Predicting Swallowing Recovery in Subacute Stroke Patients via Temporal and Spatial Parameters of Videofluoroscopy.

PURPOSE: The purpose of this study was to identify the temporal and spatial parameters of videofluoroscopic swallowing study (VFSS) that could predict the recovery of swallowing function in subacute stroke patients. METHODS: We included 102 patients who were admitted to the Department of Rehabilitation Medicine between 2019 and 2022. Patients were classified into good and poor prognosis groups according to whether they had restored prestroke swallowing function or were able to consume sufficient nutrition via oral feeding to meet their body's needs. Univariate and multivariate regression analyses were used to identify the predictors. Calibration and discrimination were tested using the Hosmer-Lemeshow test and area under the curve (AUC), respectively. RESULTS: Of the 102 included patients, 51 had a good prognosis for swallowing function within 6 months of onset. The final multivariate regression model included three significant factors: laryngeal closure duration (LCD) (OR: 0.998; 95% CI: 0.996-0.999; p < 0.05), maximum width of the upper esophageal sphincter opening (MWUESO) (OR: 1.251; 95% CI: 1.073-1.458; p < 0.05), and pharyngeal residual grade (PRG) (p < 0.05). The shorter LCD and larger MWUESO were positive predictors of good swallowing function outcomes, while higher PRG was a negative predictor of good outcomes. The AUC for PRG, MWUESO, and LCD were 0.767 (p < 0.05), 0.738 (p < 0.05), and 0.681 (p < 0.05), respectively. CONCLUSION: Identifying prognostic factors for the recovery of swallowing function in patients with poststroke dysphagia is essential for developing treatment strategies. The findings of this study may provide an important reference for developing appropriate therapeutic interventions to promote the recovery of swallowing function in stroke patients.

Efficacy of swallowing rehabilitative therapies for adults with dysphagia: a network meta-analysis of randomized controlled trials.

Dysphagia leads to poor swallowing function and high risk of aspiration; swallowing rehabilitative therapies including jaw exercises, tongue exercises, chin tuck against resistance (CTAR), Shaker exercises, effortful swallow training (EST), traditional dysphagia therapy (TDT), and respiratory muscle training (RMT) including inspiratory muscle strength training (IMST) and expiratory muscle strength training (EMST) are a crucial part of dysphagia rehabilitation. However, limited evidence exists on the comparative efficacy of swallowing rehabilitative therapies in adults with dysphagia. This is the first network meta-analysis (NMA) to investigate the comparative efficacy of swallowing rehabilitative therapies for adults with dysphagia. Web of Science, Embase, CINAHL, Cochrane Library, and PubMed were comprehensively searched until September, 2024. The Frequentist NMA model was performed in R-Software presenting standardized mean differences with corresponding 95% confidence interval (95% CI) for swallowing function and aspiration. Cochrane Q, τ2, and I2 statistics estimated heterogeneity and full design-by-treatment interaction random-effects and node-splitting models determined transitivity. Ranking of the swallowing rehabilitative therapies used the netrank function. The search yielded 7697 studies from which 25 randomized controlled trials with 1020 adults with dysphagia were included. The study findings revealed that CTAR + TDT (SMD = 3.44 [95% CI 2.42, 4.47]), EMST + TDT (SMD = 2.92 [95% CI 1.59, 4.25]), Shaker + TDT (SMD = 2.83 [95% CI 1.81, 3.84]), JE + TDT (SMD = 2.52 [95% CI 1.21, 3.83]), TE + TDT (SMD = 2.19 [95% CI 1.26, 3.12]), RMT + TDT (SMD = 2.14 [95% CI 1.36, 2.93]), and TDT (SMD = 1.92 [95% CI 1.42, 2.42]) showed very-large to huge effect in improving swallowing function. CTAR + TDT (0.93) demonstrated superior improvements for better swallowing function. Additionally, CTAR + TDT (SMD = - 1.82 [95% CI - 2.89, - 0.75]), Shaker + TDT (SMD = - 1.32 [95% CI - 2.36, - 0.27]), EMST (SMD = - 1.23 [95% CI, - 2.01, - 0.45]), and EMST + TDT (SMD = - 1.10 [95% CI - 2.15, - 0.04]) revealed very-large to large effect in preventing aspiration. CTAR + TDT (0.96) and Shaker + TDT (0.76) demonstrated superior improvements for reduced aspiration. The combination of swallowing rehabilitative therapies including CTAR + TDT and Shaker + TDT offers a more comprehensive approach for dysphagia management in adults. Study registration is PROSPERO: CRD42022321345.

