Medicine and Health Sciences Commons^™

Efficacy Of A Compound Swallowing Training Program Incorporating Neuromuscular Electrical Stimulation On Postoperative Chronic Dysphagia In Patients With Tongue Cancer, U-Hin Lai, Yu-Chi Huang, Ching-Yi Liao, Xiao-Rou Ding, Chau-Peng Leong

Rehabilitation Practice and Science

Objective: To investigate therapeutic effects of a compound swallowing training program(CSTP) that includes neuromuscular electrical stimulation, swallowing muscle strengthening, posture training, food texture modification, and the use of adaptive feeding devices on chronic dysphagia after surgical treatment of tongue cancer(TC), and review the long-term swallowing outcomes and possible adverse effects.

Materials and methods: In this retrospective longitudinal study, we included patients with chronic dysphagia after surgical treatment of TC, who received a total of 10 CSTPs three times weekly, for one hour each time. Penetration-Aspiration Scale (PAS), Functional Dysphagia Scale (FDS), and Swallowing Performance Rating Scale (SPS) scores were compared …

Swallowing Function In Parkinson's Disease: Correlation With Disease Duration And Hoehn And Yahr Stage, Yi-Ya Pan, Hsueh-Pei Wang, Ruey-Meei Wu, Tyng-Guey Wang

Rehabilitation Practice and Science

Oropharyngeal dysphagia is a common complication of Parkinson's disease (PD). Swallowing assessment scales, videofluoroscopics wallowing study (VFSS), and fiberoptic endoscopic evaluation of swallowing (FEES) are used to evaluate the swallowing function of patients with dysphagia. However, few studies have been conducted that assessed tongue muscle strength and hyoid bone movement in patients with PD. To better understand the correlation between disease duration, Hoehn and Yahr (H&Y) stage and swallowing function in patients with PD, this study evaluated the swallowing function in patients with PD using ultrasonography and Iowa Oral Performance Instrument (IOPI). Ultrasonography was performed to evaluate hyoid movement, and …

Viscosity Of Commercial Thickeners In Combination With Different Beverages Of Honey- And Nectar-Like Consistency And Their Change Over Time, Wei-Chun Che, Yuan-Ching Tsai, Meng-I Kuo, Tsan-Hon Liou

Rehabilitation Practice and Science

Objective: This study investigated the viscosity of four beverages (green tea, grape juice, sugar-free soy milk, and Ensure®) thickened to a nectar- and honey-like consistency with five thickening products (Resource® Thickenup® Clear, Toromeal, Toromi-up, eNutrition, and Sentosa) marketed in Taiwan. The sample viscosity over time was compared. Furthermore, the results were compared with the guidelines of National Dysphagia Diet (NDD) established by the American Dietetic Association. Methods: The viscosity was measured using the Brookfield RVDV-II+ Pro viscometer with small sample adaptor, shear rate set at 50 s-1, temperature at 25℃. Results: The results showed that almost all thickening products in …

Swallowing Exercisesin Enforcing And Augmenting Suprahyoid Muscles To Improve Dysphagia And Upper Esophageal Sphincter Dysfunction For Stroke Patients: A Systematic Reviewarticle, Heng-An Yeh, Yu-Jen Chen

Rehabilitation Practice and Science

Dysphagia often occurs in stroke patients, who may present oral, pharynx, and upper esophageal sphincter dysfunction, including insufficient chewing and stirring bolus ability, poor pharyngeal contraction, pharynx to upper esophageal sphincter incoordination, and relaxation of the upper esophageal sphincter. Insufficient opening of the upper esophageal sphincter is an obstacle for moving a bolus from the pharynx to the esophagus. In addition to provide swallowing training, most of the treatments for upper esophageal sphincter dysfunction are invasive. However, several non-invasive swallowing exercises have been published with the aim of treating upper esophageal sphincter dysfunction. The purpose of this article is to …

Swallowing Rehabilitation Of Dysphagia In Parkinson Disease: Recent Advances And Recommendations, Chin-Man Wang, Yih-Ru Wu, Tyng-Guey Wang

