脑卒中急性期吞咽障碍的临床影像评价

目的:探讨脑卒中急性期吞咽障碍的临床及影像学检查的表现,分析脑卒中部位与吞咽障碍发生类型的关系。方法:首次发病的急性脑卒中患者62例,根据不同病变部位分为单侧大脑半球组、双侧大脑半球组、脑干与小脑组及多发性卒中组。入院后3d内完成临床吞咽功能评估;入院7d进行吞咽X线荧光透视检查(VFSS);记录分析吞咽障碍的类型和脑卒中的病变部位。结果:入院3d内临床吞咽评定4组患者中有29例(46.8%)存在吞咽困难,其中脑干及小脑组发生吞咽困难的百分率明显高于其他组(P0.05);于7d时VFSS检测11例能完成,其中单侧大脑半球组3例、双侧大脑半球组2例,多出现口腔期困难;脑干及小脑组2例,多出现咽期困难;多发卒中组4例,口腔期和咽期均受影响。吞咽异常表现类型为唇闭合无力、舌运动减弱、误吸及环咽肌功能不全、吞咽反射延迟、喉上抬差、会厌谷和/或梨状窝滞留、喉渗透等。结论:脑卒中后吞咽障碍的临床评定可明确吞咽口阶段的生理状态,VFSS可明确咽阶段及有无误吸。为避免吞咽困难所致的并发症及预防或治疗吞咽困难,需尽早完成吞咽评定,且可以节省患者总体费用及加快改善预后。     

电视透视下吞咽能力检查在口咽期吞咽障碍中的应用

目的 分析吞咽障碍患者电视透视下吞咽能力检查(VFSS)结果.方法 16例知情同意吞咽障碍患者接受VFSS检查.分别采用稀钡餐(50％ w/v)、稠钡餐(270％ w/v)、饼干沾稠钡餐进行咀嚼测试.一口量为10 ml.采用正位、侧位动态造影测试,依次观察双侧梨状窝对称情况、口期时长、咽期起始时间、咽期时长、滞留、误吸及其时间、剂量等.结果5例为口期吞咽障碍;3例为咽期吞咽障碍,显示存在咽期起始迟缓,并且有1例表现为吞咽后误吸;8例为口咽期吞咽障碍,其中5例不伴误吸,3例伴有误吸,其中2例为安静误吸,1例表现为吞咽前误吸,1例表现为吞咽后误吸(梨状窝滞留引起),1例无法判断误吸时间.4例误吸患者中,3例存在钡剂25％以上的重度误吸,1例存在5％的轻度误吸,同时配合吞咽康复治疗.结论VFSS检测可为制订吞咽障碍的康复方案提供参考.     

Head rotation as an effective compensatory technique for dysphagia caused by unilateral cervical osteophytes

ObjectiveDysphagia is common in patients with cervical osteophytes. We aimed to determine whether head rotation as a compensatory technique is effective for dysphagia caused by unilateral cervical osteophytes.MethodsWe retrospectively analyzed videofluoroscopic swallowing study (VFSS) data obtained in one university hospital. Patients whose VFSS showed pharyngeal stasis by mechanical obstruction due to cervical osteophytes were selected. They were divided into a unilateral skewed osteophyte group and a diffuse central osteophyte group as confirmed by laryngoscopy or computed tomography. The effect of head rotation on swallowing was investigated. Fisher’s exact test was used for statistical analysis.ResultsAmong 2876 patients who underwent VFSSs, we identified 48 patients with osteophyte-induced dysphagia. The osteophytes were centrally located in 36 patients and unilateral in the remaining 12. Ten of the patients with unilateral osteophytes showed improvement when they swallowed with head rotation toward the osteophyte side, but none of the patients with central osteophytes showed effective swallowing. A statistically significant relationship was found between swallowing with head rotation and skewed cervical osteophytes.ConclusionSwallowing with head rotation was safe, easy, and effective for patients with dysphagia caused by unilateral cervical osteophytes. We advise attempting this method prior to considering surgical approaches.     

