The Effects of Adding Particles in Texture Modified Food on Tongue Strength and Swallowing Function in Patients with Oropharyngeal Dysphagia: A Proof of Concept Study.

The use of texture modified food (TMF) is widely spread in the daily care of patients with oropharyngeal dysphagia (OD). However, TMF have been shown to have a negative impact on the patients' quality of life. Adherence rates are low, increasing the risk of malnutrition and aspiration in an already vulnerable patient population. The aim of this exploratory study was to gain insight in the feasibility of adding particles to pureed food on tongue strength, swallowing safety and efficiency in patients with OD. Ten adult participants with OD swallowed three different boluses. Bolus 1 consisted of no particles (IDDSI level 4), small and bigger particles were added in bolus 2 and 3. Tongue strength during swallowing (Pswal) was measured using the Iowa Oral Performance Instrument (IOPI). Swallow safety (penetration and aspiration) and swallow efficiency (residu) were quantified during fiberoptic endoscopic evaluation of swallowing by means of the PAS scale and Pooling score. RM Anova and Friedman tests were performed for analyzing the impact of bolus on the outcome parameters. No significant effect of bolus type on Pswal was measured. Neither the PAS nor the Pooling score differed significantly between the three different boluses. Aspiration was never observed during swallowing any bolus with particles. This preliminary study shows that the addition of particles to pureed food had no impact on Pswal, swallowing efficiency or safety in patients with OD. This innovative project is the first step in research to explore the characteristics of TMF beyond bolus volume, viscosity and temperature.

Prophylactic Swallowing Therapy During Head-and-Neck Cancer Radiotherapy: Effect of Service-Delivery Mode and Overall Adherence Level on Swallowing Function and Muscle Strength-the PRESTO Trial.

Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM's (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75- group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM's and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75-. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE.Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018-retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.

Exploring autonomic dysfunction in functional dysphonia: A protocol for a case-control study and a randomized controlled trial.

BACKGROUND: Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes. OBJECTIVES: The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender- and age-matched vocally healthy controls, using a case-control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT). METHODS: Case-control study: Autonomic (dys)function of patients with FD will be compared with gender- and age-matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient-reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase. EXPECTED RESULTS: Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre-ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self-report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone. WHAT THIS PAPER ADDS: What is already known on the subject Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. What this paper adds to the existing knowledge The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender- and age-matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. What are the potential or actual clinical implications of this work? Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence-based practice in the field of voice.

Concurrent and Predictive Validity of the Mann Assessment of Swallowing Ability in Belgian Acute Stroke Patients Based on a 1-Year Follow-Up Study.

INTRODUCTION: The Mann Assessment of Swallowing Ability (MASA) is a standardized clinical swallowing examination, specifically developed as a diagnostic test for the presence of oropharyngeal dysphagia and aspiration in the early period after stroke onset. In the original validation study, cutoff scores of <178 and <170 points, respectively, for the identification of dysphagia and aspiration risk are reported. However, a literature search revealed that alternative cutoff scores for dysphagia and/or aspiration provide better diagnostic accuracy. The aim of this secondary data analysis study was to evaluate the concurrent and predictive validity of the MASA. METHODS: Data were derived from a Belgian cohort study of an acute stroke population (n = 151). The MASA total score (MASA-TS), which is the sum of weighted scores on the 24 items, was evaluated against the Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) to assess concurrent validity. To assess predictive validity of the MASA-TS, pneumonia during hospitalization and over 1 year and mortality acted as a future criterion. Analyses included receiver operating characteristic curves and area under the curve (AUC). RESULTS: Diagnostic accuracy of the MASA-TS was good for dysphagia (AUC = 0.85) and for the presence of relevant aspiration risk (AUC = 0.84). Using the original cutoff scores, the MASA-TS showed perfect sensitivity (Se = 1.00) for the identification of dysphagia and aspiration but inadequate specificity (Sp) for dysphagia (Sp = 0.16) and aspiration (Sp = 0.43). After determining new MASA cutoff scores, the optimal MASA cutoff scores were ≤146 for both dysphagia and aspiration with adequate thresholds (Se = 0.71 and Sp = 0.81 for dysphagia; Se = 0.73 and Sp = 0.80 for aspiration). The MASA-TS was a significant predictor of pneumonia during hospitalization (AUC = 0.85) and 1-year follow-up (AUC = 0.86), and of mortality (AUC = 0.79). CONCLUSION: The MASA-TS showed good concurrent validity with the FEDSS. Furthermore, using new cutoff scores (≤146 for the identification of dysphagia and aspiration) lead in general to more accurate diagnostic indexes. The MASA-TS is a good predictor of aspiration pneumonia during hospitalization and 1-year follow-up and of mortality.

