical response, we find that both groups improved regardless of the type of therapy. The confidence interval of the difference between the beginning and the end of treatment did not reach the inferior limit of the delta defined, therefore supporting the no inferiority of online versus presential. Discussion This study shows the no inferiority of the online therapy versus the face-to-face one for the oropharyngeal training of the swallow muscles.

Peningkatan functional oral intake scale dan kualitas hidup pada miastenia gravis pasca rehabilitasi menelan

2016 ◽  
Vol 46 (1) ◽  
pp. 79
Author(s):  
Erlina Julianti ◽  
Teti Madiadipoera ◽  
Ratna Anggraeni ◽  
Bambang Purwanto ◽  
Sinta Sari Ratunanda
Keyword(s):  
Quality Of Life ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Rehabilitation Program ◽  
Test Design ◽  
Open Label ◽  
Swallowing Rehabilitation ◽  
Quasi Experimental ◽  
Functional Oral Intake Scale

Latar belakang: Miastenia gravis (MG) merupakan penyakit autoimun yang mengganggu transmisineuromuskular karena berkurangnya reseptor asetilkolin di tautan saraf otot sehingga dapat menyebabkandisfagia orofaring. Disfagia pada MG dapat menyebabkan aspirasi yang meningkatkan morbiditas,mortalitas, dan menurunnya kualitas hidup.Tujuan: Menganalisis perbaikan disfagia orofaring padapasien MG dengan melihat peningkatan functional oral intake scale (FOIS) pada pemeriksaan fiberopticendoscopic evaluation of swallowing (FEES) dan untuk mengetahui perbaikan kualitas hidup denganmenggunakan swallowing quality of life (SWAL-QoL) pasca program rehabilitasi menelan.Metode:Penelitian ini merupakan quasi experimental open label pre and post-test design dan data dianalisisdengan menggunakan uji Wilcoxon. Penelitian berlangsung di Poliklinik Ilmu Kesehatan Telinga HidungTenggorok Bedah Kepala Leher Rumah Sakit Dr. Hasan Sadikin Bandung sejak Januari − April 2013 pada10 subjek penelitian. Diagnosis dibuat berdasarkan anamnesis, pemeriksaan fisik, penilaian FOIS denganmelihat konsistensi makanan yang aman ditelan berdasarkan temuan pemeriksaan FEES sebelum dansesudah mengikuti program rehabilitasi menelan selama 6 minggu dan penilaian kualitas hidup dengankuesioner SWAL-QoL.Hasil: Didapatkan perbedaan bermakna (p=0,002) pada hasil FOIS dan perbedaanbermakna pada seluruh domain kuesioner SWAL-QoL setelah program rehabilitasi menelan (p<0,05).Kesimpulan: Terdapat peningkatan FOIS sebagai perbaikan disfagia orofaring, serta peningkatan kualitashidup pada pasien MG sesudah program rehabilitasi menelan. Kata kunci: Disfagia, miastenia gravis (MG), functional oral intake scale (FOIS), fiberoptic endoscopicevaluation of swallowing (FEES), kualitas hidup ABSTRACTBackground: Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmissionassociated with acetylcholine receptor deficiency at the neuromuscular junction which may causeoropharyngeal dysphagia. Oropharyngeal dysphagia in MG patients can cause aspiration which result inmorbidity, mortality, and decreased quality of life. Objective: To analyze the improvement of oropharyngealdysphagia in MG patients by evaluating the functional oral intake scale (FOIS) on fiberoptic endoscopicevaluation of swallowing (FEES) examination and to determine the improvement of quality of life byswallowing quality of life (SWAL-QoL). Method: This study was an open label quasi experimental pre andpost-test design and the data was analyzed using the Wilcoxon statistical test. This study was conductedin Otorhinolaryngology-Head and Neck Surgery Department Dr. Hasan Sadikin General Hospital duringJanuary until April 2013 towards 10 subjects. Diagnosis based on anamnesis, physical examination,FOIS assessment in order to describe the consistency of safe food ingested during FEES examinationand SWAL-QoL questionnaire assessment before and after swallowing rehabilitation programme for 6weeks. Results: There were significant differences (p=0.002) in FOIS result and significant differencesin all domains SWAL-QoL questionnaire after swallowing rehabilitation program (p<0.05). Conclusion:There was an improvement of oropharyngeal dysphagia as seen in increased FOIS score and improvementof quality of life after swallowing rehabilitation program. Keywords: Dysphagia, myasthenia gravis (MG), functional oral intake scale (FOIS), fiberoptic endoscopyevaluation of swallowing (FEES), quality of life Alamat korespondensi: Dr. Erlina Julianti, Sp.THT-KL.,M.Kes. RSUD Kabupaten Bekasi, CibitungBekasi. Email: [email protected].