Closure of Large Tracheocutaneous Fistula Using Modified Hinge Flap and Deltopectral Flap.

BACKGROUND: Various methods for closing tracheocutaneous fistulas have been reported; however, there is no established consensus. This study reports the successful closure of a large tracheocutaneous fistula using a Modified Hinge Flap and DP flap. METHODS: Between July 2014 and December 2023, four patients underwent a modified hinge flap and DP flap for tracheocutaneous fistula at a single center. RESULTS: The maximum diameter of the fistula was 10-33 mm, the cartilage defect was 1/4-1/2 of the total circumference of the trachea, and no radiation was administered to the neck during the perioperative period. In all cases, postoperative speech and swallowing improved, and none of the patients complained of cosmetic appearance. CONCLUSIONS: The method in this study is simple and allows reliable closure of relatively large tracheocutaneous fistula of 10 mm or more, and we believe that it can be a new treatment method for tracheocutaneous fistula closure.

Agreement between patient-reported and clinician-rated speech and swallowing outcomes - Understanding the trend in post-operative oral cavity cancer patients.

AIM: To find the agreement between clinician-rated and patient-reported speech and swallowing outcomes in post-operative oral cavity cancer patients. METHODS: In this prospective observational study, a total of 53 post-operative oral cavity cancer patients were recruited. The Speech Handicap Index - Kannada (SHI-K) and the Dysphagia Handicap Index - Kannada (DHI-K) were used as the patient-reported outcome measures (PROMs), and the Mann Assessment of Swallowing Ability-Cancer (MASA-C) and Ali Yavar Jung National Institute of Speech & Hearing Disabilities (DIVYANGJAN) AYJNISHD(D)'s speech intelligibility rating scale were used as the clinician-rated scales to evaluate speech and swallowing status. RESULTS: Intraclass correlation coefficient (ICC) was poor, with a value of 0.480 between clinician-rated speech AYJNISHD(D)'s scale and patient-reported SHI-K scale. ICC was poor, with a value of 0.471 between clinician-rated swallowing MASA-C and patient-reported swallowing DHI-K. CONCLUSION: In our study, there was no agreement between patient-reported and clinician-rated speech and swallowing outcomes in post-operative oral cavity cancer patients. Incorporating PROMs into routine clinical practice is advisable, and clinicians need to balance PROMs with clinical and instrumental speech and swallowing assessments to ensure comprehensive care.

Coordination of Pharyngeal and Esophageal Phases of Swallowing.

Although swallowing has been reviewed extensively, the coordination of the phases of swallowing have not. The phases are controlled by the brainstem, but peripheral factors help coordinate the phases. The occurrence, magnitude, and duration of esophageal phase depends upon peripheral feedback activated by the bolus. The esophageal phase does not occur without peripheral feedback from the esophagus. This feedback is mediated by esophageal slowly-adapting mucosal tension receptors through the recurrent and superior laryngeal nerves. A similar reflex mediated by the same peripheral pathway is the activation of swallowing by stimulation of the cervical esophagus. This reflex occurs primarily in human infants and animals, and this reflex may be important for protecting against aspiration after esophago-pharyngeal reflux. Not only are there inter-phase excitatory processes, but also inhibitory processes. A significant inhibitory process is deglutitive inhibition. When one swallows faster than peristalsis ends, peristalsis is inhibited by the new pharyngeal phase. This process prevents the ongoing esophageal peristaltic wave from blocking the bolus being pushed into the esophagus by the new wave. The esophageal phase returns during the last swallow of the sequence. This process is probably mediated by mucosal tension receptors through the superior laryngeal nerves. A similar reflex exists, the pharyngo-esophageal inhibitory reflex, but studies indicate that it is controlled by a different neural pathway. The pharyngo-esophageal inhibitory reflex is mediated by mucosal tension receptors through the glossopharyngeal nerve. In summary, there are significant peripheral processes that contribute to swallowing, whereby one phase of swallowing significantly affects the other.

