Treatment of Dysphagia with Biofeedback and Functional Electrical Stimulation in a Patient with Wallenberg Syndrome: A Prospective Case Report

Biofeedback games and automated functional electrical stimulation (FES) can be used in the treatment of dysphagia. This case study aims to evaluate the effect of the treatment on a 77-year-old man with chronic Wallenberg syndrome and his and the therapist’s experiences when using this therapy form. The participant received intensive treatment for nine days with Facial Oral Tract Therapy, biofeedback games and FES. The Penetration Aspiration Scale was scored using Functional Endoscopic Evaluation of Swallowing at baseline and the end of the intervention period. Swallowing-specific parameters were measured daily, and interviews were conducted with the patient and therapist during the intervention period. The patient and therapist both expressed a positive attitude to the ease of use and usefulness of this technology, despite there being no measurable change in the participant’s swallowing and eating function and only small improvements in swallowing parameters. The experience from this study was that biofeedback games and FES gave only small improvements in swallowing for this participant but were motivating and easy to use. Further research is needed to investigate the effect of this therapy on other participants with a more robust research design.

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

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.

Safety and Efficacy of Specially Designed Texture-Modified Foods for Patients with Dysphagia Due to Brain Disorders: A Prospective Study

Providing texture-modified food for patients with dysphagia is a cornerstone of dysphagia treatment. This study aimed to evaluate the safety and efficacy of a specially designed texture-modified food that can be easily swallowed while maintaining the unique taste by adjusting hardness and adhesiveness in patients with brain disorders using a videofluoroscopic swallowing study. We included 101 patients with oropharyngeal dysphagia due to brain disorders who were referred to the rehabilitation department. To evaluate the safety and efficacy of a specially designed texture-modified food, rice gruel was compared with a regular instant rice porridge, and bulgogi mousse was compared with ground bulgogi, which normally serves as a texture-modified diet for patients with dysphagia in our hospital during the videofluoroscopic swallowing study. The Penetration–Aspiration Scale score, oropharyngeal transit time, number of swallows required to maximally eliminate food materials from the oropharyngeal space, and vallecular and pyriform sinus residue after swallowing scale score were compared. Rice gruel required a shorter oropharyngeal transit time and fewer number of swallowing per the given amount of food than regular instant rice porridge; however, no statistical difference was found in the vallecular and pyriform sinus residue after swallowing scale scores and the Penetration–Aspiration Scale scores. Bulgogi mousse required more swallowing and had lower Penetration–Aspiration Scale scores than ground bulgogi; however, no significant difference was found in the oropharyngeal transit time and the vallecular and pyriform sinus residue after swallowing scale scores. The study foods were safe and efficacious compared to control foods usually provided for patients with dysphagia from various brain disorders.

Progression of swallowing dysfunction and associated complications of dysphagia in a cohort of patients with serial videofluoroscopic swallow examinations

Objective Dysphagia is a common symptom with associated complications ranging from mild discomfort to life-threatening pulmonary compromise. Videofluoroscopic swallow is the ‘gold standard’ evaluation for oropharyngeal dysphagia, but little is known about how patients’ performance changes over time. Method This was a retrospective cohort study evaluating dysphagia patients’ clinical course by serial videofluoroscopic swallow study. Univariate analysis followed by multivariate analysis were used to identify correlations between pneumonia outcomes, diet allocation, aetiology and comorbidities. Results This study identified 104 patients (53 per cent male) stratified into risk groups by penetration-aspiration scale scores. Mean penetration-aspiration scale worsened over time (p < 0.05), but development of pneumonia was not associated with worsened penetration-aspiration scale score over time (p = 0.57) or severity of dysphagia (p = 0.88). Conclusion Our dataset identified a large cohort of patients with oropharyngeal dysphagia and demonstrated mean penetration-aspiration scale tendency to worsen. Identifying prognostic factors associated with worsening radiological findings and applying this to patients at risk of clinical swallowing difficulty is needed.

