Rehabilitative intervention for successful decannulation in adult patients with acquired brain injury and tracheostomy: a systematic review.

PURPOSE: Tracheostomy and dysphagia are independently associated with increased complications and poorer functional outcome after acquired brain injury (ABI). The aim of this study was to identify and evaluate rehabilitation to restore functional swallowing ability and respiratory capacity during tracheal tube weaning. MATERIALS AND METHODS: The review was conducted according to PRISMA guidelines. Any study design with adult patients with ABI and tracheostomy was eligible. The primary outcome was decannulation. RESULTS: A total of 2647 records were identified and eight papers included. Four studies investigated pharyngeal electrical stimulation (PES), two explored Facial Oral Tract Therapy (F.O.T.T.), one respiratory physiotherapy (RPT), and one study investigated external subglottic air flow (ESAF). Two RCTs found a significant difference between intervention and control on successful decannulation and readiness for decannulation in favour of PES. Time from rehabilitation admission and tracheostomy to decannulation was significantly reduced after implementing an F.O.T.T.-based protocol. CONCLUSION: Four interventions were identified, PES, F.O.T.T., RPT, and ESAF, all aimed at increasing oropharyngeal sensory input through stimulation. Due to heterogeneity of interventions, designs and outcome measures, effect could not be estimated. This review highlights the limited research on rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.

Rehabilitation for early decannulation after brain injuryDysphagia and tracheostomy often coexist in neurocritical care and early rehabilitation.Four rehabilitative interventions were identified­pharyngeal electrical stimulation, external subglottic airflow, respiratory physiotherapy and facial-oral tract therapy.Interventions points to a consensus that sensory stimulation of the oropharynx can increase excitability of the swallowing network and support pharyngeal sensorimotor cortex reorganisation.This review highlights the limited research on therapeutic rehabilitative interventions and thus the limited evidence to guide clinical rehabilitation.

Return-to-work and rehabilitation needs in cardiac arrest survivors: an exploratory cross-sectional study.

Patient-reported return-to-work and job functioning 6 and 12 months after hospital discharge and received rehabilitation interventions and unmet rehabilitation needs were explored in a consecutive population of out-of-hospital cardiac arrest survivors. Patients working prior to cardiac arrest were invited to participate in a telephone administered survey. Thirty-eight surveys were conducted and included for analysis, equivalent to a minimum response rate of 95%. Survivors of out-of-hospital cardiac arrest had extensive challenges returning to work. Six- and 12-months post-arrest, 58% and 45% were respectively on full time sick leave or working notably less (>10 h/week) and with extensive unmet rehabilitation needs.

Defining dysphagia - a modified multi-professional Danish Delphi study.

OBJECTIVE: To establish a generally accepted Danish definition of dysphagia to enhance collaboration across sectors and professions. METHODS: The study was initiated by a multi-professional group of experienced researchers and board members of the Danish Society for Dysphagia. We used a modified Delphi methodology to achieve consensus among experienced health care professionals from different professions and contexts. The initial stage consisted of a literature search leading to the draft of different definitions followed by two Delphi rounds between professionals and a stakeholder consultation round. RESULTS: We conducted two Delphi rounds until one definition was clearly preferred. A total of 194 participants responded in round one, and 279 in round two. Both rounds had a broad representation of sectors and geography and most participants had worked with dysphagia for more than four years. CONCLUSION: The preferred definition was 'Dysphagia is a functional impairment that either prevents or limits the intake of food and fluids, and which makes swallowing unsafe, inefficient, uncomfortable or affects quality of life'. The definition was widely accepted among different health professional groups, patients and across sectors.

Exploring the Ability to Perform Activities of Daily Living and Cognitive Status after Hospitalization with COVID-19: A Multiple Case Study.

Background: Multidisciplinary rehabilitation including occupational therapy after COVID-19 is recommended. However, evidence on how COVID-19 affects the ability to perform activities of daily living (ADL) is sparse. Objective: The aim of this study was to explore the ability to perform ADL and cognitive status in patients with COVID-19 at time of discharge and three months postdischarge. Methods: This prospective multiple case study included adults with COVID-19, who at time of discharge had decreased ADL performance compared to habitual functional level. Data collection included Assessment of Motor and Process Skills (AMPS) and Montreal Cognitive Assessment (MoCA) at discharge and three-month follow-up. Exploratory analysis was used to identify similarities and trends within and across cases. Results: Eleven patients were included. 75% had a significant increase in motor ability measures, and 27% had a significant increase in process ability measures at follow-up. 67% of follow-up cases showed mild cognitive impairment, where executive functioning and memory were most predominant. Conclusions: The ability to perform ADL was affected at discharge and at three-month follow-up. Furthermore, mild cognitive impairment was present at both hospital discharge and follow-up in most cases. Significance. Occupational therapists can apply performance-based assessments to identify the need for rehabilitation of ADL in patients with COVID-19 during and posthospitalization.