Comparison of measurement of integrated relaxation pressure by esophageal manometry with analysis of swallowing sounds with artificial intelligence in patients with achalasia.

BACKGROUND: Esophageal motility disorders are mainly evaluated with high-resolution manometry (HRM) which is a time-consuming and uncomfortable procedure with potential adverse events. Acoustic characterization of the swallowing has the potential to be an alternative noninvasive procedure. METHODS: We compared the findings on HRM and swallowing sounds in 43 patients who were referred for evaluation of dysphagia. The sound analysis was done with empirical mode decomposition method and with artificial intelligence (AI) and the estimated integrated relaxation pressure (IRP) from a two-layer neural network method was compared to measured IRP on HRM. The model then was tested in five patients. KEY RESULTS: IRP was estimated with high accuracy using the model developed with two-layer neural network method. CONCLUSIONS & INFERENCES: The analysis of acoustic properties of swallowing has the potential to be used for evaluation of esophageal motility disorders, this needs to be further evaluated in larger studies.

A Case Presentation in Management of Dysphagia and Dysarthria Caused due to Organophosphorus and Carbamate Insecticide Poisoning.

Organophosphorus and carbamate Insectiside is common in Asia-Pacific region consisting of 63% of the Global death. Organophosphorus and Carbamate poisoning can lead into different complications in the respiratory,digestive,neurological aspects and maybe fatal in certain cases.Besides medical management of the same,early rehabilitation is also required to manage different kinds of neurological aspects caused due to Organophosphorus and carbamate poisoning. The study was done to introspect the early intervention in swallowing and speech therapy in organophosphorus and carbamate poisoning individual,as a part of management besides medical intervention. A 19 years old female reported to the hospital with history of consuming organophos and carbamate insecticide with the intention of self harming causing cardiac arrest and as diagnosed as Flaccid Dysarthria with Oro-Pharyngeal Dysphagia when assessed with diagnostic tools respectively. Early speech and swallowing intervention was provided and introspected using MASA which showed improvement in scores during the therapeutic intervention and was statistically analysed using linear regression analysis. The result showed the improvement in MASA scores (the slope of the best fit) and proved that MASA scores improved significantly (slope = 14.3, p < 0.05) over time as the therapy sessions proceeded. The regression model was also significant (p < 0.05). The motor-speech therapeutic intervention provided improvement in the kinematics of oro-motor skills along with improvement in intelligibility of speech. This study concludes that early intervention in managing speech and swallowing abilities in Dysarthria and Dysphagia is helpful besides medical intervention in such cases.

Evaluating of Supraglottic Subunits in Swallowing Function in Supraglottic Cancer Patients Pre- and Post-Transoral Laser Microsurgery.