Impaired laryngopharyngeal sensitivity in patients with COPD: The association with swallow function

Abstract

Research indicates that patients with Chronic Obstructive Pulmonary Disease (COPD) have increased aspiration risk. Several factors may pre-dispose a patient to aspiration including a reduction in laryngopharyngeal sensitivity (LPS). Reduced LPS has been associated with increased aspiration risk in pathologies including stroke; however, this has not been examined in COPD. This study aims to explore possible associations between LPS and swallowing function in COPD patients, and determine whether a LPS predictive value may be used as a method of evaluating dysphagia risk in this patient population. Twenty participants with COPD underwent LPS discrimination testing, respiratory function testing, self-reporting swallowing questionnaire, clinical swallowing examination, and fibre-optic endoscopic evaluation of swallowing (FEES). Participants with COPD demonstrated impaired LPS defined by elevated laryngeal adductor reflex thresholds and high incidence of pharyngeal residue on FEES. Positive correlations were identified between their clinical swallowing examination and FEES results for the presence of laryngeal penetration/aspiration (p < 0.04), vallecular residue (p < 0.01), and piriform residue (p < 0.01). In conclusion, COPD patients have reduced laryngopharyngeal mechanosensitivity and impaired swallowing function characterized primarily by pharyngeal stasis. The combination of these deficits may place patients with COPD at increased aspiration risk due to lack of detection of pharyngeal residue and subsequent inhalation of pharyngeal contents.     

Clinical progression and outcome of individuals with and without swallowing impairment following non-traumatic subarachnoid haemorrhage: A retrospective cohort study

Abstract

Purpose: To establish the clinical profiles of individuals with and without dysphagia following non-traumatic subarachnoid haemorrhage (SAH), and to further describe the clinical progression and outcome of dysphagia within the acute phase for those individuals with dysphagia.

Method: Retrospective chart review of 250 patients consecutively admitted with non-traumatic SAH to a major, tertiary neurosurgery referral centre in Australia over a three-year period. Clinical information associated with usual clinical care was collected for the duration of the acute hospital admission. Characteristics of participants with dysphagia (n?=?73/250) were further analysed to evaluate dysphagia progression and recovery.

Result: Participants with dysphagia took 10.93 times longer to commence oral intake following admission than those without dysphagia (p?<?0.01). Those with dysphagia took approximately 12.86 times longer to reach total oral feeding than those without dysphagia (p?<?0.01). There was no statistically significant difference between groups for time to SLP referral (p?=?0.549) or commencement of supplemental feeding (p?=?0.256). Safe management of thin fluids occurred for >50% of participants by weeks 2 and 3 following admission, with 75.34% of participants with dysphagia resuming thin fluids by discharge. Safe management of full diet took slightly longer with 32.88% of participants resuming unmodified diet by week 3. By discharge, only 53.42% of participants resumed a full diet.

Conclusion: The clinical progression and recovery of dysphagia within the acute phase following non-traumatic SAH can be protracted for some patients, necessitating ongoing speech-language pathology (SLP) input after discharge. The study findings will enhance SLP assessment processes, management focuses and guide prognostic decision making for this population.     