Mixed Consistencies in Dysphagic Patients: A Myth to Dispel

Only limited and inconsistent information about the effect of mixed consistencies on swallowing are available. The aim of this study was to evaluate the location of the head of the bolus at the swallow onset, the risk of penetration/aspiration, and the severity of post-swallow pharyngeal residue in patients with dysphagia when consuming mixed consistencies. 20 dysphagic patients underwent a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) testing five different textures: liquid, semisolid, solid, biscuits-with-milk and vegetable-soup. The location of the head of the bolus at the onset of swallowing was rated using a five-points scale ranging from zero (the bolus is behind the tongue) to four (the bolus falls into the laryngeal vestibule), the severity of penetration/aspiration was rated using the Penetration Aspiration Scale (PAS), the amount of pharyngeal residue after the swallow was rated using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in the vallecula and pyriform sinus. When consuming biscuits-with-milk and liquid the swallow onset occurred more often when the boluses were located in the laryngeal vestibule. Penetration was more frequent with biscuits-with-milk, while aspiration was more frequent with Liquid, followed by biscuits-with-milk and vegetable-soup, Semisolid and Solid. In particular, no differences in penetration and aspiration between liquids and biscuits-with-milk were found as well as among vegetable-soup, semisolid and solid. No significant differences in the amount of food residue after swallowing were demonstrated. The risk of penetration-aspiration for biscuits-with-milk and liquid is similar, while the risk of penetration-aspiration is lower for vegetable-soup than for liquid.

The Risk of Penetration–Aspiration Related to Residue in the Pharynx

Purpose Reference data from healthy adults under the age of 60 years suggest that the 75th and 95th percentiles for pharyngeal residue on swallows of thin liquids are 1% and 3%(C2-4) 2 , respectively. We explored how pharyngeal residue below versus above these values prior to a swallow predicts penetration–aspiration. Method The study involved retrospective analysis of a previous research data set from 305 adults at risk for dysphagia. Participants swallowed six thin boluses and three each of mildly, moderately, and extremely thick barium in videofluoroscopy. Raters measured preswallow residue in %(C2-4) 2 units and Penetration–Aspiration Scale (PAS) scores for each swallow. Swallows were classified as (a) “clean baseline” (with no preswallow residue), (b) “clearing” swallows of residue with no new material added, or (c) swallows of “additional material” plus preswallow residue. Frequencies of PAS scores of ≥ 3 were compared across swallow type by consistency according to residue severity (i.e., ≤ vs. > 1%(C2-4) 2 and ≤ vs. > 3%(C2-4) 2 . Results The data set comprised 2,541 clean baseline, 209 clearing, and 1,722 swallows of additional material. On clean baseline swallows, frequencies of PAS scores of ≥ 3 were 5% for thin and mildly thick liquids and 1% for moderately/extremely thick liquids. Compared to clean baseline swallows, the odds of penetration–aspiration on thin liquids increased 4.60-fold above the 1% threshold and 4.20-fold above the 3% threshold (mildly thick: 2.11-fold > 1%(C2-4) 2 , 2.26-fold > 3%(C2-4) 2 ). PAS scores of ≥ 3 did not occur with clearing swallows of moderately/extremely thick liquids. Lower frequencies of above-threshold preswallow residue were seen for swallows of additional material than for clearing swallows. Compared to clean baseline swallows, the odds of PAS scores of ≥ 3 on swallows of additional material increased ≥ 1.86-fold above the 1% threshold and ≥ 2.15-fold above the 3% threshold, depending on consistency. Conclusion The data suggest that a pharyngeal residue threshold of 1%(C2-4) 2 is a meaningful cut-point for delineating increased risk of penetration–aspiration on a subsequent swallow.

Effect of Laryngeal Suspension and Upper Esophageal Sphincter Myotomy for Severe Dysphagia Due to Brainstem Disease

Objectives: Surgical procedure is considered in patients with severe dysphagia when conservative treatment fails. This study aimed to evaluate laryngeal suspension (LS) and upper esophageal sphincter (UES) myotomy for treating severe dysphagia due to brain disease. Methods: Fourteen patients underwent LS and UES myotomy, with a median follow-up of 5 years and 6 months when conservative treatment failed. The penetration-aspiration scale (PAS), the Dysphagia Severity Scale (DSS), the Eating Status Scale (ESS), and diet contents were evaluated just before surgery, at discharge, and at the last follow-up. Results: Preoperative intake was tube feeding in all patients. The patients learned the extended head and flexed neck posture to open the esophageal inlet. PAS, DSS and ESS scores, and diet contents were significantly improved at discharge compared with before surgery, and were maintained until the last follow-up. Eight patients had pneumonia during their hospital stay, and five had pneumonia between discharge and at the last follow-up. Age was significantly, negatively correlated with DSS and ESS at the last follow-up. Conclusion: Although LS and UES myotomy require a long inpatient rehabilitation and the risk of pneumonia after surgery is high, the outcome is favorable and the effects last for a long time.