BACKGROUND AND AIM: This study aims to assess the impact of supraglottic cancer on swallowing functionality and its anatomical correlations before and after laser surgery. The study seeks to determine the extent of score changes post-surgery, pinpoint the most influential anatomical component in swallowing, predict post-surgery outcomes, and ascertain the effect on patients' quality of life. METHODS: Patients with supraglottic cancer and dysphagia were identified through stroboscopy and indirect laryngoscopy. Exclusion criteria encompassed a history of prior radiotherapy, chemotherapy, or distant metastases. Demographic data, tumor stage, comorbidities, risk factors, and treatment details were documented. Swallowing evaluation employed the translated EAT10 self-assessment questionnaire, administered before and after transoral laser microsurgery (TLM) at baseline and 6 months later. Additional treatments, rehabilitation duration, NG tube use, and post-surgery complications were recorded. RESULTS: At the six-month follow-up, 9 patients had EAT-10 scores ≥ 3, while 7 patients scored < 3. Five patients underwent post-TLM additional therapies, and 9 patients had neck dissections. Involved subunits were epiglottis (11 patients), arytenoid (5 patients), FVC (13 patients), and TVC (3 patients). Seven patients received dysphagia treatment. Analysis revealed significant associations between follow-up EAT-10 scores and dysphagia treatment (p = 0.04), smoking (p = 0.02), and FVC involvement (p = 0.02). CONCLUSION: Our study on supraglottic cancer treatment with transoral laser microsurgery (TLM) revealed variable EAT-10 scores after a six-month follow-up. Adjunctive therapies and neck dissections were administered to some patients. Significant associations were found between follow-up scores, dysphagia treatment, smoking history, and FVC involvement, highlighting the complex interplay between interventions and patient factors. Further research is needed for optimization.

Impact of Prehabilitation With Preoperative Swallowing Exercises on Postoperative Swallowing Morbidity in Oral Cavity Cancer: Randomized Controlled Trial.

Background and Objective: Oral cancer surgery and the associated reconstructive procedures cause mechanical and neurological impairment of swallowing. Despite postoperative rehabilitation, functional impairment of swallowing remains a concern. This study is to investigate the potential benefits of prehabilitation with preoperative swallowing exercises to patients undergoing composite resections and compartmental tongue resections so that it results in better swallowing outcomes and improved quality of life after surgery. Materials and Methods: Sixty patients included in the study were randomized into an exercise and control group of 30 each. Patients with squamous cell carcinoma of the oral cavity undergoing composite resection or compartmental tongue resections were included, and patients with severe trismus at presentation were excluded. Patients in the exercise group were instructed on a set of six active exercises to be followed strictly for a period of at least 1 week before surgery. Preoperative swallowing exercises comprised of evidence-based exercises targeting the muscle groups involved in swallowing. Postoperative swallowing rehabilitation was the same as that of the control group. Patients were assessed after 6 months of surgery. Outcomes were assessed both subjectively and objectively. Objective assessment was done by inexpensive, novel clinical methods of repetitive saliva swallow test (RSST), water swallow test (WST) and food swallow test (FST) to and graded using dysphagia severity scale (1-7). Results: Average oral intake scale (1-Oral solids, 2-Oral semisolids/easy to chew foods, 3-Oral liquids only and 4-Non-oral, orogastric tube dependent) assessed subjectively was significantly lower in exercise arm, and the control arm had a significantly higher OIS score. Exercise arm had higher number of patients in DSS scores of 5, 6 and 7. The control arm had a higher number of patients in DSS scores of 3 and 4. The differences between the two groups were found to be statistically significant taking into consideration the confounding factors of radiation, wound morbidity and tongue resections. Conclusion: Preoperative swallowing exercises have shown a positive impact on postoperative swallowing ability. This is the first randomized trial to assess the effect of PSE in postoperative oral cancer patients. Our exercise protocol needs standardization, and clinical objective method of dysphagia assessment requires further validation. However, prehabilitation with PSE has the potential to improve the quality of life in oral cancer patients.

Rumination Swallowing in Limb-Girdle Muscular Dystrophy.

Patients with limb-girdle muscular dystrophy (LGMD) may develop swallowing disorders as the disease progresses. We detected a novel swallowing pattern in patients with LGMD, characterized by unique findings such as a rumination-like behavior, where food reaches the vallecula and piriform sinuses and then is regurgitated back into the oral cavity, re-chewed, and swallowed again. We termed this swallowing pattern "rumination swallowing." In this report, we describe a case of rumination swallowing, as observed through a videofluoroscopic (VF) examination, in a 56-year-old patient with LGMD.

Oral cavity obliteration is a novel predictor of functional outcomes after glossectomy reconstruction.

