Research and professional briefs: characterizing process control of fluid viscosities in nursing homes

Swallowing impairment with advancing age is a major health care problem, especially among nursing home residents. An estimated 40% to 60% of nursing home residents have signs of swallowing disorders or dysphagia. The high number of nursing home residents with dysphagia is, at least in part, caused by patients with swallowing disorders being more likely to be discharged to institutional care. Aging alone does not result in swallowing disorders. Conditions that contribute to swallowing problems include dementia, cerebral vascular accidents, Parkinson's disease, neuromuscular disorders, and some medications. This article discusses the health-related rationale for thickened liquids and fluid viscosities, reviews each phase of the study, and concludes with the practical implications of the study for clinical dietitians.     

Enteral nutrition in geriatric patients

The elderly are an important part of the population. They are more frail, more often sick and it takes them longer to get better; therefore they consume a larger proportion of health services. Nutrition is adjuvant to medical treatment. Swallowing disorders are common in elderly patients. These may be manifestations of different neurological disorders, but the most common swallowing disorder is deconditioning during acute illness. Enteral nutrition bypasses the swallowing system, using nasogastric tubes or percutaneous gastric and enteric tubes. These feeding technologies can supply the needs of the elderly patient. Nevertheless, rehabilitation of the swallowing system, giving the elderly patient optimal functionality, is our main task. In addition to the medical treatment, logotherapists also have a crucial role in swallowing rehabilitation. Enteral nutrition (EN) is an essential part of geriatric medicine.     

A review of the textured diets developed for the management of dysphagia

Background : Dysphagia from whatever cause is a major source of morbidity. A diverse range of modified food consistencies and dysphagia diets have been developed to provide safe meals for the management of people with eating, drinking and swallowing disorders. In this paper the current literature on this topic is reviewed and areas for further study are highlighted. Methods : An initial review of the literature was carried out using the MEDLINE database. Covering the years 1981–96 we used the following key words: dysphagia, swallowing disorders, dysphagia diets. We also reviewed textbooks, back issues of the British Dietetic Associations' Dietetics Today and consulted with colleagues with a special interest in dysphagia. Results and conclusions : Swallowing disorders occur in all age groups, as a result of problems occurring in the preparatory, oral and pharyngeal stages of the swallow. Swallowing disorders at the oesophageal level are not amenable to techniques of swallowing therapy, however, it should be noted that these patients benefit from alteration of diet consistency. The importance of providing suitable and nutritionally adequate meals for individuals with neurological dysphagia is clear, but selection of a textured diet to implement is not. National guidelines are needed for the development and implementation of textured diets for the management of dysphagia.     

Bulimia and swallowing: cause for concern.

OBJECTIVE: To determine whether there is evidence of a relationship between bulimia and abnormalities in swallowing function. METHOD: Literature review across a variety of professional areas concerning the physiological effects of bulimia on oropharyngeal swallow structures and function. RESULTS: Investigations of bulimic subjects have identified abnormalities in the oral cavity and oropharynx including dental erosion, changes in taste, tissue manifestations, and potential motility disorders that could impact swallowing function. DISCUSSION: While there is cause for concern regarding the effects of repeated self-induced vomiting behavior in bulimic subjects on swallowing function, more research is needed.     

Telerehabilitation for service delivery in speech-language pathology

Communication disorders in adults and children can have a significant effect on their quality of life and on that of their families. Speech-language pathologists face several challenges in providing assessment and treatment services to such people. Challenges include facilitating equitable access to services and providing appropriate management within a changing social and economic context. Telerehabilitation has the potential to deliver services in the home or local community via videoconferencing and through interactive computer-based therapy activities. This form of service delivery has the capacity to optimize functional outcomes by facilitating generalization of treatment effects within the person's everyday environment, and enable monitoring of communication and swallowing behaviours on a long-term basis. A number of image-based telerehabilitation applications have been used in the management of adult neurogenic speech and language disorders, stuttering, voice disorders, speech and language disorders in children, laryngectomy and swallowing dysfunction. Further development of such applications and other computer-based therapies, cost-benefit and cost-effectiveness analyses, and professional education are needed if telerehabilitation is to become an integral part of speech-language pathology practice.     