scholarly journals Validation of the Italian Version of the Functional Oral Intake Scale (FOIS-It) Against Fiberoptic Endoscopic Evaluation of Swallowing and Nutritional Status

Dysphagia ◽  
2021 ◽  
Author(s):  
Aurora Ninfa ◽  
Nicole Pizzorni ◽  
Angelo Eplite ◽  
Claudia Moltisanti ◽  
Antonio Schindler
Keyword(s):  
Nutritional Status ◽  
Rating Scale ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Endoscopic Evaluation ◽  
Severity Rating ◽  
Group Validity ◽  
Functional Oral Intake Scale ◽  
Spearman’S Correlation ◽  
Etiological Heterogeneity

AbstractThe Functional Oral Intake Scale (FOIS) is a reliable and valid tool to assess functional oral intake of food and liquids in patients with oropharyngeal dysphagia (OD). Its validity was established for stroke patients against Videofluoroscopic Swallowing Study in English and Chinese and against Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in German. FOIS was cross-culturally validated into Italian (FOIS-It), but construct validity against instrumental assessment and nutritional status was not investigated. The study aims at contributing to the validation of the FOIS-It, by performing convergent and known-group validity against FEES and nutritional status in patients with OD of different etiologies. Overall, 220 adult patients with OD of etiological heterogeneity were recruited. FOIS-It score and Body Mass Index (BMI) were collected. FEES was performed to assess swallowing safety and efficiency based on the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Moderate to weak associations with PAS (ρ = − .37, p < .01), YPRSRS in the pyriform sinuses (ρ = − .20, p < .01), and BMI (ρ = .24, p < .01) were detected with Spearman’s correlation. FOIS-It distribution was compared with the Mann–Whitney U and Kruskal–Wallis tests. Significantly lower FOIS-It scores were detected among patients with penetration/aspiration (PAS > 2) and penetration (PAS > 2 ≤ 5) for all consistencies (p < .01), aspiration (PAS > 5) of liquids and semisolids (p < .001), residue in the pyriform sinuses (YPRSRS > 3) with semisolids (p < .001) and solids (p = .02), and malnutrition (BMI ≤ 18.5; p = .019). FOIS-It appears as a valid tool to assess functional oral intake against FEES’ measures of swallowing safety and efficiency and nutritional status in patients with OD of etiological heterogeneity.

scholarly journals Prevalence of oropharyngeal dysphagia in hereditary spastic paraplegias

2019 ◽  
Vol 77 (12) ◽  
pp. 843-847 ◽  
Author(s):  
Laís Alves Jacinto-Scudeiro ◽  
Gustavo Dariva Machado ◽  
Annelise Ayres ◽  
Daniela Burguêz ◽  
Marcia Polese-Bonatto ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Genetic Diseases ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Hereditary Spastic Paraplegias ◽  
Swallowing Dysfunction ◽  
Clinically Significant ◽  
Functional Oral Intake Scale

ABSTRACT Hereditary spastic paraplegias (HSP) are a group of genetic diseases characterized by lower limb spasticity with or without additional neurological features. Swallowing dysfunction is poorly studied in HSP and its presence can lead to significant respiratory and nutritional complications. Objectives: The aim of this study was to evaluate the frequency and clinical characteristics of dysphagia in different types of HSP. Methods: A two-center cross-sectional prevalence study was performed. Genetically confirmed HSP patients were evaluated using the Northwestern Dysphagia Patient Check Sheet and the Functional Oral Intake Scale. In addition, self-perception of dysphagia was assessed by the Eat Assessment Tool-10 and the Swallowing Disturbance Questionnaire. Results: Thirty-six patients with spastic paraplegia type 4 (SPG4), five with SPG11, four with SPG5, four with cerebrotendinous xanthomatosis (CTX), three with SPG7, and two with SPG3A were evaluated. Mild to moderate oropharyngeal dysphagia was present in 3/5 (60%) of SPG11 and 2/4 (50%) of CTX patients. A single SPG4 (2%) and a single SPG7 (33%) patient had mild oropharyngeal dysphagia. All other evaluated patients presented with normal or functional swallowing. Conclusions: Clinically significant oropharyngeal dysphagia was only present in complicated forms of HSP Patients with SPG11 and CTX had the highest risks for dysphagia, suggesting that surveillance of swallowing function should be part of the management of patients with these disorders.