Swallowing Exercise During Head and Neck Cancer Treatment: Results of a Randomized Trial.

The diagnosis and treatment of head and neck cancer (HNC) can have substantial impact on swallowing function, nutritional balance, physical function and quality of life (QoL). Early initiated swallowing exercises are hypothesized to improve swallowing function in HNC patients. The aim was to investigate the effects of swallowing exercises and progressive resistance training (PRT) during radiotherapy on swallowing function, physical function and QoL in patients with pharynx-, larynx-, oral cavity cancer or unknown primary compared to usual care. In a multi-centre RCT participants were assigned to (a) twice-weekly PRT and daily swallowing exercises throughout treatment or (b) usual care. Outcomes were measured at end of treatment and 2, 6 and 12 months after. Primary outcome was penetration aspiration score (PAS). Data were analysed on an "intention-to-treat" basis by GEE logistic regression model, linear mixed effects model and cox regression. Of 371 invited HNC patients, 240 (65%) enrolled. Five participants were excluded. At 12 months follow-up, 59 (25%) participants were lost. Analyses showed significant effect on mouth opening, QoL, depression and anxiety at 12 months when comparing intervention to non-active controls. The trial found no effect on swallowing safety in HNC undergoing radiotherapy, but several positive effects were found on secondary outcomes when comparing to non-active controls. The intervention period may have been too short, and the real difference between groups is too small. Nevertheless, the need to identify long-lasting intervention to slow down or avoid functional deteriorations is ever more crucial as the surviving HNC population is growing.

Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury.

INTRODUCTION: Dysphagia is a common and critical consequence of acquired brain injury (ABI) and can cause severe complications. Dysphagia rehabilitation is transforming from mainly compensatory strategies to the retraining of swallowing function using principles from neuroscience. However, there are no studies that map interventions available to retrain swallowing function in patients with moderate-to-severe ABI. OBJECTIVE: To systematically map the accessible 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 ABI in the acute and subacute phase? DESIGN: Scoping review based on the methodology of Arksey and O'Malley and methodological advancement by Levac et al. DATA SOURCES: MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, OTseeker, speechBITE and PEDro were searched up until 14 March 2021. ELIGIBILITY CRITERIA: All studies reporting rehabilitative interventions within 6 months of injury for patients with moderate-to-severe ABI and dysphagia were included. DATA EXTRACTION AND SYNTHESIS: Data was extracted by two independent reviewers and studies were categorised based on treatment modality. RESULTS: A total of 21 396 records were retrieved, and a final of 26 studies were included. Interventions were categorised into cortical or non-cortical stimulation of the swallowing network. Cortical stimulation interventions were repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. Non-cortical were complex swallowing interventions, neuromuscular electrical stimulation, pharyngeal electrical stimulation (PES), sensory stimulation, strengthening exercises and respiratory muscle training. CONCLUSION: This scoping review provides an overview of rehabilitative dysphagia interventions for patients with moderate and severe ABI, predominantly due to stroke, in the acute and subacute phase. Positive tendencies towards beneficial effects were found for rTMS, complex swallowing interventions, PES and cervical strengthening. Future studies could benefit from clear reporting of patient diagnosis and disease severity, the use of more standardised treatment protocols or algorithms and fewer but standardised outcome measures to enable comparison of effects across studies and interventions.

Motor and process skills in activities of daily living in survivors of out-of-hospital cardiac arrest: a cross-sectional study at hospital discharge.

AIMS: An individuals' ability to perform basic activities of daily living (ADL) is said to be one of the strongest predictors of performance ability and independent living within the community. The Assessment of Motor and Process Skills (AMPS) tool was designed to assess global functional level during ADL by investigating motor and process skills. The purpose of this study was to assess ADL performance ability by investigating motor and process skills in a consecutive cohort of adult survivors of out-of-hospital cardiac arrest at the time of discharge from hospital. METHODS AND RESULTS: This cross-sectional study uses data from a prospective cohort of cardiac arrest survivors admitted to the Copenhagen University Hospital, Rigshospitalet. The specific data used in this study were obtained at the time of the days or the day before hospital discharge. Adult survivors of out-of-hospital cardiac arrest due to cardiac causes were eligible for inclusion. Assessment of Motor and Process Skills was used to assess ADL performance ability by investigating motor and process skills. The ADL ability of 61 individuals was assessed. The mean ADL ability measures recorded were AMPS process 1.40 logits (0.48) and AMPS motor 1.82 logits (0.40). Based on the dichotomized AMPS results, 23% were most likely to need assistance to live independently in the community. CONCLUSION: Performance ability during ADL revealed difficulty in the performance of process skill and an increased need for rehabilitation among survivors of out-of-hospital cardiac arrest at the time of hospital discharge.

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

INTRODUCTION: Dysphagia 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. OBJECTIVE: The 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 ANALYSIS: The methodological framework for the study is based on methodology by Arksey and O'Malley and methodological advancement by Levac et 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 DISSEMINATION: Scoping 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.