OBJECTIVES: The primary goal for reconstruction of oral tongue defects is to improve speech and swallowing. The purpose of this study is to present a new reconstructive metric that uses volume displacement to measure oral cavity obliteration and correlate this metric to outcomes of speech and swallowing. METHODS: 47 patients underwent resection and primary closure or free-tissue reconstruction of oral tongue defects. Oral cavity obliteration was measured using a novel oral volume assessment test (OVAT). Briefly, a latex balloon filled with pudding was placed on the patient's tongue and patients performed mouth closure to expel the pudding. Residual volumes represented dead space in the oral cavity and was measured by water displacement. These results were correlated with the Speech and Swallowing Assessment and Assessment of Intelligibility of Dysarthric Speech (AIDS) instruments. RESULTS: The mean residual volume was 7.4 cc (range 3 - 20 cc; sd 4.5 cc). There was a correlation with lower residual volumes (better obliteration) with increasing AIDS efficiency ratio (R = 0.72, p < 0.001). A receiver operator curve was used to identify 10 cc of residual volume as the optimal cutoff point. Binary logistic regression using this cut point showed that residual volume significantly predicts normal nutritional mode (p < 0.001), ability to tolerate all liquids (p = 0.007), range of solids (p = 0.004), eating in public (p = 0.007), understandability (p < 0.001), and speaking in public (p = 0.01). CONCLUSIONS: Oral volume assessment test (OVAT) is a novel measure of residual volume (obliteration) that correlates with improved speech efficiency, intelligibility, speaking in public and swallowing outcomes.

Daily Challenges and Resources of Adults with Chronic Dysphagia: A Qualitative Investigation.

Identifying and addressing daily challenges and resources associated with chronic oropharyngeal dysphagia (OD) is a pivotal, though still neglected component of person-centred care, yet overlooked in research studies. To investigate these dimensions, 25 Italian adults with chronic OD due to cancer or neurodegenerative diseases participated in semi-structured interviews, designed following a modified framework analysis approach. Two researchers independently transcribed and coded interviews, elaborated a working analytical framework, indexed and charted the data, solving discrepancies through negotiated agreement and discussion with a third researcher. Proportion agreement on extracted quotations was calculated. Overall, 457 quotations were extracted from the interviews (88% agreement). Daily challenges pertained to physical, practical, and social domains; most participants reported OD-related problems; almost half mentioned care needs and obstacles in using healthcare services. Concerning resources in OD management, most participants referred to problem-focused and meaning-focused coping strategies, personal capabilities, and support from family and healthcare services. Finally, almost half of the participants reported OD-related changes in life view and meaning. Findings suggest that adjusting to OD implies challenges and resource mobilization in different life domains. Future studies should longitudinally elucidate the dynamics of positive adjustment, to promote patient-centred OD care based on individually perceived needs and challenges, and to inform healthcare policies.

Fluoxetine promotes the recovery of dysphagia and improves nutritional status and neurotrophic status in dysphagia patients after acute ischemic stroke.

This study aimed to investigate the effects of fluoxetine on swallowing function, neurotrophic factors, and psychological status in patients with dysphagia after acute ischemic stroke (AIS). A total of 118 patients with dysphagia after AIS who were diagnosed and treated in our hospital from July 2020 to March 2022 were selected as the study objects with 59 cases in each group. Patients in the control group underwent routine treatment and swallowing rehabilitation without fluoxetine. Patients in the study group received routine treatment, swallowing rehabilitation, and fluoxetine treatment. The quality of life was compared according to the Generic Quality of Life Inventory-74 (CQOLI-74). Patients were followed for 90 days, and the grades were compared with the Modified Rankin Scale (mRS). The total effective rate of the study group was 84.75%, which was higher than that of the control group with 62.71% (χ2 = 7.394, P < 0.05). The life quality scores of the two groups were both dramatically elevated compared to those before the treatment, and the study group had a sensibly higher life quality score than the control group (P < 0.05). The proportion of grade 4~5 in the study group was significantly lower than that in the control group (χ2 = 492, P < 0.05). The total incidence of adverse reactions in the control group was 5.08% (3/59), which was significantly lower than that in the study group with 11.86% (7/59) (χ2 = 1.748, P = 0.186). Fluoxetine has a significant effect on the treatment of dysphagia after AIS by enhancing the recovery of dysphagia and promoting the recovery of neurological function.

