Swallowing in neurological outpatients: Use of a timed test

Swallowing was studied prospectively in a consecutive group of 90 neurology outpatients under 70 years of age. No patient had been referred primarily because of dysphagia. Patients were classified into four groups: those with (1) neurological or (2) non-neurological diagnoses possibly relevant to disordered swallowing, (3) functional disorders, and (4) definite diagnoses not likely to be relevant. They were defined as having abnormal or probably abnormal swallowing if two or more of the following were present: a complaint of swallowing problem, abnormal symptoms or signs, a slow swallowing speed (<10 ml.s^-1). Nineteen patients among the four groups (21%) were found to have abnormal/probably abnormal swallowing. Swallowing speed was significantly slower in patients who perceived a swallowing problem or who had abnormal symptoms or signs compared with those who did not, providing further evidence for the validity of a timed test of swallowing capacity. The study also provides evidence of a significant incidence of disordered swallowing in outpatients who may not have complained spontaneously but who have diagnoses potentially relevant to swallowing.     

Dysphagi in Huntington's disease: A 16-year retrospective

Degenerative diseases of the basal ganglia are commonly complicated by dysphagia. In 35 patients with Huntington's disease (HD), a hereditary neurodegenerative basal ganglia disease characterized by chorea, dementia, and emotional changes, an extensive battery of clinical and radiologic procedures helped to identify numerous abnormalities of deglutition. The results permitted the classification of our patients with HD into hyperkinetic (HD-h) or rigid-bradykinetic (HD-rb) groups. Although the two groups share multiple abnormalities, statistically significant intergroup differences were observed. Clincial assessmen of the HD-h cohort (30 patients) demonstrated rapid lingual chorea, swallow incoordination repetitive swallows, prolonged laryngeal elevation, inability to stop respiration and frequent eructations. In the HD-rb group (five patients), frequently observed abnormalities included mandibular rigidity, slow lingual chorea, coughing on foods, and choking on liquids. Videofluoroscopic swallowing studies (VFSS) using a variety of barium-impregnated, foods and liquids confirmed the abnormalities noted on the clinical assessment. Respiratory and laryngeal chorea, pharyngeal space retention, and aspiration were also identified. Numerous compensatory techniques introduced during videofluoroscopy benefited all patients.     

Pilot study of 12-month outcomes of nursing home patients with aspiration on videofluoroscopy

The 12-month clinical outcomes of nursing home patients who underwent videofluoroscopic swallowing evaluation was determined. A retrospective review of 40 patients in a teaching nursing home who had videofluoroscopic swallowing studies from 1987 through 1989 was performed. Clinical outcomes measured included feeding tube placement, rehospitalization within 1 year, prolonged nursing home stay (>6 months), pneumonia, and pneumonia death. It was determined if outcomes were associated with the presence of aspiration on videofluoroscopy and subsequent feeding tube placement. In the 12-month follow-up period, 17 of 40 patients (43%) who underwent videofluoroscopic swallowing evaluation developed pneumonia and 18 of 40 (45%) died. Twenty-two patients demonstrated aspiration on videofluoroscopy. Increased rehospitalization was the only outcome measure that was associated with the presence of aspiration on videofluoroscopy (p0.05). Of 22 patients with aspiration, 15 had feeding tubes placed. This group had a higher rate of pneumonia (p0.05) and pneumonia death (p0.05) compared with the 7 patients with aspiration who did not receive feeding tubes. Patients with nasogastric tubes had a higher death rate (7/9) than patients with gastrostomy tubes (2/8; p0.05), but similar rates of rehospitalization and pneumonia. Nursing home patients who underwent videofluoroscopic swallowing evaluation had poor clinical outcomes at 12 months, regardless of their test results. Though limited by its small size and retrospective nature, this pilot study questions whether videofluoroscopic swallowing studies accurately identify patients at risk for developing aspiration pneumonia and whether feeding tubes prevent aspiration or improve clinical outcomes. A larger, prospective study is needed to address these issues.Presented in part at the American Geriatrics Society Annual Meeting, Chicago, Illinois, May 1991.     

