Dysphagia and Functional Limitations Among Adults in the United States: Findings from the 2022 National Health Interview Survey.

Dysphagia or swallowing dysfunction is associated with reduced quality of life and poor long term outcomes. While standard dysphagia treatment focuses on improving swallowing function, it is not clear if people with dysphagia also have difficulties performing daily tasks. This study aimed to determine if individuals with dysphagia had difficulties with participating in daily tasks requiring physical function, as compared to those with no dysphagia. We conducted a secondary data analysis using the responses of 24,107 adults aged 18 years or older who completed the 2022 National Health Interview Survey. The independent variable was report of swallowing problem during the past 12 months, and the dependent variables were report of difficulty in physical function tasks (e.g., self-care, mobility, working, social participation). We utilized propensity score methods to balance demographic and clinical variables between groups, and examined if individuals with dysphagia had more difficulties with the physical function tasks. The propensity score methods balanced the demographic and clinical variables (absolute standardized differences < 0.1). People with dysphagia had significantly higher odds ratios (ranged from 1.23 to 1.70, all p < 0.05) of having difficulties in physical function tasks than those without dysphagia. The findings revealed an association between experiencing dysphagia and encountering difficulties in self-care, mobility, working, and social participation in the general adult population in the US. Results of our study indicate that during the course of rehabilitation, healthcare professionals should consider the potential impact of dysphagia symptoms on clients' ability to partake in independent activities in their community settings.

Effect of oral motor facilitation technique on oral motor and feeding skills in children with cerebral palsy : a case study.

BACKGROUND: Deficiencies in oral motor function and feeding skills are common in children with cerebral palsy (CP). Oral motor therapy is a useful method to improve oral motor function and feeding skills. Oral motor facilitation technique (OMFT) is a newly designed comprehensive oral motor therapy, including postural control, sensory adaptation, breathing control, sensorimotor facilitation, and direct feeding. METHODS: This study was performed to identify the effect of OMFT on oral motor function and feeding skills in children with CP. A total of 21 children with CP (3-10 years, GMFCS III-V) participated in 16 weeks (16 sessions) of OMFT. The effects on oral motor function and feeding skills were assessed using the Oral Motor Assessment Scale (OMAS) before the treatment, 8 and 16 weeks after OMFT. Data were analyzed using the Friedman test and post-hoc analysis. RESULTS: Significant improvement was found in oral motor function and feeding skills including mouth closure, lip closure on the utensil, lip closure during deglutition, control of the food during swallowing, mastication, straw suction, and control of liquid during deglutition after OMFT. Mouth closure was the most effective and mastication was the least effective item. Sixteen weeks is more effective than 8 weeks of OMFT. CONCLUSION: OMFT could be an effective and useful oral motor therapy protocol to improve oral motor function and feeding skills in children with CP.

Analysis of body imbalance in various writing sitting postures using sitting pressure measurement.

[Purpose] This study set out to substantiate the importance of the right sitting posture by measuring the sitting pressure. It also described the influence of an imbalanced sitting posture on the body. [Subjects and Methods] The subjects included 30 healthy adults. A pressure mapping system was used to measure the sitting pressure in the right, one side prone, chin propped, and slumped sitting positions. [Results] The WDI (XAP) showed a statistically significant difference between the 3 incorrect postures (one side prone, chin propped, and slumped sitting) and the right sitting posture. With regard to the WDI (XLR), there was a statistically significant difference between the right sitting posture and the one side prone sitting posture only. [Conclusion] One side prone sitting was found to affect the body balance most adversely. This imbalanced posture may have an indirect effect on chronic diseases. The results prove that it is important to assume a proper posture to maintain body balance.

Effects of asymmetric sitting on spinal balance.