外周磁刺激与神经肌肉电刺激治疗脑卒中后咽期吞咽障碍的疗效对比

目的 观察对比外周磁刺激（PMS）与神经肌肉电刺激（NMES）治疗脑卒中后咽期吞咽障碍的疗效。 方法 采用随机数字表法将60例符合筛选标准的脑卒中咽期吞咽障碍患者分成对照组、电刺激组及磁刺激组,每组20例。3组患者均给予常规吞咽功能训练,电刺激组在此基础上辅以神经肌肉电刺激,磁刺激组则辅以外周磁刺激,上述干预均每天治疗2次,每周治疗6d。于治疗前、治疗4周后分别采用标准吞咽量表（SSA）、功能性经口摄食量表（FOIS）及包括渗透-误吸量表评分（PAS)和视频吞咽障碍分级（VDS)在内的视频透视吞咽检查（VFSS）对3组患者治疗效果进行评价。 结果 治疗4周后发现3组患者SSA评分、渗透-误吸量表（PAS)评分、视频吞咽障碍分级（VDS)评分及FOIS评分均较治疗前明显改善（P<0.05）;进一步分析发现,电刺激组、磁刺激组SSA评分［分别为(30.6±3.2)分、(24.1±2.8)分］、VDS评分［分别为(24.4±5.6)分、(18.2±8.2)分］、PAS评分［分别为(3.25±1.12)分、(2.56±0.66)分］及FOIS评分［分别为(4.31±0.97)分、(4.94±0.81)分］改善幅度均显著优于对照组（P<0.05）,并且磁刺激组上述指标的改善幅度亦显著优于电刺激组,组间差异具有统计学意义（P<0.05）。 结论 外周磁刺激可明显改善脑卒中后咽期吞咽障碍,其治疗效果明显优于神经肌肉电刺激。     

A randomized controlled trail of combination therapy of neuromuscular electrical stimulation and balloon dilatation in the treatment of radiation-induced dysphagia in nasopharyngeal carcinoma patients

Dysphagia is a most common complication induced by radiotherapy in nasopharyngeal carcinoma (NPC) patients. This randomized controlled trail (RCT) was performed to evaluate the therapeutic effect of combination therapy of neuromuscular electrical stimulation (NMES) and balloon dilatation in the treatment of radiation-induced dysphagia in NPC patients. Sixty NPC patients with radiation-induced dysphagia were assigned to either the combination rehabilitation group (treatment group) or the routine rehabilitation group (control group) at random. Both groups were subjected to routine rehabilitation treatment, while the combination rehabilitation group also received combination therapy of NMES and balloon dilatation for 4 months. The water swallow test (WST) and videofluoroscopic swallowing study (VFSS) were used to evaluate the severity of dysphagia. The treatment group showed a significant improvement in swallowing function when compared with the control group. When the WST was used, the efficacy rate (percentage of patients with excellent and effective results) of treatment group was higher than that of control group (90.1 vs. 76.3%), and the difference was statistically significant (χ² = 8.55, p = 0.036). When the VFSS was used, the videofluoroscopy results in our study showed that the values of oral transit time (OTT), swallow reaction time (SRT), pharyngeal transit time (PTT) and laryngeal closure duration (LCD) in treatment group were notably improved when compared with those in control group. In conclusion, combination rehabilitation treatment can improve swallow function in the treatment of radiation-induced dysphagia in NPC patients.

Implications for Rehabilitation

• Dysphagia is also a most important complication associated with radiotherapy and may result in serious complications, such as aspiration pneumonia, and permanent or long-term feeding tube dependence which significantly decrease the quality of life of nasopharyngeal carcinoma patients (NPC).

• Rehabilitation treatment is the most important therapy scheme for radiation-induced dysphagia, and neuromuscular electrical stimulation and balloon dilatation are useful therapy method for dysphagia.

• Combination rehabilitation treatment can improve swallow function in the treatment of radiation-induced dysphagia in NPC.

     

Growing a profession: Clinician perspectives on the evolving practice of speech-language pathology in Vietnam

Abstract

Purpose: This paper reports findings from phase two of a multiphase cross-cultural research programme exploring the professional practice of a group of Vietnam’s first university-qualified speech-language pathologists.

Method: Employing qualitative research methodology, this study involved a series of workshops with seven Vietnamese speech-language pathologists in which visual research methods were used to explore the evolution of their work, the challenges they faced, and opportunities to progress their professional practice. Thematic analysis employing a mixed deductive-inductive approach was used to analyse the textual data.

Result: Heightened awareness of the speech-language pathology profession in Vietnam, movement into specialisation and expansion of services into the private sector were described. Dual professional roles, limited access to culturally-relevant resources to support practice and lack of experience in advocating for services posed challenges, whilst community education, the conduct of research, and the training of others in speech-language pathology were progressing the profession.