Conduite à tenir devant des troubles de la déglutition

Swallowing disorders are frequent in daily practice. They could involve liquids or solid diets or both, and are mainly caused by neurological or ENT diseases. They impair patients or their relatives’ quality of life and increase the risks of aspiration, undernutrition and dehydration. Assessment includes careful interview and physical examination. The DePippo's test is a key examination. Additionally, endoscopy or video fluoroscopy, which remains the gold standard for swallowing assessment, could be needed. Nutritional and respiratory assessments are mandatory. The management of swallowing disorders should be multidisciplinary, involving physicians, speech therapist, dietician, sometimes dentist or surgeon, and needs a strong contribution of the paramedical staff and the patient's relatives.     

Percutaneous endoscopic gastrostomy in 41 patients: indications and clinical outcome.

Percutaneous endoscopic gastrostomy, under local anaesthetic, was successfully used in 40 out of 41 patients referred for nutritional support. The indications were neurological disorders of swallowing in 32 patients, head and neck cancer in four patients and supplemental feeding in a miscellaneous group of five patients. The main complications of this procedure were one failed insertion and one peritubal infection. At prospective follow-up, the tube continued to function in 16 patients (seven at home) a mean of 184 days post-insertion (range 6-610 days). In 11 patients resumption of swallowing at a mean of 122 (20-390) days allowed tube removal. Thirteen patients died from their disease, a mean of 96 (12-320) days post-insertion. Patient tolerance and patient and carer satisfaction have been excellent and early results suggest that recovery of speech and swallowing in acute neurological disorders may be enhanced. Percutaneous endoscopic gastrostomy should be performed in all patients referred for a gastrostomy and should be considered in all patients requiring long-term tube feeding.     

脑瘫儿童胃肠道问题的研究进展

脑性瘫痪是一组持续存在的中枢性运动和姿势发育障碍、活动受限症候群,这种症候群是由于发育中的胎儿或婴幼儿脑部非进行性损伤所致。胃肠道问题是脑瘫儿童常见的伴随症状,主要包括口咽吞咽障碍、胃食管反流病和便秘。本文对脑瘫儿童主要的胃肠道问题进行综述,以期提高家长及医务人员对脑瘫儿童胃肠道问题的认识。     

Functional consequences of cleft palate and its management

On the basis of the experience with 5200 various types of orofacial cleft operations performed during 42 years (1959-2000) and of the 60-70 cases with velopharyngeal insufficiency without cleft examined yearly author stresses that the surgical closure of the cleft is not enough in the care: the functional consequences (respiratory, sucking, swallowing, speech, hearing and maxillofacial developmental disorders) should also be managed. The first symptom of Robin sequent (cleft palate associated with dysgnathia) is respiratory disorder improving mostly spontaneously but worsening sometimes after palatoplasty. Polysomnography has been performed by the author routinely before all primary palatoplasties for establishing the possible surgical risks and for choice of the optimal time for surgery. On the basis of the results in 61 infants, the surgery was contraindicated and postponed in 6 cases. The various orofacial clefts may cause swallowing problems in different phase of swallowing and different types of dysphagia: the cleft lip cause sucking problems in the preparatory phase, the cleft palate in the oral transitory phase and the velopharyngeal insufficiency in the pharyngeal phase, but the sensomotor function is more decisive in the swallowing process than the cleft itself. Use of an obturator is not necessary, long-term catheter feeding is inappropriate, early closure of the soft palate (in the age of 8-10 months) is recommended. The liquid or food reflux through the nose can be established by cinefluoroscopy with contrast material and with nasoendoscopy following the way of coloured boluses. Retarded speech development, hyperrhinophony, nasal escape, facial grimacing, articulation disorders and dysphonia are the most frequent voice and speech disorders; speech therapy is in 70%, velopharyngoplasty in 20% of the cases indicated. Anatomical result was good in 98% of 1107 flap surgeries operated on by the author, hyperrhinophony ceased in 90%. The results are assessed by a 5-grade perceptual scale. Among the instrumental procedures videofluoroscopy, videoendoscopy, and nasometry seems to be the most informative. The cause of the frequent hearing disorders is mostly the eustachian tube dysfunction. Author found pathological tympanograms in 64% of their cases. The hearing slightly improves after staphylorraphy and often after flap surgery. Adenoidectomy and grommet insertion are alternative procedures in the therapy. The surgeries have an effect on the maxillofacial growth but this is not significant. Multidisciplinary co-operation in the management of cleft patients is indispensable.     