[Purpose] To investigate the effects of two common asymmetric sitting positions on spinal balance. [Subjects and Methods] Thirty-seven healthy subjects in their twenties were enrolled and randomly divided into two groups. Asymmetric positions of resting the chin on a hand and crossing the legs were performed by each group for 1 hour. After 1 hour, the subjects lay in the supine position again and spinal imbalance was measured using a device. [Results] After 1 hour of resting with the chin on a hand, sagittal imbalance, coronal imbalance, pelvic obliquity and lordosis angle presented spinal imbalance worsening of 1 hour of crossing legs, sagittal imbalance, pelvic torsion showed in mainly learned spinal imbalance living. [Conclusion] Good posture could be an innate ability, however it through habits. So this study is meaningful from the perspective of the importance of good posture.

Intramuscular innervation patterns of the brachialis muscle.

The aim of this study was to provide accurate anatomical descriptions of the patterns of innervation of the brachialis muscle by the musculocutaneous, radial, and median nerves. Sihler's staining method was applied to 20 brachialis muscles from 10 cadavers to reveal the intramuscular distribution patterns of the musculocutaneous, radial, and median nerves. Three patterns of innervation of the brachialis muscle by the three studied nerves were found: single, double, and triple. These innervation patterns were categorized into four types: Type I--only the musculocutaneous nerve; Type II--double innervation by the musculocutaneous and radial nerves; Type III--double innervation by the musculocutaneous and median nerves; and Type IV--triple innervation by all three nerves. Single, double, and triple innervation patterns occurred 25%, 70% (Type II, 55%; Type III, 15%), and 5% of the samples, respectively. The brachialis muscle is not solely innervated by the musculocutaneous nerve but also by the radial and median nerves, thus making it a potentially triply innervated muscle. Double innervation of this muscle with either the musculocutaneous and median nerve or the musculocutaneous and radial nerves was also observed.

Neuroanastomosis and the innervation territory of the mental nerve.

The aim of this study was to clarify the distribution pattern and innervation territory of the mental nerve (MN) in the skin and mucosa by topographic examination by Sihler's staining, thereby providing reference anatomical information for surgical procedures and to enable prediction of regions of sensory disturbance following nerve damage. Ten human specimens were subjected to Sihler's staining, which is a highly accurate method for visualizing the distribution of nerve fibers without altering their topography. Each branch of the MN overlapped adjacent branches (five cases), or else they were distributed individually at the lower lip (five cases). The MN anastomosed with some branches of the facial nerve near the mental foramen. Moreover, some branches of the MN anastomosed with the buccal nerve of the trigeminal nerve, which supplies sensation to the skin and mucosa over the lateral region of the lower lip (six cases). The details of the distribution pattern and innervations territory of the MN presented herein may enable the prediction of a region of sensory disturbance following MN damage. Moreover, knowledge of the pattern of synapses with adjacent branches of other nerves, such as the facial (marginal mandibular and cervical branches) and the buccal nerves, might help to improve our understanding around incomplete anesthesia during the surgical procedures in oral & maxillofacial region.

Effectiveness of an Online Dementia Prevention Program on Cognitive Function and Depression in Community-Dwelling Older Adults during the COVID-19 Pandemic in Korea.

(1) Background: Continuous participation in a comprehensive dementia prevention program is important for community-dwelling older adults during the coronavirus disease (COVID-19) pandemic, as limitations on their communities and social participation have increased and participation in daily tasks has decreased. These factors can negatively affect their cognitive function and symptoms of depression. This study aimed to introduce an evidence-based online dementia prevention program in the South Korean context and to identify its effect on cognitive function and symptoms of depression in community-dwelling older adults during the COVID-19 pandemic. (2) Methods: One hundred and one community-dwelling older adults without dementia participated in twelve sessions of an online dementia prevention program designed by occupational therapists. Cognitive function and symptoms of depression were assessed before and after the program. Cognitive function was tested using the Cognitive Impairment Screening Test and symptoms of depression were assessed using the Korean version of the Short Geriatric Depression Scale. The participants' opinions were gathered using open-ended questions. (3) Results: After the program, according to the raw score, orientation was maintained and attention, visuospatial function, executive function, memory, and language function increased. The memory and total cognitive score was improved significantly. Symptoms of depression significantly decreased. The program's benefits according to the participants were participation in new activities, boredom reduction, online communication, and reminiscence. (4) Conclusions: An online dementia prevention program is effective in maintaining and increasing cognitive function and preventing depression in community-dwelling older adults. An online dementia prevention program is a useful method in providing opportunities to participate in cognitive training and continuous daily activities during the COVID-19 pandemic.