Conclusion: The professional practice of a group of Vietnam’s first speech-language pathologists is growing. Opportunities to advance their practice will best be informed by knowledge that reflects local context and culture and includes the experiences and preferences of persons living with communication and swallowing disabilities in Vietnam and their families.     

Comparison of two small bowel distending agents for enterography in pediatric small bowel imaging

Objective

To evaluate the ability of pediatric patients with known or suspected inflammatory bowel disease to ingest a new oral distending agent at CT or MR enterography (CTE/MRE), and to determine the impact on small bowel (SB) distension and diagnostic confidence.

Materials and methods

The study design is that of retrospective review of pediatric patients who underwent CTE or MRE from January 2014 to June 2016. Patients ingested low-concentration barium suspension or flavored beverage containing sorbitol and mannitol. The need for nasogastric tube (NGT) administration, amount ingested, emesis, distal extent of contrast, SB distension, terminal ileum (TI) transverse dimension, and diagnostic confidence in TI disease were assessed. Three radiologists each blindly reviewed a subset of the studies.

Results

Of the total 591 scans in 504 patients, 316 scans used low-concentration barium suspension and 275 scans flavored beverage. Nearly all consumed the entire amount (97% vs. 96%). Low-concentration barium suspension exams required NGT more often (7% [23/316] vs. 1% [3/275]; p < 0.0003), and tended to have more emesis (3% [9/316] vs. 1% [3/275]; p = 0.13). Diagnostic confidence score was nearly identical (p = 0.94). Qualitative and quantitative analyses showed no difference in SB distension, except for distension of mid-ileum (flavored beverage > low-concentration barium suspension; p = 0.02). Flavored beverage exams demonstrated a slight increase in distal extent of luminal distension (p = 0.02).

Conclusions

A new flavored beverage distends small bowel as well as low-concentration barium suspension, with decreased requirement for NGT insertion and improved distal extent of luminal distension, and without any decrease in diagnostic confidence in the presence or the absence of TI disease.

     

Effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients

PurposeThe aim of the present study was to evaluate the effect of swallowing training on dysphagia and depression in postoperative tongue cancer patients.MethodFifty-eight tongue cancer patients aged 45–81 years participated in the present study. All patients were scheduled to undergo partial tongue resection and flap rehabilitation. Changes in dysphagia and depression before and after swallowing training were measured. The water swallow test (WST) and the Zung Self-Rating Depression Scale (SDS) were used to evaluate the severity of dysphagia and depression, respectively.ResultsThe WST level and SDS scores in the less than 50% tongue resection and rehabilitation group were significantly lower than those of the greater than 50% group. The WST level and SDS scores of the early tumor stage group were significantly lower than those of the advanced tumor stage group. WST levels and SDS scores before swallowing training were significantly greater than those measured after swallowing training. In all cases, lower WST levels were associated with lower SDS scores.ConclusionsPostoperative dysphagia, depression and anxiety were improved after swallowing training. Early identification and management of dysphagia can improve treatment outcomes and reduce depression.     

Lateral Pharyngeal Wall Motion Analysis Using Ultrasonography in Stroke Patients with Dysphagia

We aimed to analyze lateral pharyngeal wall (LPW) motion using ultrasonography. The subjects were stroke patients with dysphagia (n = 26) and normal controls (n = 15). The stroke patients were divided into two groups based on a videofluoroscopic swallowing study (VFSS). Group A (n = 12) had a penetration or aspiration in VFSS findings, while group B (n = 14) had no evidence of a penetration or aspiration. We assessed LPW motion using B/M-mode ultrasonography. We performed the comparative analysis among each group and the relationship between LPW motion parameters and the VFSS parameters of the pharyngeal phase. The mean LPW displacement of group A, B was significantly decreased than that of normal controls. The mean LPW duration of group A, B was increased than that of normal controls, but not statistically significant. The mean LPW displacement of group A was significantly correlated with the residue in valleculae, pharyngeal delay time and laryngeal elevation, but that of group B was not significantly correlated. The mean LPW duration of group A, B was not significantly correlated with the VFSS parameters of the pharyngeal phase. We suggest that LPW motion analysis could be a useful alternative method for the evaluation of the pharyngeal phase in stroke patients with a penetration or aspiration in VFSS findings.     

