An overview of dysphagia rehabilitation for stroke patients

ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.

Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

Background Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. Methods Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. Results Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have ‘serious’ to ‘critical’ risk of bias. Conclusions This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.

Postoperative dysphagia caused by a delay in mandibular fracture treatment in a patient with severe intellectual disability: a case report

Background The postoperative complications of mandibular fracture include malocclusion, infection, nonunion, osteomyelitis, and sensorial mental nerve dysfunction. However, there are no reports regarding postoperative dysphagia as a complication of mandibular fracture. Herein, we report a rare case of postoperative dysphagia caused by delayed mandibular fracture treatment in a patient with severe intellectual disability. Case presentation A 46-year-old Japanese male patient with severe intellectual disability fell down and struck his chin. The patient was referred to our department 10 days after the accident. Upon examination, he could not close his mouth because of severe left mandibular body fracture. Open reduction and internal fixation was performed under general anesthesia 16 days after sustaining the injury, and normal occlusion was eventually achieved. However, the patient could not swallow well a day after surgery. He was then diagnosed with postoperative dysphagia caused by disuse atrophy of muscles for swallowing based on videoendoscopic examination findings. Adequate dysphagia rehabilitation could not be facilitated because of the patient’s mental status. Postoperative dysphagia did not improve 21 days after surgery. Therefore, percutaneous endoscopic gastrostomy was required. Conclusions The treatment course of the patient had two important implications. First, postoperative dysphagia caused by disuse atrophy may occur if treatment is delayed in severe mandibular body fracture. Second, in particular, if a patient with severe intellectual disability develops postoperative dysphagia caused by disuse atrophy, adequate dysphagia rehabilitation cannot be facilitated, and percutaneous endoscopic gastrostomy may be required. Therefore, early open reduction and internal fixation is required for mandibular fracture in a patient with severe intellectual disability.

Dysphagia rehabilitation following acquired brain injury, including cerebral palsy, across the lifespan: a scoping review protocol

Background Swallowing impairment (dysphagia) following brain injury can lead to life-threatening complications such as dehydration, aspiration pneumonia and acute choking episodes. In adult therapeutic practice, there is research and clinical evidence to support the use of swallowing exercises to improve swallowing physiology in dysphagia; however, the use of these exercises in treating children with dysphagia is largely unexplored. Fundamental questions remain regarding the feasibility and effectiveness of using swallowing exercises with children. This review aims to outline the published literature on exercise-based treatment methods used in the rehabilitation of dysphagia secondary to an acquired brain injury across the lifespan. This will allow the range and effects of interventions utilised to be mapped alongside differential practices between adult and child populations to be formally documented, providing the potential for discussions with clinicians about which rehabilitative interventions might be appropriate for further trial in paediatrics. Methods This study will use a scoping review framework to identify and systematically review the existing literature using Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews (PRISMA) scoping review guidelines. Electronic databases (MEDLINE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED)), grey literature and the reference lists of key texts including systematic reviews will be searched. Information about the rehabilitation design, dosage and intensity of exercise programmes used as well as demographic information such as the age of participants and aetiology of dysphagia will be extracted. The number of articles in each area and the type of data source will be presented in a written and visual format. Comparison between the literature in adult and child populations will be discussed. Discussion This review is unique as it directly compares dysphagia rehabilitation in adults with that of a paediatric population in order to formally identify and discuss the therapeutic gaps in child dysphagia rehabilitation. The results will inform the next stage of research, looking into the current UK-based speech and language therapy practices when working with children with acquired dysphagia. Systematic review registration Open science framework osf.io/ja4dr