不同深度针刺双侧风池、翳风穴治疗脑卒中后吞咽障碍的临床观察

目的比较不同深度针刺双侧风池、翳风穴治疗脑卒中后吞咽障碍的临床疗效。方法收集2017年3月—2018年11月在辽宁中医药大学附属医院神经内科治疗的脑卒中后吞咽障碍患者90例,随机分为对照组和观察组,每组各45例。两组均给予康复训练、神经肌肉电刺激联合针刺治疗(两组取穴相同,针刺深度不同),治疗4周。观察两组临床疗效、吞咽功能、表面肌电图(sEMG)、血清IL-6和hs-CRP水平、不良反应、神经功能评分、中医症状评分和生活质量评分等。结果治疗后,对照组无不良反应发生,观察组出现1例瘀青,1例血肿;观察组治疗有效率明显高于对照组(P0.05),且观察组更优(P0.05);观察组口角歪斜程度、眼裂闭合程度等症状,WST、VFSS、NIHSS和SWAL-QOL评分,sEMG最大波幅值以及吞咽过程等改善情况均优于对照组(P0.05);观察组血清IL-6、hs-CRP水平均显著低于对照组(P0.05)。结论深刺双侧风池穴、翳风穴联合神经肌肉电刺激治疗脑卒中后吞咽障碍疗效显著。     

脑性瘫痪儿童喂养/吞咽困难和营养不良筛查工具的临床应用

目的 验证脑性瘫痪儿童喂养/吞咽困难和营养不良筛查工具(简称筛查工具)在临床应用中的有效性。方法 纳入2021年1—10月于安徽省儿童医院康复医学科住院治疗的脑瘫儿童94例,分别使用筛查工具、Z评分、主观全面营养评估(SGNA)、饮食功能分级系统(EDACS)进行评估,重新确定筛查工具的截断值,并计算一致性和效度指标。结果 评价营养不良时截断值取2,评价喂养/吞咽困难时截断值取3。筛查工具与传统的Z评分分级、2014年美国肠内肠外营养学会(ASPEN)共识声明中的Z评分分级、SGNA、EDACS的Kappa系数分别为0.349 (95%CI:0.177～0.521)、0.466 (95%CI:0.288～0.644)、0.574 (95%CI:0.409～0.739)、0.747 (95%CI:0.582～0.912)。以传统的Z评分分级为参照,筛查工具的灵敏度为80.0%,特异度为63.8%;以ASPEN的Z评分分级为参照,筛查工具的灵敏度为73.8%,特异度为73.1%;以SGNA为参照,筛查工具的灵敏度为76.6%,特异度为80.9%;以EDACS为参照,筛查工具的灵敏度为72....     

脑卒中患者营养不良风险评估及对康复护理的对策研究

[目的]分析脑卒中患者营养风险影响因素,并探讨康复护理对策的制定.[方法]随机选取2018年7月—2020年7月丽水市中心医院神经外科收治的急性出血性脑卒中患者152例,根据微型营养评估(MNA)量表评分结果,将患者分为正常组、风险组和不良组.采用单因素分析与相关性分析方法,分析患者可能存在的营养风险影响因素,并针对影...     

Analysis of the food consumption of 87 elderly nursing home residents,depending on food texture

Objectives  

Texture-modified food (chopped, mashed, or mixed) is often used for patients, and particularly for dependent elderly people facing swallowing disorders or dental problems. Food must be energy and protein enriched, because dilution is needed for preparation, and several meals like bread can be removed. The aim of the study was to assess the food consumption of residents in four French nursing homes depending on diet texture.     

Training the allied health assistant for the telerehabilitation assessment of dysphagia

We examined the effect of knowledge and task specific training provided to an allied health assistant (AHA), prior to her involvement in facilitating assessments of dysphagia (swallowing disorders) via telerehabilitation. The AHA received four hours of training, which included basic theoretical information regarding dysphagia as well as hands-on training with simulated patients. A written test examining swallowing function and its evaluation was completed pre- and then immediately post-training, and then again after the 15th and 30th of 31 consecutive patient assessments. In addition, after each set of 5 clinical dysphagia assessments completed with patients following the training, two speech pathologists rated the AHA's competence in relation to performing the tasks and activities required of her during the telerehabilitation swallowing assessment. The AHA also self-rated the perceived level of confidence at these times. Before training, the assistant's knowledge of dysphagia theory was at 40%. Following training, all tests were above the 80% level. The AHA's performance was rated as competent on each evaluation post-training. The AHA also expressed overall satisfaction with the initial training provided and reported feeling confident after the initial sessions with patients. Thus for an AHA with previous clinical experience, competence and perceived comfort in providing assistance in the sessions was achieved with only a few hours of task specific training.     