Acoustic Analysis of Voluntary Coughs, Throat Clearings, and Induced Reflexive Coughs in a Healthy Population.

Cough efficacy is considered a reliable predictor of the aspiration risk in head and neck cancer patients with radiation-associated dysphagia. Currently, coughing is assessed perceptually or aerodynamically. The goal of our research is to develop methods of acoustic cough analysis. In this study, we examined in a healthy population the acoustical differences between three protective maneuvers: voluntary cough, voluntary throat clearing, and induced reflexive cough. Forty healthy participants were included in this study. Voluntary cough, voluntary throat clearing, and reflexive cough samples were recorded and analyzed acoustically. Temporal acoustic features were the following: the slope and curvature of the amplitude contour, as well as the average, slope, and curvature of the sample entropy and kurtosis contours of the recorded signal. Spectral features were the relative energy in the frequency bands (0-400 Hz, 400-800 Hz, 800-1600 Hz, 1600 Hz-3200 Hz, > 3200 Hz) as well as the weighted spectral energy. Results showed that, compared to a voluntary cough, a throat clearing starts with a weaker onset pulse and involves oscillations from the onset to the offset (concave curvature of the amplitude contour, p < 0.05), lower average (p < 0.05), and slope (p < 0.05) as well as lower convex curvature (p < 0.05) of the kurtosis contour. An induced reflexive cough starts with a higher and briefer onset burst and includes higher frication noise (larger convexity of the curvature of the amplitude and kurtosis contours (p < 0.05)) compared to a voluntary cough. The conclusion is that voluntary coughs are acoustically significantly different from voluntary throat clearings and induced reflexive coughs.

Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial.

BACKGROUND: Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients' adherence. METHODS: A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. RESULTS: Adherence and evolution of adherence over time was significantly different between the three groups (p < .001). Adherence rates decreased in all three groups during the 4 training weeks (p < .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. CONCLUSIONS: PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. TRIAL REGISTRATION: Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 - retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search .

Supportive care among head and neck cancer patients: An initial validation of the Dutch version of the Performance Status Scale for Head and Neck Cancer (D-PSS-HN).

BACKGROUND: Acute and late toxicities in patients treated with (chemo)radiotherapy for head and neck cancer (HNC) is common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. AIMS: Since Dutch performance status scales for the HNC population are lacking, we conducted this study to translate the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) into Dutch (D-PSS-HN) and to validate this version. METHODS & PROCEDURES: The D-PSS-HN was translated into Dutch according to the internationally described cross-cultural adaptation process. It was administered to HNC patients and together with the Functional Oral Intake Scale completed by a speech and language pathologist at five different time points during the first 5 weeks of (chemo)radiotherapy. Patients were asked each time to complete the Functional Assessment of Cancer Therapy and the Swallowing Quality of Life Questionnaire. Pearson correlation coefficients were used to calculate convergent and discriminant validity and the evolution of D-PSS-HN scores was assessed by means of linear mixed models. OUTCOMES & RESULTS: A total of 35 patients were recruited and > 98% of the clinician-rated scales were completed. Convergent and discriminant validity were demonstrated, with all correlations rs between 0.467 and 0.819, and between 0.132 and 0.256, respectively. The subscales of the D-PSS-HN are sensitive to detect changes through time. CONCLUSION & IMPLICATIONS: The D-PSS-HN is a valid and reliable instrument to assess performance status in patients with HNC treated with (chemo)radiotherapy. It is a useful tool to measure HNC patients' current diet level and functional abilities to perform daily life activities. WHAT THIS PAPER ADDS: What is already known on the subject Acute and late toxicities in patients treated with (chemo)radiotherapy for HNC are common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. However, Dutch performance status scales for the HNC population are lacking. Therefore, we translated the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) into Dutch (D-PSS-HN) and validated this version. What this paper adds to existing knowledge We translated the PSS-HN and demonstrated its convergent and discriminant validity. The subscales of the D-PSS-HN are sensitive to detect changes through time. What are the potential or actual clinical implications of this work? The D-PSS-HN is a useful tool to measure HNC patients' functional abilities to perform daily life activities. The tool can easily be used in clinical settings: since data collection duration is very short, this facilitates clinical (and research-related) implementation of the scale. Patients' individual needs could be identified by using the D-PSS-HN, resulting in more appropriate approaches and (early) referrals if needed. Interdisciplinary communication could be facilitated.