Revealing Goal-Directed Neural Control of the Pharyngeal Phase of Swallowing.

Swallowing is considered a three-phase mechanism involving the oral, pharyngeal, and esophageal phases. The pharyngeal phase relies on highly coordinated movements in the pharynx and larynx to move food through the aerodigestive crossing. While the brainstem has been identified as the primary control center for the pharyngeal phase of swallowing, existing evidence suggests that the higher brain regions can contribute to controlling the pharyngeal phase of swallowing to match the motor response to the current context and task at hand. This suggests that the pharyngeal phase of swallowing cannot be exclusively reflexive or voluntary but can be regulated by the two neural controlling systems, goal-directed and non-goal-directed. This capability allows the pharyngeal phase of swallowing to adjust appropriately based on cognitive input, learned knowledge, and predictions. This paper reviews existing evidence and accordingly develops a novel perspective to explain these capabilities of the pharyngeal phase of swallowing. This paper aims (1) to integrate and comprehend the neurophysiological mechanisms involved in the pharyngeal phase of swallowing, (2) to explore the reflexive (non-goal-directed) and voluntary (goal-directed) neural systems of controlling the pharyngeal phase of swallowing, (3) to provide a clinical translation regarding the pathologies of these two systems, and (4) to highlight the existing gaps in this area that require attention in future research. This paper, in particular, aims to explore the complex neurophysiology of the pharyngeal phase of swallowing, as its breakdown can lead to serious consequences such as aspiration pneumonia or death.

[Evaluation of the effect of endoscopic CO2laser arytenoidectomy on re-operation for failed posterior cordotomy].

Objective:To analyze the efficacy of endoscopic CO2 laser arytenoidectomy in treating bilateral vocal cord paralysis. Methods:Ninety-five patients who underwent endoscopic CO2 laser arytenoidectomy for bilateral vocal cord paralysis at the First Affiliated Hospital of Naval Medical University（Changhai Hospital） of Shanghai from January 2009 to December 2022 were included in this study. Among them, 59 patients underwent endoscopic CO2 laser arytenoidectomy as their first glottic enlargement surgery（Group A）, while 36 patients, who had previously undergone two unsuccessful CO2 laser-assisted posterior cordotomies, underwent endoscopic CO2 laser arytenoidectomy as a subsequent surgery（Group B）. Swallowing function, electronic laryngoscopy, perceptual voice evaluation, and objective voice analysis indicators were statistically analyzed before and after surgery to evaluate clinical efficacy. Results:The extubation rate after the first surgery was 84.75% in Group A and 86.11% in Group B, with total extubation rates of 94.92% and 94.44%, respectively. There were no significant differences between the two groups in preoperative and postoperative swallowing function, glottic size, or various voice evaluation indicators（P>0.05）. Within-group comparisons showed that postoperative swallowing function, glottic closure during phonation, perceptual evaluations of G（grade of hoarseness）, A（asthenia）, and B（breathiness） significantly worsened, with increased grades. The maximum transverse diameter of the posterior glottis during inspiration significantly increased, and the VHI-10 score was significantly higher postoperatively. Jitter, shimmer, and the harmonics-to-noise ratio significantly deteriorated, and maximum phonation time significantly shortened（P<0.05）. No significant differences were observed in postoperative R（roughness） and S（strain） compared to preoperative values（P>0.05）. Conclusion:Endoscopic CO2 laser arytenoidectomy can impair voice quality to some extent but effectively alleviates breathing difficulties in patients with bilateral vocal cord paralysis. For patients who did not achieve successful extubation with CO2 laser-assisted posterior cordotomy, endoscopic CO2laser arytenoidectomy is an effective reoperative method, ensuring a high extubation rate while preserving certain voice functions.

[Tracheotomy : Indication and implementation]. / Tracheotomie : Indikation und Durchführung.