Nutrition entérale à domicile en site jéjunal

Jejunal nutrition has developed nowadays, especially for patients with swallowing disorders, severe gastro-oesophageal reflux disease or previous history of aspiration pneumonia, and obstruction of the upper GI tract. Access to the jejunum is no longer restricted to surgery thanks to the development of tube feeding insertions radiological and endoscopic techniques. This clinical case of a stroke patient underlines the clinical indications of these recent radiology or endoscopy-guided jejunostomies and gastrojejunostomies. They are suitable for home nutrition support as they could avoid surgical laparotomy or laparoscopy or even, parenteral nutrition.     

重症脑卒中患者早期肠内营养预防误吸管理策略

重症脑卒中患者常伴有不同程度的意识障碍、吞咽障碍,是误吸的高发人群,误吸可影响患者的肺部功能,造成吸入性肺炎、窒息甚至死亡等严重后果,应对误吸可控因素是预防重点。重症脑卒中患者肠内营养预防误吸管理主要从误吸风险评估、肠内营养喂养管理、气道管理三方面进行防控,本文对此进行综述,以便为临床医护人员提供指导与借鉴。     

Oropharyngeal Dysphagia and Impaired Motility of the Upper Gastrointestinal Tract—Is There a Clinical Link in Neurocritical Care?

Patients in the neurological ICU are at risk of suffering from disorders of the upper gastrointestinal tract. Oropharyngeal dysphagia (OD) can be caused by the underlying neurological disease and/or ICU treatment itself. The latter was also identified as a risk factor for gastrointestinal dysmotility. However, its association with OD and the impact of the neurological condition is unclear. Here, we investigated a possible link between OD and gastric residual volume (GRV) in patients in the neurological ICU. In this retrospective single-center study, patients with an episode of mechanical ventilation (MV) admitted to the neurological ICU due to an acute neurological disease or acute deterioration of a chronic neurological condition from 2011–2017 were included. The patients were submitted to an endoscopic swallowing evaluation within 72 h of the completion of MV. Their GRV was assessed daily. Patients with ≥1 d of GRV ≥500 mL were compared to all the other patients. Regression analysis was performed to identify the predictors of GRV ≥500 mL/d. With respect to GRV, the groups were compared depending on their FEES scores (0–3). A total of 976 patients were included in this study. A total of 35% demonstrated a GRV of ≥500 mL/d at least once. The significant predictors of relevant GRV were age, male gender, infratentorial or hemorrhagic stroke, prolonged MV and poor swallowing function. The patients with the poorest swallowing function presented a GRV of ≥500 mL/d significantly more often than the patients who scored the best. Conclusions: Our findings indicate an association between dysphagia severity and delayed gastric emptying in critically ill neurologic patients. This may partly be due to lesions in the swallowing and gastric network.     

Proposition d’un référentiel national de prise en charge des modifications des capacités olfactives,gustative et/ou de la déglutition dans les cancers des voies aérodigestives supérieures

Introduction

Malnutrition is particularly related with olfactory, gustatory and swallowing disorders in patients with head and neck cancer. Nutrition is often considered with a therapeutic and quantitative point of view (sum of calories, of proteins, oral supplements, enteral feeding…). However, especially in France, eating is central in the social and familial dynamic and the cancer and its treatments can lead to a dramatic quality of life impairment.

Nutrition Rehabilitation in the Intensive Care Unit

The maintenance of homeostasis after severe injury requires the restoration of the physiological regulation of food intake. A wide array of functional alterations can hinder the intake of adequate amounts of nutrients to support the recovery from critical illness. These alterations encompass changes in the preprandial phase, reflected by a loss of appetite; changes in the prandial phase, yielding swallowing disorders; and changes in the postprandial phase, including impairments of gastric emptying, gut motility, and satiety. This tutorial aims to review these often overlooked features and to suggest recommendations for the nutrition rehabilitation of the critically ill.