Rehabilitation Practice and Science

Dysphagia is common in Parkinson disease (PD). Dysphagia may affect quality of life in the early stage of PD and can cause dehydration, malnutrition, or even result in pneumonia and mortality in the late stage. Accordingly, management of dysphagia is a crucial issue in PD. Clinicians and researchers should spend more effort developing sensitive evaluation tools and effective intervention strategies for dysphagia in PD. In the early stage of disease, the Swallowing Disturbance Questionnaire, Münich Dysphagia Test for Parkinson’s Disease questionnaire, or noninvasive tools involving surface electromyography or sensors should be used to detect subtle or mild dysphagia. In the …

Management Of Dysphagia In Spinal Muscular Atrophy, Kuo-Chang Wei, Wen-Chin Weng, Tyng-Guey Wang

Rehabilitation Practice and Science

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease. SMA phenotypes can be determined by the timing of disease onset and the highest level of motor development reachable by the patient. Generally speaking, proximal muscle involvement is more severe than in the distal extremities. In addition, cervical and the masticatory and pharyngeal muscles were likely affected by the disease, which can cause feeding problems and dysphagia. Clinically, dysphagia is more common among patients with type I and type II SMA. To thoroughly evaluate swallowing-related issues, both subjective information from patients and their caregivers and findings from objective tools including …

Poststroke Swallowing Rehabilitation And Recent Development, Shu-Fen Sun, Ping-Hsin Chang, Chien-Wei Hsu, I-Hsiu Liou

Rehabilitation Practice and Science

Dysphagia is a common poststroke complication. It is associated with aspiration, malnutrition, dehydration, and disability, and it may increase the risk of pneumonia, and even death. Early diagnosis and treatment of patients with dysphagia reduces not only the aforementioned risks, but also the length of hospitalization and overall healthcare expenditures. Patients with poststroke oropharyngeal dysphagia exhibit highly variable patterns of swallowing abnormalities, and the related symptoms remain challenging to identify clinically. Patients who have experienced stroke should be screened for dysphagia as early as possible on admission and prior to any form of oral intake. Those who fail dysphagia screening …

The Roles Of Videofluoroscopic Swallowing Study (Vfss) And Fiberoptic Endoscopic Evaluation Of Swallowing (Fees) In The Assessment Of Dysphagia, Yi-Hsiang Chiu, Wen-Hsuan Tseng, Tyng-Guey Wang

Rehabilitation Practice and Science

Dysphagia is a prevailing complication of various central nervous diseases and oral pharyngeal cancer. Once dysphagia occurred, it may affect a patient's physical and psychological condition and thus their quality of daily activities. Therefore, early detection and the application of appropriate treatments for patients with dysphagia is essential. Videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) are two common instrument modalities used to evaluate swallowing function. VFSS has been acknowledged as the gold standard for the diagnosis of dysphagia by most scholars. Nevertheless, there is debate that FEES is superior to VFSS as it provides additional information …

A Focal Survey Of Medical Professionals' Conceptions Of Gastrostomy In Patients With Dysphagia After Stroke In Taiwan, Sheng-Hao Cheng, Yi-Ching Chen, Ming-Yen Hsiao, Tyng-Guey Wang

Rehabilitation Practice and Science

Background and aims: People with dysphagia may require long-term tube feeding to maintain adequate nutrition. In Taiwan, nasogastric (NG) tubes are more commonly used than gastrostomy tubes. This practice is inconsistent with international treatment guidelines. Medical professionals' attitudes toward treatment may influence patients' decisions. Therefore, we designed a questionnaire to assess whether medical professionals' conceptions of gastrostomy are consistent with current international treatment principles. Methods: We used an online questionnaire hosted on ＂Google Forms＂ to collect medical professionals' conceptions of gastrostomy. Societies related to dysphagia distributed copies of the questionnaire to their members. The professionals included specialists (physiatrists, otolaryngologists, oral …