Clinical Practice Guidelines for Oropharyngeal Dysphagia.

OBJECTIVE: Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one's physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. METHODS: Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. RESULTS: Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. CONCLUSION: This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Comparison of Hand Dexterity According to Selected Thermal and Auditory Stimuli.

The hand plays a crucial role in our daily lives and affects the quality of life. Sensory stimuli can affect the activation of the autonomic nervous system to control body homeostasis and finger motions. This study aimed to determine the optimal thermal and auditory stimuli that affect hand dexterity. The experiment included thirty healthy adults. In the experiment, the thermal stimuli were classified into 20, 30, and 40 °C. The auditory stimuli were classified into fast- and slow-tempo music. Each stimulus was randomly provided for 5 min and hand dexterity was tested with the Groove and Purdue pegboard tests. After each stimulus and test was conducted, a resting time of 20 min was provided before the next stimulus. When the thermal stimulus of 30 °C and auditory stimulus of fast-tempo music was provided, the completion duration of the hand dexterity test was the shortest. Except the thermal stimulus of 20 °C, all thermal and auditory stimuli induced increased hand dexterity, compared to the non-stimulated condition. Among the five categories of thermal and auditory stimuli, the thermal stimulus of 30 °C and auditory stimulus of fast-tempo music were the most effective in improving hand dexterity.

Cognitive strategy on upper extremity function for stroke: A randomized controlled trials.

BACKGROUND: Cognitive orientation to daily occupational performance (CO-OP) is a task-specific training applied using a cognitive behavioral approach to improve performance in daily activities and to enable the patient to overcome limitations related to them. OBJECTIVES: The purpose of this study was to investigate the effects of the CO-OP approach in comparison with task-specific upper extremity training (TUET) on performance related to daily and functional activities in individuals with chronic hemiparetic stroke. METHODS: Forty-nine participants diagnosed with stroke for the first time underwent 30 minutes of either the CO-OP approach or TUET 5 days a week for 4 weeks. We evaluated their performance on the box-and-block test (BBT), Canadian occupational performance measure (COPM), and community integration questionnaire (CIQ) and Wolf motor function test-functional score (WMFT-F) before and after the training. RESULTS: Our results show a significantly improvement in the WMFT-F, COPM-P, COPM-S, BBT, and CIQ scores after training in the CO-OP group, but only COPM-S score was significantly improvement after training in TUET group (p <  0.05). This study also found higher increases in the mean WMFT-F, COPM-P, COPM-S and BBT scores in the CO-OP group than in the TUET group, but CIQ score did not have a significantly higher increase between-group after training. CONCLUSIONS: The results of this study suggest that the CO-OP approach resulted in a positive therapeutic effect on self-selected occupational performance and daily and functional activities in individuals with chronic hemiparetic stroke.

Equating activities of daily living outcome measures: the Functional Independence Measure and the Korean version of Modified Barthel Index.

