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

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.

Swallowing disorders during and after the treatment of larynx cancer

Dysphagia is a swallowing disorder that is characterized by difficulty to swallow and to control saliva as well as by feeding difficulties. Dysphagia is a common symptom of laryngeal cancer, or a consequence of surgical treatment as well as radiotherapy and chemotherapy of this neoplasma. The patients after laryngectomy are at risk of developing malnutrition, and aspiration pneumonia. Removal of anatomical structures and reorganization of remaining tissues has a significant impact on the physiology of swallowing. For most patients, safe swallowing is the main feature of a positive treatment outcome. Swallowing therapy is important before, during and after treatment of larynx cancer. The aim of this paper is to explore a correlation between swallowing disorders and laryngeal cancer treatment, and to understand the anatomical and physiological bases of dysphagia treatment.

Adherence to Dysphagia Treatment Recommendations: A Conceptual Model

Purpose Conceptual models of complex health problems are useful when designing targeted clinical interventions and focused research studies. Understanding and studying patient adherence often involves interplay among many factors that influence whether a patient successfully follows recommendations or completes a therapy program. Functional frameworks serve to arrange these factors visually, increasing interpretability and allowing for empirical testing of relationships among concepts. The purpose of this article is to integrate relevant factors from the literature into a comprehensive framework that describes adherence to dysphagia treatment. Method Using peer-reviewed, published guidelines regarding conceptual model construction, the authors created a list of potential factors that influence patient adherence to dysphagia-related treatment recommendations. During model construction, following extensive review of the literature and existing theories that have been applied in other areas of health care, factors were identified and grouped into conceptually similar domains (clusters). Clusters were arranged into larger categories that emerged during model optimization. Ultimately, two models were created: one that illustrates the interrelated factors of patient adherence and another that illustrates a subset of modifiable risk factors that a clinical speech-language pathologist may influence when developing a dysphagia treatment plan. Results Three general categories from 14 factors emerged based on relationships between factors and aspects of patient care: health factors, individual patient factors, and contextual factors. A second model consisting of modifiable risk factors included access, treatment type, patient perceptions, self-efficacy, health literacy, support factors, and provider bias. Conclusions This conceptual model allows clinicians and researchers to identify and explore the mechanisms driving adherence. Continual refinements of this model should be made as future studies uncover how the interconnectedness of factors affects adherence in dysphagia management. The models we have presented here are ready for clinical application and should also serve researchers as they generate hypotheses and design targeted research questions.

Protocol for a scoping review study to identify and map treatments for dysphagia following moderate to severe acquired brain injury

IntroductionDysphagia is highly prevalent in patients with acquired brain injury (ABI) and is associated with high morbidity and mortality. However, dysphagia management varies greatly between units and internationally, and there is currently no consensus, standard intervention or treatment. A review mapping the existing literature on dysphagia treatment is needed. In this paper, the protocol for a scoping review to identify and map dysphagia treatment following ABI is outlined.ObjectiveThe objective of the scoping review is to systematically map the existing research literature to answer the research question:Which non-surgical, non-pharmacological interventions are used in the treatment of dysphagia in patients with moderate and severe acquired brain injury in the acute and subacute phase?Methods and analysisThe methodological framework for the study is based on methodology by Arksey and O’Malley and methodological advancement by Levacet al. We will search electronic databases in June 2019: MEDLINE (Ovid); Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library); EMBASE (Ovid); CINAHL (EBSCO); PsycINFO; Science Citation Index Expanded on Web of Science; OTseeker; Speechbite and PEDro. The search terms will be limited to patients with moderate to severe ABI and dysphagia. Four review authors will independently conduct an initial screening of title and abstract and subsequent full-text review of included studies. Data will be extracted and summarised in diagrammatic or tabular form (numerical summary), and a descriptive format (narrative summary). The strategy for data synthesis entails qualitative methods to categorise the interventions based on the treatment modality and subgroup diagnosis.Ethics and disseminationScoping the existing literature will provide a foundation for further evaluating and developing our dysphagia treatment and inform future studies assessing the effectiveness of treatments. The review is part of an ongoing expansive research into dysphagia. The results will be disseminated through a peer-reviewed publication and conference presentations.

The Utility of High-Resolution Pharyngeal Manometry in Dysphagia Treatment

Purpose High-resolution pharyngeal manometry (HRPM) is an emerging technology that shows promise as both an adjuvant diagnostic and therapeutic tool in oropharyngeal dysphagia management. Advances in manometric technology, including increased number of sensors and topographical pressure plots, enhance the biofeedback potential for the pharynx. This clinical focus article serves as an overview of the utility of HRPM in dysphagia treatment. Conclusion HRPM-facilitated biofeedback aids the patient in the correct implementation of clinical recommendations and also provides the clinician an assessment of the effectiveness and accuracy of those targeted interventions. Topographic pressure plots provide intuitive feedback, allow easier swallow-to-swallow comparisons, and produce visually color-coded pressure information for the patient and clinician in real time. Paired with existing, evidence-based interventions, HRPM biofeedback may facilitate maneuver and strategy planning, exercise training and monitoring, temporal coordination, upper esophageal segment relaxation and duration, swallow mapping (topographic pattern recognition and approximation), fatigue monitoring, dose planning, adherence tracking, and efficacy assessment of selected interventions. Although competency training is needed to effectively utilize HRPM, there are growing opportunities for the speech-language pathologist to acquire and implement this technology for the benefit of patients.