Bedside Thyroid Palpation Technique As Indicator For Penetration/Aspiration Risk In Stroke Patients, Yung-Chun Chi, Mu-Hung Tsai, Jerry Tsung-Kai Lin, Yi-Chen Yu, Shih-Chung Chang

Rehabilitation Practice and Science

Background: Bedside thyroid cartilage palpation technique is a quick and non-invasive swallowing screening test. However, the correlation between thyroid cartilage movement and penetration/aspiration risks in stroke patients has not been conclusive to date. Therefore, we compared the result of videofluoroscopic swallowing study (VFSS) and bedside thyroid cartilage palpation to determine the penetration/ aspiration risks in stroke patients. Material and methods: Our study included 53 patients admitted to a medical center for rehabilitation within 6-months of stroke onset. We recorded penetration-aspiration scale by VFSS and compared it with a bedside thyroid cartilage palpation technique. Results: Our results show significant higher rates …

Cytomegalovirus Infection Complicated With Severe Rhabdomyolysis And Dysphagia: A Casereport And Literature Reviewarticle, Heng-An Yeh, Yu-Jen Chen, Jean-Lon Chen

Rehabilitation Practice and Science

Cytomegalovirus(CMV) is a common virus that usually occurs in immunocompromised patients. After primary infection with CMV, the virus becomes latent in multiple organs and can later be reactivated during severe immune system dysregulation. Rhabdomyolysis is a disease of human muscle cell necrosis, and the rapid dissolution of damaged or injured muscles may lead to acute kidney injury or multiple organ failure. After reviewarticleing relevant literature, patients with severe rhabdomyolysis caused by CMV infection are rarely reported and even less commonly, CMV leads to severe dysphagia. The patient was a 35-year-old woman without underlying disease. Two months before hospitalization,she visited the …

Viscosity Of Commercial Thickeners At A Honey- Or Nectar-Like Consistency And Their Changes Over Time, Wei-Chun Che, Meng-I Kuo, Tsan-Hon Liou, Yuan-Ching Tsai

Rehabilitation Practice and Science

Background: Patients with dysphagia often have difficulties in swallowing liquids. Using thickened liquids is a compensatory strategy frequently recommended by speech－language pathologists to reduce the risk of aspiration in patients with dysphagia . However, the thickening effects might vary with time and different thickening products. Furthermore, the desired viscosity might not be attained. This study investigated the viscosity of water that was thickened to a nectar- or honey-like consistency by using five thickening products marketed in Taiwan. The viscosity of the samples at different time periods was compared. The results were also compared with the guidelines of the National Dysphagia …

Factors Associated With Nasogastric Tube Removal In Patients With Post-Stroke Dysphagia Following Acute/Subacute Stroke, Hsin-Chiao Wen, Hao-Wei Tang, Chang-Ren Peng, Kuan-Lin Chen, Ching-Min Hsiao, Chung-Che Lin

Rehabilitation Practice and Science

Purpose: Stroke is a common cause of dysphagia, and persistent post-stroke dysphagia is associated with a poor outcome and an increased mortality rate. Nasogastric tubes (NGTs) are frequently the recommended method for the safe administration of nutrition and hydration in stroke patients. However, prolonged use of NGTs can lead to complications, such as gastro-esophageal reflux and aspiration pneumonia. The purpose of this study was to determine the factors associated with NGT removal in patients with post-stroke dysphagia. Method: This was a retrospective study. We recruited patients with post-stroke dysphagia who had received feeding either partially or totally via NGT and …

The Effects Of Chin-Tuck Position In Stroke Patient With Dysphagia Evaluated By Fiberoptic Endoscopy, Yuyu Chen, Tienwen Chen, Maohsiung Huang