健康成人吞咽表面肌电图研究

目的 研究健康成年人吞咽表面肌电图的特点.方法 应用肌电图仪对126例健康成人志愿者吞咽时的表面肌电图进行研究,其中男性66例,女性60例;年龄范围是18～65岁.将记录电极放置于甲状软骨上方1 cm,记录每次吞咽时肌肉电活动的持续时间和振幅.吞咽方式有:空吞咽、吞咽20 ml水、吞咽40 ml水.结果 健康成年男性空吞咽、吞咽20 ml水、吞咽40 ml水时肌电活动持续时间平均((x)±s,下同)分别为(1.133±0.209)s、(1.097±0.208)s和(1.510±0.432)s,振幅分别为(0.332±0.115)mV、(0.308±0.095) mV和(0.399±0.139) mV.健康成年女性同样吞咽时肌电活动持续时间分别为(1.118±0.170)s、(1.085±0.209)s和(1.765±0.463)s,振幅分别为(0.292±0.100) mV、(0.261±0.113)mV和(0.342 ±0.129) mV.所有的吞咽方式中男性受试者吞咽时的振幅均大于女性(P值均＜0.05),除吞咽40 ml水的吞咽持续时间女性长于男性(t=3.199,P＜0.05)外,其余吞咽方式的持续时间差异均无统计学意义(P值均＞0.05).所有受试者吞咽40 ml水的时间均长于空吞咽和吞咽20 ml水时,吞咽20 ml水和空吞咽时差异无统计学意义;吞咽40 ml水的振幅大于空吞咽,空吞咽的振幅大于吞咽20 ml水时.不同年龄组男性受试者的肌电图持续时间和振幅差异均无统计学意义(P值均＞0.05);女性受试者除年轻组(＜30岁)吞咽40 ml水的时间长于年长组外(P＜0.05),其余吞咽方式肌电图参数差异均无统计学意义(P值均＞0.05).结论 吞咽的表面肌电图是一种简单、无创的评估吞咽功能的检查方法,本研究取得的健康人群吞咽表面肌电图的数据有望为今后开展吞咽功能筛查提供参考.     

Spontaneous mucocele of the upper esophagus: Radiologic demonstration

We present a patient with dysphagia resulting from a pedunculated, spontaneous mucocele of the upper esophagus. We briefly discuss the radiologic, endoscopic and pathologic findings of this unusual lesion.     

Schedule for Oral-Motor Assessment (SOMA): Methods of validation

The Schedule for Oral Motor Assessment (SOMA) was developed for the purpose of objectively rating the oral-motor skills of preverbal children, with a view to identifying areas of deficient abilities that could have clinical significance. The instrument can be administered without special equipment, by a trained observer. Oral-motor function is assessed across a range of food textures and fluids. Ratings of oral-motor skills are largely made post hoc by analysis of a videorecording of the test administration. The test-retest and interrater reliability of the instrument have been shown to be excellent. Criterion validity was investigated by means of a novel seeded cluster analysis procedure in which 127 young children were assessed, most of whom were between 8 and 24 months of age. Ten percent of the sample had known abnormal oral-motor function in association with cerebral palsy (ages between 12 and 42 months). Not only was criterion validity satisfactorily established by the analysis but an abbreviated version of the SOMA—suitable for screening purposes—was developed. This has been shown to have a positive predictive validity greater than 90% and sensitivity greater than 85% for the detection of infants with clinically significant oral-motor dysfunction.     

La disfagia en cuidados intensivos,un problema real: análisis de factores de riesgo

AimsTo identify risk factors present in patients with dysphagia in a population of critically ill patients.MethodsCase series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia.Outcomes103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p=0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge.ConclusionsAlmost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.