Tracheotomy has long been performed outside of intensive care medicine. In modern medicine, it has a firm place in the management of critically ill and emergency care patients as well as in cancer surgery of the head and neck, the care of long-term ventilated patients, patients with swallowing disorders, and neurological diseases. The indication, technique, and timing of tracheotomy are very different for the various diseases. This article provides an overview of the different indications, surgical techniques, and timing of tracheotomy in modern intensive care medicine.

Prevalence and Risk Factors for Swallowing Dysfunction in Patients With Laryngomalacia Treated Medically and Surgically.

Objective: To identify the prevalence, pattern, and nature of swallowing dysfunction (SwD) in a consecutive cohort of patients with laryngomalacia (LM), and to determine factors associated with a higher burden of SwD. Study Design: This was a retrospective review of consecutive patients diagnosed with LM by 2 pediatric otolaryngologists between 2013 and 2022 and a minimum of 3-month follow-up. Setting: Tertiary care pediatric otolaryngology referral center. Methods: Consecutive cohort of patients less than 3 years old with LM diagnosed on flexible laryngoscopy were reviewed. Patients with incomplete follow-up, lack of swallowing assessment, and genetic conditions or syndromes were excluded. All patients underwent at minimum a systematic clinical swallowing evaluation by a speech-language pathologist specialized in pediatric dysphagia. Patients with concerning clinical exams underwent instrumental swallow evaluation (Videofluoroscopic Swallow Study [VFSS] or Flexible Endoscopic Evaluation of Swallowing [FEES]). The prevalence of abnormalities of clinical swallowing evaluation, instrumental swallow evaluation data, and details of management were collected. Results: Two hundred and twelve patients met criteria and were included in the final analysis. One hundred and fifteen patients (54%) had an instrumental assessment (VFSS or FEES). Of the instrumental assessments performed, 96 (69%) were abnormal. Of the total patient cohort, 55 (26%) had laryngeal penetration and/or aspiration. One hundred and seventeen (55%) had clinical or instrumental indications for intervention, with 18 (8%) requiring tube feeding. Patients with severe LM and those treated surgically had a statistically significant higher rate of penetration and aspiration. Conclusion: Patients with LM have a high burden of dysphagia requiring medical intervention. The authors advocate for routine and systematic assessment of all patients with LM for swallowing dysfunction.

What am I looking at? Graduate student accuracy in identification of anatomic structures/landmarks on swallow imaging.

Speech-language pathologists need to accurately identify structures/landmarks on swallow imaging. Foundational learning begins in graduate training. This study aimed to determine graduate student accuracy at identifying anatomical structures/landmarks during swallow evaluations and to determine if accuracy was predicted by type of imaging, anatomical structure, case type (i.e., normal/abnormal). Researchers recruited first-year graduate speech-language pathology students. Each participant reviewed five static images from lateral radiographic swallow studies and five static images from endoscopic swallow studies across 10 cases. Participants identified key anatomic structures and landmarks by clicking on the structure/landmark within a web-based platform. Two experienced speech-language pathologists reviewed and coded participant responses for accuracy. Sixteen graduate speech-language pathology students participated in a within-subjects design. Overall participant accuracy in identification of structure/landmarks was 69% (range 46%-88%). Binomial logistic regression was performed to study the effects of anatomical structure, case type (i.e., normal/abnormal), and image type on likelihood of participant accuracy in identifying anatomical structures (X2(4) = 143.65, p < 0.001). Only anatomical structure was statistically significant (X2(4) = 187.729, p < 0.001). The model explained 23.2% (Nagelkerke's R squared) of the variance in accuracy and correctly classified 78.4% of cases. Sensitivity was 92.1%, specificity was 47.3%, positive predictive value was 79.84%, and negative predictive value was 72.50%. The area under the ROC curve was 0.754, 95% CI [0.716, 0.791]. Graduate student's ability to correctly identify structures/landmarks overall was lower than desired and accuracy varied per structure. Results have implications for improving graduate student training for identification of structures/landmarks on swallow imaging.