Swallowing in individuals with disorders of consciousness: A cohort study

BackgroundAfter a period of coma, a proportion of individuals with severe brain injury remain in an altered state of consciousness before regaining partial or complete recovery. Individuals with disorders of consciousness (DOC) classically receive hydration and nutrition through an enteral-feeding tube. However, the real impact of the level of consciousness on an individual's swallowing ability remains poorly investigated.ObjectiveWe aimed to document the incidence and characteristics of dysphagia in DOC individuals and to evaluate the link between different components of swallowing and the level of consciousness.MethodsWe analyzed clinical data on the respiratory status, oral feeding and otolaryngologic examination of swallowing in DOC individuals. We analyzed the association of components of swallowing and participant groups (i.e., unresponsive wakefulness syndrome [UWS] and minimally conscious state [MCS]).ResultsWe included 92 individuals with DOC (26 UWS and 66 MCS). Overall, 99% of the participants showed deficits in the oral and/or pharyngeal phase of swallowing. As compared with the MCS group, the UWS group more frequently had a tracheostomy (69% vs 24%), with diminished cough reflex (27% vs 54%) and no effective oral phase (0% vs 21%).ConclusionAlmost all DOC participants had severe dysphagia. Some components of swallowing (i.e., tracheostomy, cough reflex and efficacy of the oral phase of swallowing) were related to consciousness. In particular, no UWS participant had an efficient oral phase, which suggests that its presence may be a sign of consciousness. In addition, no UWS participant could be fed entirely orally, whereas no MCS participant orally received ordinary food. Our study also confirms that objective swallowing assessment can be successfully completed in DOC individuals and that specific care is needed to treat severe dysphagia in DOC.     

Dysarthria and dysphagia are highly prevalent among various types of neuromuscular diseases

Abstract

Purpose: Patients with a neuromuscular disease (NMD) can present with dysarthria and/or dysphagia. Literature regarding prevalence rates of dysarthria and dysphagia is scarce. The purpose of this study was to determine prevalence rates, severity and co-presence of dysarthria and dysphagia in adult patients with NMD. Method: Two groups of adult patients with NMD were included: 102 consecutive outpatients (the “unselected cohort”) and 118 consecutive patients who were referred for multidisciplinary assessment (the “selected cohort”). An experienced speech-language pathologist examined each patient in detail. Results: The pooled prevalence of dysarthria was 46% (95% CI: 36.5–55.9) and 62% (95% CI: 53.3–70.8) in the unselected and selected cohorts, respectively. The pooled prevalence of dysphagia was 36% (95% CI: 27.1–45.7) and 58% (95% CI: 49.4–67.2) in the unselected and selected cohorts, respectively. There was a modest but significant association between the presence of dysarthria and dysphagia (r_s?=?0.40; p?<?0.01). Although the dysphagia was generally mild, dysarthria was moderate to severe in 15% of the dysarthric patients. Conclusion: The prevalence rates of dysarthria and dysphagia among patients with various types of NMD are high. Physicians should therefore be aware of this prevalence and consider referring NMD patients to a speech-language pathologist.

• Implicatons of Rehabilitation

• Both dysarthria and dysphagia are highly prevalent among patients with neuromuscular diseases; moreover, although often mild, these disorders can occur relatively early in the course of the disease.

• Clinicians should routinely check for signs and symptoms related to dysarthria and/or dysphagia in patients who present with a neuromuscular disease, preferably using standardised instruments.