PURPOSE: To create a crosswalk between the Functional Independence Measure (FIM) motor items and the Korean version of the Modified Barthel Index (K-MBI). METHOD: Korean community-dwelling adult patients (n = 276) completed the FIM and K-MBI on the same day in outpatient rehabilitation hospitals. We used a single group design with the Rasch common person equating and conducted a factor analysis of the co-calibrated item pool using the two measures. Rasch analysis was used to investigate the psychometrics of the equated test items in the identified factor structure(s). The correlation between FIM raw scores and converted K-MBI scores was examined. RESULTS: Three measurement constructs were identified: self-care, mobility, involuntary movement. The equated test items in the three constructs demonstrated good person separation reliability (r = 0.94-0.96) and good internal consistency (Cronbach's alpha =0.93-0.97). The three crosswalks between the FIM raw scores and converted K-MBI scores demonstrated good correlations (r = 0.91-0.93, all p < 0.0001). CONCLUSIONS: The Rasch equating method successfully created three crosswalks between the FIM motor items and K-MBI, with the equated test items demonstrating good psychometrics. The crosswalks would address the incomparable scoring systems between the FIM motor items and K-MBI. Implications for Rehabilitation The three crosswalk tables (scoring tables) would allow clinicians to compare or translate a patient's motor scores between the FIM and K-MBI. The crosswalk tables would allow health-care administrators to track patients' functional status across various rehabilitation facilities that exclusively use the FIM or K-MBI.

Application of the Korean Version of the Modified Barthel Index: Development of a keyform for use in Clinical Practice.

OBJECTIVE: To demonstrate the clinical application of the Korean version of the Modified Barthel Index (K-MBI) using Rasch analysis. METHODS: A total of 276 patients with neurological disorders were assessed with the K-MBI in outpatient clinics. The Rasch partial-credit model was used to generate a keyform based on investigating the psychometric properties of the K-MBI, including dimensionality, precision (person strata and reliability), and hierarchical item difficulty. The Minimal Detectable Change (MDC) in item difficulty was used to establish right-challenging treatment goals and long-term treatment plans. RESULTS: The findings demonstrated that the Korean version of the MBI satisfied the assumption of unidimensionality. It also showed a hierarchical structure in terms of item difficulty, good reliability (Cronbach alpha, 0.92), and approximately five distinct person strata (4.6). The MDC (raw score, 20.1) of the item difficulty of the test items demonstrated equivalent cutoff scores for targeted short-term treatment goals on the keyform, a Rasch-derived display of patient responses. Long-term treatment goals were identified based on the test items of the keyform. CONCLUSIONS: The findings suggest that a Rasch keyform can be applied to clinical practice in Korean settings by identifying clinically and statistically meaningful test items and their step thresholds as short- and long-term goals.

Longitudinal Trends in Fall Accidents in Community Dwelling Korean Adults: The 2008-2013 Korean Community Health Survey.

OBJECTIVE: To describe the longitudinal characteristics of unintentional fall accidents using a representative population-based sample of Korean adults. METHODS: We examined data from the Korean Community Health Survey from 2008 to 2013. Univariate analysis and multivariable logistic regression were used to identify the characteristics of fall accidents in adults. RESULTS: Between 2008 and 2013, the incidence rate of fall accidents requiring medical treatment increased from 1,248 to 3,423 per 100,000 people (p<0.001), while the proportion of indoor fall accidents decreased from 38.12% to 23.16% (p<0.001). Females had more annual fall accidents than males (p<0.001). The major reason for fall accidents was slippery floors (33.7% in 2011 and 36.3% in 2013). Between 2008 and 2010, variables associated with higher fall accident risk included specific months (August and September), old age, female gender, current drinker, current smoker, diabetes, osteoarthritis, osteoporosis, and depression. A high level of education and living with a partner were negatively associated with fall accident risk. In 2013, people experiencing more than 1 fall accident felt more fear of falling than those having no fall accidents (odds ratio [OR] for 1 fall, 2.12; 95% confidence interval [CI], 2.04-2.12; OR for more than 2 falls, 2.97; 95% CI, 2.83-3.10). CONCLUSION: The occurrence of fall accidents has consistently increased in Korea from 2008 to 2013. Future intervention studies are needed to reduce the increasing incidence rates of fall accidents in community dwelling adults.