Molecular biomarkers of dysphagia targeted exercise induced neuroplasticity: A review of mechanistic processes and preliminary data on detraining effects.

While molecular adaptations accompanying neuroplasticity during physical exercises are well-established, little is known about adaptations during dysphagia-targeted exercises. This research article has two primary purposes. First, we aim to review the existing literature on the intersection between resistance (strength) training, molecular markers of neuroplasticity, and dysphagia rehabilitation. Specifically, we discuss the molecular mechanisms of two potential molecular markers: brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) in exercise-induced neuroplasticity. Second, we present preliminary data on the effects of two weeks of detraining on circulating serum BDNF, IGF-1 levels, and expiratory muscle strength. This subset is a part of our more extensive studies related to dysphagia-targeted resistance exercise and neuroplasticity. Five young adult males underwent four weeks of expiratory muscle strength training, followed by two weeks of detraining. We measured expiratory strength, circulating levels of BDNF, and IGF-1 at post-training and detraining conditions. Our results show that expiratory muscle strength, serum BDNF, and IGF-1 levels decreased after detraining; however, this effect was statistically significant only for serum BDNF levels. Oropharyngeal and upper airway musculature involved in swallowing undergoes similar adaptation patterns to skeletal muscles during physical exercise. To fully comprehend the mechanisms underlying the potential neuroplastic benefits of targeted exercise on swallowing functions, mechanistic studies (models) investigating neuroplasticity induced by exercises addressing dysphagia are critical. Such models would ensure that interventions effectively and efficiently achieve neuroplastic benefits and improve patient outcomes, ultimately advancing our understanding of dysphagia-targeted exercise-induced neuroplasticity.

The Effects of Noninvasive Respiratory Support on Swallowing Physiology, Airway Protection, and Respiratory-Swallow Pattern in Adults: A Systematic Review.

PURPOSE: The use of noninvasive respiratory support- namely high flow of oxygen delivered via nasal cannula (HFNC), continuous positive airway pressure (CPAP), and noninvasive ventilation (NIV) - has been expanding in recent years. The physiologic mechanisms underlying each of these forms of support are generally well understood. In contrast, the effects on the sensorimotor mechanisms of swallowing movements, and of breathing and swallowing coordination ─ critical elements of airway protection and bolus clearance ─ remain unclear. The purpose of this systematic review is to assess the existing evidence about the impact of noninvasive respiratory support on swallowing mechanics, airway protection, and respiratory-swallowing patterns in adults. METHODS: Six databases (PubMed, EMBASE, Web of Science, Scopus, CINAHL and ProQuest Dissertations & Theses) were searched using predetermined terms. Inclusion criteria were: 1) adult humans 2) use of noninvasive respiratory support, and 3) assessment of swallowing. RESULTS: We identified 8,727 articles for screening; 15 met the inclusion criteria. Six studies assessed noninvasive respiratory support in healthy adults, and 9 assessed participants with heterogenous respiratory diagnoses including chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), acute respiratory failure, and chronic respiratory failure due to neuromuscular disease. Risk of bias was assessed using a modified NIH Quality Assessment Tool. In healthy adults, results demonstrated mixed effects of HFNC and CPAP on measures of swallowing function, airway protection, and respiratory swallowing patterns. Negative effects on respiratory-swallowing patterns were reported with NIV. In adults with heterogeneous respiratory diagnoses, six studies reported that HFNC, CPAP, or nasal NIV improved measures of swallowing and respiratory-swallowing patterns. HFNC has mixed effects on swallowing measures in ICU patients. NIV increased atypical respiratory-swallowing patterns in patients with stable COPD. CONCLUSIONS: Due to small sample sizes and the wide variation in study designs, the impact of noninvasive respiratory support on swallowing, airway protection, and respiratory-swallowing patterns cannot be confidently assessed based on the current evidence. Future studies using standardized, validated, and reproducible methods to assess the impact of noninvasive respiratory support on swallowing physiology and airway protection are warranted.