Dutch translation and validation of the Communicative Participation Item Bank (CPIB)-short form.

BACKGROUND: Several conditions and diseases can result in speech problems that can have a negative impact on everyday functioning, referred to as communicative participation. Subjective problems with acquired speech problems are often assessed with the speech handicap index (SHI). To assess generic participation problems, the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) questionnaire is frequently used. The English questionnaire Communicative Participation Item Bank-short form (CPIB short form) is a 10-item valid, reliable instrument that assesses communicative participation. In the absence of a Dutch equivalent, translation and validation of the CPIB short form was required. AIMS: To translate the CPIB short form into Dutch, and to determine its psychometric properties for the group of adults with speech problems resulting from a neurological aetiology or head and neck cancer. METHODS & PROCEDURES: Translation of the CPIB short form was performed following the instructions of the European Organisation for Research and Treatment for Cancer (EORTC). In a cross-sectional multi-centre study, participants completed the Dutch CPIB short form together with the SHI and USER-P, and the CPIB a second time after 2 weeks. We assessed internal consistency and test-retest reliability of the CPIB. Construct validity was assessed based on correlations with SHI, USER-P and speech assessments. OUTCOMES & RESULTS: In the validation study, 122 participants were included: 51 with dysarthria due to different neurological disorders, 48 with speech problems due to head and neck cancer treatment and 23 healthy controls. Internal consistency of the items was high (Cronbach's alpha = 0.962), the intraclass correlation coefficient (ICC) for test-retest reliability was high 0.908 (95% CI = 0.870-0.935). Construct validity was supported by a strong correlation between the Dutch CPIB short form and the SHI total score (SHI total rs = 0.887) and a moderate correlation between the Dutch CPIB-10 and the USER-P subscales (USER-P Frequency rs = 0.365; USER-P restrictions and USER-P satisfaction rs = 0.546). A moderate correlation was found between the Dutch CPIB-10 and the speech performance assessments (degree of distortedness r = -0.0557; p ≤ 0.001; degree of intelligibility r = 0.0562). CONCLUSIONS & IMPLICATIONS: The Dutch CPIB short form provides a valid and reliable tool for clinical practice and research purposes. It allows clinicians to start using this PROM in clinical and research practice to systematically investigate the impact of the speech problems on communicative participation in a Dutch-speaking population. WHAT THIS PAPER ADDS: What is already known on the subject Communicative participation allows people to take part in life situations, but can be affected by acquired speech problems. The CPIB is a patient-reported outcome measure for the assessment of this concept. For the English language the 46-item bank and a 10-item short form is available. What this paper adds to existing knowledge This paper describes the process of translation of the CPIB short form into Dutch, and confirms its reproducibility and validity. What are the potential or actual clinical implications of this work? With this validated Dutch version of the CPIB short form available, professionals can implement this tool in clinical and research practice to systematically evaluate communicative participation.

Effect of boost articulation therapy (BArT) on intelligibility in adults with dysarthria.