     

Delegation models in dysphagia management: Current policy,clinical perceptions and practice patterns

Abstract

Purpose: Delegation to Allied Health Assistants (AHAs) is an effective workforce solution in a number of areas of adult speech-language pathology (SLP) practice. However, reports of AHA delegation in the area of dysphagia management are limited. The aim of this study was to synthesise information from policy documents and current clinical practice to examine the nature of AHA delegation in dysphagia management.

Method: A mixed method design involving a document review of 13 policy documents on AHA delegation, and a survey of 44 SLP managers regarding current delegation models.

Result: Policy and current practice were largely congruent. Despite policy support for AHA delegation, 77% reported using delegation models but only 26% used them fairly often/very often in dysphagia management. Both policy and survey findings support AHA training prior to task delegation, however, the nature of training was unspecified. Good governance is integral to successful delegation and managers recognised the need to increase standardisation of AHA capability assessment.

Conclusion: AHA delegation in dysphagia management is supported by policy and is being implemented in clinical services. However further work detailing governance and training requirements is needed, as well as systematic evaluation of the safety and benefits of these models.     

New intra-abdominal mass after operation for colorectal cancer: desmoid tumor versus peritoneal seeding

Purpose

To identify differential clinical and imaging findings between intra-abdominal desmoid tumors and peritoneal seeding that developed after surgery for colorectal cancer.

Methods

8 patients (9 desmoid tumors) and 11 patients (13 peritoneal seeding masses) were enrolled in our retrospective study. Patients with three or more tumors were excluded. Clinical findings including location of initial tumors, type of surgery, T- and N-stages of initial tumors, time interval between initial surgery and development of intra-abdominal tumors, and level of carcinoembryonic antigen (CEA) were evaluated. Imaging findings of intra-abdominal tumors including size, number, growth rate, location, shape, homogeneity, relative enhancement, and maximum standardized uptake value were evaluated. The Mann–Whitney U test and Fisher’s exact test were used to compare clinical and imaging findings between desmoid tumors and peritoneal seeding.

Results

In patients with a desmoid tumor, initial T-stage, initial N-stage, and level of CEA at the time of surgery for intra-abdominal tumor were lower than in patients with peritoneal seeding (p = 0.027, p = 0.033, and p = 0.017). The desmoid tumors were frequently located in the small bowel mesentery (p = 0.018) and were larger at detection (p = 0.041). Round or ovoid shapes on CT images were more frequently observed with the desmoid tumors (p = 0.035).

Conclusions

Stage of colorectal cancer, CEA level, and location, size, and shape of new intra-abdominal tumors can be helpful for differentiating between intra-abdominal desmoid tumors and peritoneal seeding in patients with a history of colorectal cancer surgery.

     

在电视X线透视吞咽功能检查指导下进行治疗性进食结合吞咽训练对脑卒中后吞咽障碍患者功能的影响

目的:探讨在电视X线透视吞咽功能检查(VFSS)指导下进行治疗性进食结合吞咽训练对脑卒中后吞咽障碍的疗效。方法:选取脑卒中后留置胃管的吞咽障碍患者60例,随机分为对照组和观察组各30例,2组入院后都进行VFSS,对照组给予常规吞咽训练,观察组给予吞咽训练后进行治疗性进食,每周5d,共3周。2组患者分别于治疗前后进行洼田饮水试验(WST),渗漏-误吸分级(PAS)及功能性经口摄食评估(FIOS),并比较2组患者拔管率、患者出院后咳嗽咳痰情况。结果:治疗前,2组患者WST、PAS、FIOS结果比较差异无统计学意义,治疗3周后,对照组WST、PAS分级情况改善(P<0.01,0.05),FIOS等级无明显变化;观察组各项评分较治疗前均有改善(均P<0.01),与对照组相比,观察组3项评估指标、拔管率均有显著改善(均P<0.01),出院1个月后咳嗽咳痰情况有显著改善(P<0.01)。结论:在VFSS指导下进行治疗性进食结合吞咽训练能显著改善脑卒中后吞咽障碍患者的吞咽功能。     