scholarly journals End of Life, Food, and Water: Ethical Standards of Care

2021 ◽  
pp. 261-271
Author(s):  
Stefano Eleuteri ◽  
Arianna Caruso ◽  
Ranjeev C. Pulle
Keyword(s):  
End Of Life ◽  
Tube Feeding ◽  
Oral Intake ◽  
Nutrition Therapy ◽  
Oral Feeding ◽  
Standards Of Care ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Substitute Decision Maker ◽  
Nutrition And Hydration

AbstractEnd-of-life care constitutes an important situation of extreme nutritional vulnerability for older adults. Feeding decisions in late-stage dementia often provoke moral and ethical questions for family members regarding whether or not to continue hand-feeding or opt for tube-feeding placement. Despite the knowledge that starvation and dehydration do not contribute to patient suffering at the end of life and in fact may contribute to a comfortable passage from life, the ethics of not providing artificial nutrition and hydration (ANH) continue to be hotly debated. However, in the past two decades, voluntary stopping of eating and drinking (VSED) has moved from a palliative option of last resort to being increasingly recognized as a valid means to intentionally hasten death for cognitively intact persons dealing with a serious illness. Across many settings globally, when oral intake is deemed unsafe, decisions to withhold oral feeding and to forgo artificial means of providing nutrition are deemed to be ethically and legally sanctioned when the decision is made by a capable patient or their legally recognized substitute decision-maker. Decision-making at the end of life involves knowledge of and consideration of the legal, ethical, cultural, religious, and personal values involved in the issue at hand. This chapter attempted to illustrate the unique complexities when considering nutrition therapy (by oral and artificial means) at the end of life.

Efficacy of a comprehensive dysphagia intervention program tailored for the residents of nursing homes

2020 ◽  
pp. 1-4
Author(s):  
R. Fong ◽  
S.W.K. Wong ◽  
J.K.L. Chan ◽  
M.C.F. Tong ◽  
K.Y.S. Lee
Keyword(s):  
Nursing Homes ◽  
Intervention Program ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Caregiver Training ◽  
Interventional Study ◽  
Feeding Assessment ◽  
Functional Oral Intake Scale ◽  
Management Of Dysphagia ◽  
Swallowing Assessment

Oropharyngeal dysphagia is a widespread condition in older people and thus poses a serious health threat to the residents of nursing homes. The management of dysphagia relies mainly on compensatory strategies, such as diet and environmental modification. This study investigated the efficacy of an intervention program using a single-arm interventional study design. Twenty-two participants from nursing homes were included and had an average of 26 hours of intervention, including oromotor exercises, orosensory stimulation and exercises to target dysphagia and caregiver training. Four of the 22 participants exhibited improvement in functional oral intake scale (FOIS) but was not statistically significant as a group. All oromotor function parameters, including the range, strength, and coordination of movements, significantly improved. These results indicate that this intervention program could potentially improve the oromotor function, which were translated into functional improvements in some participants’ recommended diets. The validity of this study could be improved further by using standardized swallowing and feeding assessment methods or an instrumental swallowing assessment.

Family mealtime behaviors in children who are tube fed and preparing to transition to oral eating: A comparison to other pediatric populations

2020 ◽  
pp. 135910532098203
Author(s):  
Andrea M Garcia ◽  
Marshall T Beauchamp ◽  
Susana R Patton ◽  
Sarah Edwards ◽  
Meredith L Dreyer Gillette ◽  
...  
Keyword(s):  
Eating Behaviors ◽  
Tube Feeding ◽  
Chronic Illnesses ◽  
Oral Feeding ◽  
Pediatric Illness ◽  
Pediatric Populations ◽  
Children With Chronic Illnesses ◽  
Standardized Measure ◽  
Mealtime Interactions ◽  
Parent Child