The power struggle: exploring the reality of clinical reasoning

Purpose: Historically, clinical reasoning has largely been considered from an empirical, biomedical standpoint. This epistemology, rooted in imperial rule, is influential in how healthcare practitioners practice. An empirical approach to healthcare often oversimplifies the complex nature of clinical reasoning by obscuring the influence of imperial ideologies on decision-making. This can perpetuate inequitable approaches to healthcare delivery which deepen social, political and economic divides globally. This paper aims to explore and challenge this standpoint by exploring how power, imperialism and performativity influences healthcare provision and decision-making amongst healthcare practitioners in dysphagia rehabilitation. Methods: Qualitative exploratory interviews were undertaken with seven South African trained SLPs with experience working in dysphagia. To allow for participation and collaboration from participants, three data collection tools were employed within the interviews: oral histories, cognitive mapping and arts-based tasks. An initial modified thematic analysis followed by a further ideological analysis were undertaken to analyse the data collected. Results: The results suggest that the participants felt influenced by several manifestations of power within healthcare. We argue that this demonstrates that imperial practices can influence knowledge, interaction and context and therefore affect how healthcare practitioners make decisions. Conclusion: By acknowledging the impact of imperialism and power dynamics on healthcare provision and clinical reasoning we can potentially begin to transform the epistemology from which we approach healthcare provision in favour of one which is better suited to the current realities of healthcare to allow for equitable service provision.

Dysphagia in Oculopharyngeal Muscular Dystrophy: A Rapid Scoping Review

Purpose Dysphagia is a common symptom of the rare genetic disease oculopharyngeal muscular dystrophy (OPMD). There are, however, limited resources and recommendations for speech-language pathologists who treat individuals with this condition. This review provides a consolidation of the literature to understand how the components and outcomes of intervention for dysphagia rehabilitation are described and studied in adults with OPMD. Method A rapid scoping review was completed to identify studies related to dysphagia interventions for adults with OPMD. Data were extracted and analyzed through the lens of the Rehabilitation Treatment Specification System and the International Classification of Functioning, Disability and Health frameworks. Results A total of eight studies met the review criteria. Six of the studies described rehabilitative interventions, and three focused on outcomes of intervention. Rehabilitation interventions were not described in detail, and a wide variety of outcome measures were used. Conclusions There is limited research to guide clinical decision-making and intervention for dysphagia rehabilitation in OPMD at this time. Neurodegenerative disorder research may be beneficial in guiding clinical practice. Further research is required to determine the most effective interventions for individuals with OPMD.

Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation

Dysphagia is a common and devastating complication following brain damage. Over the last 2 decades, dysphagia treatments have shifted from compensatory to rehabilitative strategies that facilitate neuroplasticity, which is the reorganization of neural networks that is essential for functional recovery. Moreover, there is growing interest in the application of cortical and peripheral neurostimulation to promote such neuroplasticity. Despite some preliminary positive findings, the variability in responsiveness toward these treatments remains substantial. The purpose of this review is to summarize findings on the effects of neurostimulation in promoting neuroplasticity for dysphagia rehabilitation and highlight the need to develop more effective treatment strategies. We then discuss the role of metaplasticity, a homeostatic mechanism of the brain to regulate plasticity changes, in helping to drive neurorehabilitation. Finally, a hypothesis on how metaplasticity could be applied in dysphagia rehabilitation to enhance treatment outcomes is proposed.

YouTube as a Source of Patient Information Regarding Exercises and Compensated Maneuvers for Dysphagia

Objective: Acquiring online health-related information has become increasingly widespread. In this study, we aimed to evaluate the quality of the most-viewed YouTube videos on dysphagia regarding exercises and compensated maneuvers. Method: We searched for the keywords “dysphagia exercise”, “dysphagia rehabilitation”, “dysphagia maneuver”, “dysphagia therapy”, and “dysphagia compensation” on YouTube on 5 February 2021. The educational quality of videos on YouTube was investigated based on the Global Quality Scale (GQS) and categorized into three groups: high-, intermediate-, and low-quality. The modified DISCERN tool was used to evaluate the reliability of the YouTube videos. Video parameters were compared between the groups according to the quality of the videos. Results: Of the 51 videos evaluated, according to the GQS, 54.9% (n = 28) were of high-quality, 35.3% (n = 18) were of intermediate-quality, and 9.8% (n = 5) were of low-quality, respectively. When the video parameters were compared among the groups, there were no significant differences in the number of views, likes, dislikes, or comments per day (p > 0.05). However, there was a significant difference in the DISCERN scores between the groups (p < 0.001). Conclusion: YouTube can be deemed as a predominant source for high-quality videos on dysphagia exercise and compensated maneuvers. However, YouTube should be accepted as a mixed pool, with high-, intermediate-, and low-quality videos. Therefore, healthcare professionals, such as physicians and therapists, should verify the suitability and quality of the video, and suggest it to the patient, to ensure that the patient obtains the appropriate information.