Treatment of Dysphagia with pyridostigmine bromide in a patient with the pharyngeal-cervical-brachial variant of guillain-barré syndrome

A 24-year-old male developed bulbar palsy, ophthalmoplegia, ptosis, and shoulder weakness bilaterally 2 weeks after he had experienced an upper respiratory infection. The electrodiagnostic study demonstrated axonal polyradiculoneuropathy. The repetitive nerve stimulation study (RNS) showed no significant decrement of the compound muscle action potentials (CMAPs). The videofluoroscopic swallowing study (VFSS) showed severe impairment of the pharyngeal phase of swallowing. He was diagnosed as having the pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. The patient's dysphagia was not improved for 3 months. A follow up RNS showed a significant decrement of the CMAPs. Pyridostigmine bromide was tried to improve the dysphagia. The patient showed immediate improvement of his dysphagia on the VFSS after the trial with pyridostigmine bromide. Pyridostigmine bromide was given before each meal for 8 days and he showed continuous improvement of his dysphagia. The follow up VFSS after 3 months showed complete recovery of dysphagia.     

Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program

Crary MA, Carnaby GD, LaGorio LA, Carvajal PJ. Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the McNeill Dysphagia Therapy Program.ObjectiveTo investigate functional and physiological changes in swallowing performance of adults with chronic dysphagia after an exercise-based dysphagia therapy.DesignIntervention study: before-after trial with 3-month follow-up evaluation.SettingOutpatient clinic within a tertiary care academic health science center.ParticipantsAdults (N=9) with chronic (>12mo) dysphagia after unsuccessful prior therapies. Subjects were identified from among patients referred to an outpatient dysphagia clinic. Subjects had dysphagia secondary to prior treatment for head/neck cancer or from neurologic injury. All subjects demonstrated clinical and fluoroscopic evidence of oropharyngeal dysphagia. No subject withdrew during the course of this study.InterventionsAll subjects completed 3 weeks of an intensive, exercise-based dysphagia therapy. Therapy was conducted daily for 1h/d, with additional activities completed by subjects each night between therapy sessions.Main Outcome MeasuresPrimary outcomes were clinical and functional change in swallowing performance with maintenance at 3 months after intervention. Secondary, exploratory outcomes included physiological change in swallow performance measured by hyolaryngeal elevation, lingual-palatal and pharyngeal manometric pressure, and surface electromyographic amplitude.ResultsClinical and functional swallowing performances improved significantly and were maintained at the 3-month follow-up examination. Subject perspective (visual analog scale) on functional swallowing also improved. Four of 7 subjects who were initially feeding tube dependent progressed to total oral intake after 3 weeks of intervention. Physiological indices demonstrated increased swallowing effort after intervention.ConclusionsSignificant clinical and functional improvement in swallowing performance followed a time-limited (3wk) exercise-based intervention in a sample of subjects with chronic dysphagia. Physiological changes after therapy implicate improved neuromuscular functioning within the swallow mechanism.     

Neuromuscular Electrical Stimulation Therapy for Dysphagia Caused by Wilson's Disease

Wilson's disease is an autosomal recessive disorder of abnormal copper metabolism. Although dysphagia is a common complaint of patients with Wilson's disease and pneumonia is an important cause of death in these patients, management of swallowing function has rarely been reported in the context of Wilson's disease. Hence, we report a case of Wilson's disease presenting with dysphagia. A 33-year-old man visited our hospital with a complaint of difficulty in swallowing, since about last 7 years and which had worsened since the last 2-3 months. He was diagnosed with Wilson's disease about 13 years ago. On the initial VFSS, reduced hyoid bone movement, impaired epiglottic movement and moderate amount of residue in the valleculae during the pharyngeal phase were noted. After 10 sessions of neuromuscular electrical stimulation for 1 hour per day, decreased amount of residue was observed in the valleculae during the pharyngeal phase on the follow-up VFSS.