This study examined differences in observed mealtime behaviors between children preparing to transition to oral feeding and children with various other chronic illnesses using a standardized measure of mealtime beaviors. The parent-child mealtime relationship can become strained due to problematic mealtime behaviors that limit food intake, as well as inadvertent reinforcement of disruptive behavior by caregivers. Frequency/rate of behaviors were compared between children with tube feeding (CwTF) and from previous studies of children with chronic illnesses using the Dyadic Interactive Nomenclature for Eating (DINE). Parents of CwTF used more coaxing, physical prompts, and reinforcement during meals, while parents of children with chronic illnesses used more direct commands and engaged in more parent talk. Findings support differences in parent-child mealtime interactions and eating behaviors across pediatric illness subgroups.

Change in Spontaneous Swallowing Frequency in HNC Patients Undergoing C/RT

2021 ◽  
pp. 019459982110207
Author(s):  
Giselle D. Carnaby ◽  
Aarthi Madhavan ◽  
Ali Barikroo ◽  
Michael Crary
Keyword(s):  
Repeated Measures ◽  
Prospective Cohort ◽  
Area Under The Curve ◽  
Objective Measure ◽  
Oral Intake ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Swallowing Function ◽  
Function Change ◽  
Functional Oral Intake Scale

Objective This study sought to evaluate the role and trajectory of spontaneous swallowing frequency (SFA) in patients with head and neck cancer (HNC) undergoing chemoradiotherapy (C/RT). Study Design. Prospective cohort. Setting University comprehensive cancer center. Methods A prospective cohort of 80 patients with HNC was followed from baseline to 3 months post-C/RT. Subjects were evaluated for performance on swallowing function, functional diet consumed, weight, swallowing frequency rate, perceived xerostomia, perceived pain, and mucositis. Relationships were evaluated using univariate correlations, t tests, and repeated-measures analysis of variance. The diagnostic accuracy of SFA to express dysphagia was calculated by area under the curve (AUROC) and displayed using receiver operator characteristic curves. Results In general, patients with HNC demonstrated a parabolic decline in most measures over the C/RT trajectory. SFA and perceived xerostomia did not show improved recovery by 3 months. SFA was related to swallow function, xerostomia, and functional diet consumed posttreatment and pain at 3 months. The ability of SFA to correctly identify clinical dysphagia (Mann Assessment of Swallowing–Cancer version [MASA-C]) and reduced oral intake (Functional Oral Intake Scale [FOIS]) at posttreatment was strong (AUROC MASA-C: 0.824 [95% CI, 0.63-1.00], P < .0018; AUROC FOIS: 0.96 [95% CI, 0.87-0.96], P < .0001). Conclusion This exploratory study suggests SFA may provide a useful method to identify dysphagia after HNC treatment. Furthermore, SFA may offer a simple, objective measure of swallowing function change in HNC over the C/RT trajectory.

scholarly journals iKanEat: protocol for a randomized controlled trial of megestrol as a component of a pediatric tube weaning protocol

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sarah Edwards ◽  
Paul E. Hyman ◽  
Hayat Mousa ◽  
Amanda Bruce ◽  
Jose Cocjin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Tube Feeding ◽  
Parent Stress ◽  
Oral Feeding ◽  
Child Quality ◽  
Randomized Controlled ◽  
Tube Weaning

Abstract Background Although tube feeding routinely saves the lives of children who do not eat by mouth, chronic tube feeding can be a burden to patients, caregivers, and families. Very few randomized trials exist regarding the best methods for weaning children from their feeding tubes. Methods The current paper describes a randomized controlled trial of an empirically supported outpatient treatment protocol for moving children from tube to oral eating called iKanEat. Specifically, we describe the methods of randomized double-blind, placebo-controlled trial which includes a 4-week course of megestrol, the only medication used in the iKanEat protocol, to determine whether the addition of megestrol results in improved child outcomes. The primary and secondary aims are to assess the safety and efficacy of megestrol as part of the iKanEat protocol. The third aim is to provide critical information about the impact of the transition from tube to oral feeding on parent stress and parent and child quality of life. Discussion This trial will provide data regarding whether megestrol is a safe and effective component of the iKanEat tube weaning protocol, as well as important data on how the tube weaning process impacts parent stress and parent and child quality of life. Trial registration ClinicalTrials.gov NCT#03815019. Registered on January 17, 2019

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