Rehabilitation Practice and Science

Background and Purpose: Dysphagia is a frequent symptom after stroke. Dysphagia increases the risk of aspiration pneumonia, malnutrition, and is associated with poor prognosis. Fiberoptic endoscopic evaluation of swallowing (FEES) is a suitable method for dysphagia assessment after acute stroke. Chin-tuck position has been used in dysphagia patients to prevent aspiration during swallowing. But the combined application of these promising modalities has rarely been studied. We aimed to evaluate the effects of chin-tuck position in stroke patient with dysphagia evaluated by fiberoptic endoscopy. Methods: A total of 34 consecutive patients with first stroke were enrolled. FEES after swallowing was done …

Recovery Of Oral Intake Function In Elderly Patients With First-Ever Acute Ischemic Stroke, Ya-Fang Hsu, Wen-Chih Lin, Ching-I Hu, Mei-Ju Ko, Chia-Yu Chang, Hing-Man Wu, Willy Chou

Rehabilitation Practice and Science

Introduction and Objective: The effects of aging on swallowing are particularly evident in elderly adults who are ill. Previous studies have reported that prolonged nasogastric tube (NGT) feeding in patients who have had a stroke increases the risk of pneumonia and mortality. However, few studies have investigated the recovery of oral intake function and the factors regarding NGT removal in patients with poststroke dysphagia. In the present study, we investigated the differences in oral intake function between elderly (age: ≥65 y) and nonelderly patients with first-ever acute ischemic stroke. Methods: In this retrospective study, we reviewarticleed the medical charts of …

Dysphagia In Critical Illness Polyneuropathy And Myopathy: A Casereport, Hung-Chou Chen, Yen-Hsia Hsu, Shin-Ching Chen, Tyng-Guey Wang, Sung-Hui Tseng, Jiunn-Horng Kang

Rehabilitation Practice and Science

Critical illness polyneuropathy and myopathy (CIPNM) is a common complication seen in patients with critical illness. However, long-lasting oropharyngeal dysphagia in patients with CIPNM has not been reported previously. Besides, severe dysphagia is also a rare condition in patients with diabetes. Here, we present the case of a woman with diabetes, who developed neuromuscular weakness after recovery from severe pneumonia and respiratory failure. Brain lesion was excluded by magnetic resonance imaging of brain. CIPNM was confirmed by nerve conduction and electromyographic studies. Videofluoroscopic swallow study showed severe oropharyngeal dysphagia. The general weakness and functional status improved gradually after rehabilitation. However, …

Swallowing Therapy For Systemic Amyloidosis-Induced Dysphagia: A Casereport, I-Hsien Wu, Ching-Chi Chen, Mei-Yi Wu, Li-Chen Tung, Jung-Tai Liu

Rehabilitation Practice and Science

Amyloidosis is defined as the extracellular deposition of fibrillar proteins in different organs and tissues. The clinical features of amyloidosis include cardiomyopathy, hepatomegaly, proteinuria, macroglossia, and dysphagia. We report the case of a 52-year-old man with myeloma-associated amyloidosis who complained of progressive dysphagia, dysarthria, and macroglossia. Videofluoroscopic swallowing study revealed severe reduction in tongue movements, aspiration after swallowing, and retention in the valleculae and pyriform sinuses. The patient underwent swallowing therapy for 6 months; the therapy included compensatory neck flexion, vocal cord adduction exercises, supraglottic swallow, and the Mendelsohn maneuver. The swallowing therapy enabled the patient to swallow liquid and …

Dysphagia After Anterior Cervical Spine Surgery: A Casereport, Hsi-Ting Chiu, Ssu-Yuan Chen, Tyng-Guey Wang, Yen-Ho Wang

Rehabilitation Practice and Science

Dysphagia is one of the complications that develops after anterior cervical spine surgery. Its etiology is multifactorial. It is transient in most patients, and few patients suffer from dysphagia for more than several months. This study reports 1 patient with a dislocation fracture at the C5-C6 level who suffered from dysphagia for 6 months after the anterior cervical spine surgery. Videofluoroscopic examination of swallowing revealed pharyngeal muscle weakness and cricopharyngeal muscle dysfunction with obstruction at the level of the left upper esophageal sphincter. Serial examination revealed neither laryngeal organic lesions, such as those observed in vocal cord palsy, nor evidence …