BACKGROUND: The articulatory accuracy of patients with dysarthria is one of the most affected speech dimensions with a high impact on speech intelligibility. Behavioural treatments of articulation can either involve direct or indirect approaches. The latter have been thoroughly investigated and are generally appreciated for their almost immediate effects on articulation and intelligibility. The number of studies on (short-term) direct articulation therapy is limited. AIMS: To investigate the effects of short-term, boost articulation therapy (BArT) on speech intelligibility in patients with chronic or progressive dysarthria and the effect of severity of dysarthria on the outcome. METHODS & PROCEDURES: The study consists of a two-group pre-/post-test design to assess speech intelligibility at phoneme and sentence level and during spontaneous speech, automatic speech and reading a phonetically balanced text. A total of 17 subjects with mild to severe dysarthria participated in the study and were randomly assigned to either a patient-tailored, intensive articulatory drill programme or an intensive minimal pair training. Both training programmes were based on the principles of motor learning. Each training programme consisted of five sessions of 45 min completed within one week. OUTCOMES & RESULTS: Following treatment, a statistically significant increase of mean group intelligibility was shown at phoneme and sentence level, and in automatic sequences. This was supported by an acoustic analysis that revealed a reduction in formant centralization ratio. Within specific groups of severity, large and moderate positive effect sizes with Cohen's d were demonstrated. CONCLUSIONS & IMPLICATIONS: BArT successfully improves speech intelligibility in patients with chronic or progressive dysarthria at different levels of the impairment. What this paper adds What is already known on the subject Behavioural treatment of articulation in patients with dysarthria mainly involves indirect strategies, which have shown positive effects on speech intelligibility. However, there is limited evidence on the short-term effects of direct articulation therapy at the segmental level of speech. This study investigates the effectiveness of BArT on speech intelligibility in patients with chronic or progressive dysarthria at all severity levels. What this paper adds to existing knowledge The intensive and direct articulatory therapy programmes developed and applied in this study intend to reduce the impairment instead of compensating it. This approach results in a significant improvement of speech intelligibility at different dysarthria severity levels in a short period of time while contributing to exploit and develop all available residual motor skills in persons with dysarthria. What are the potential or actual clinical implications of this work? The improvements in intelligibility demonstrate the effectiveness of a BArT at the segmental level of speech. This makes it to be considered a suitable approach in the treatment of patients with chronic or progressive dysarthria.

Automatic boost articulation therapy in adults with dysarthria: Acceptability, usability and user interaction.

BACKGROUND: Imprecise articulation has a negative impact on speech intelligibility. Therefore, treatment of articulation is clinically relevant in patients with dysarthria. In order to be effective and according to the principles of motor learning, articulation therapy needs to be intensive, well organized, with adequate feedback and requires frequent practice. AIMS: The aims of this pilot study are (1) to evaluate the feasibility of a virtual articulation therapy (VAT) to guide patients with dysarthria through a boost articulation therapy (BArT) program; (2) to evaluate the acoustic models' performance used for automatic phonological error detection; and (3) to validate the system by end-users from their perspective. METHODS & PROCEDURES: The VAT provides an extensive and well-structured package of exercises with visual and auditory modelling and adequate feedback on the utterances. The tool incorporates automated methods to detect phonological errors, which are specifically designed to analyse Dutch speech production. A total of 14 subjects with dysarthria evaluated the acceptability, usability and user interaction with the VAT based on two completed therapy sessions using a self-designed questionnaire. OUTCOMES & RESULTS: In general, participants were positive about the new computer-based therapy approach. The algorithm performance for phonological error detection shows it to be accurate, which contributes to adequate feedback of utterance production. The results of the study indicate that the VAT has a user-friendly interface that can be used independently by patients with dysarthria who have sufficient cognitive, linguistic, motoric and sensory skills to benefit from speech therapy. Recommendations were given by the end-users to further optimize the program and to ensure user engagement. CONCLUSIONS & IMPLICATIONS: The initial implementation of an automatic BArT shows it to be feasible and well accepted by end-users. The tool is an appropriate solution to increase the frequency and intensity of articulation training that supports traditional methods. WHAT THIS PAPER ADDS: What is already known on the subject Behavioural interventions to improve articulation in patients with dysarthria demand intensive treatments, repetitive practice and feedback. However, the current treatments are mainly limited in time to the interactive sessions in the presence of speech-language pathology. Automatic systems addressing the needs of individuals with dysarthria are scarce. This study evaluates the feasibility of a VAT program and investigates its acceptability, usability and user interaction. What this paper adds to existing knowledge The computer-based speech therapy approach developed and applied in this study intends to support intensive articulation training of patients with dysarthria. The virtual speech therapy offers the possibility of an individualized and customized therapy programme, with an extensive database of exercises, visual and auditory models of the target utterances, and providing adequate feedback based on automatic acoustic analysis of speech. What are the potential or actual clinical implications of this work? The automatic BArT overcomes the limitation in time of face-to-face traditional speech therapy. It offers patients the opportunity to have access to speech therapy more intensively and frequently in their home environment.

Tongue-Strengthening Exercises in Healthy Older Adults: Effect of Exercise Frequency - A Randomized Trial.

INTRODUCTION: Positive effects from tongue-strengthening exercises (TSE) are widely described, but dose-dependent studies concerning exercise frequency have not yet been reported. This study aimed to determine the training and detraining effects of TSE with exercise frequencies of respectively 3 and 5 times per week on maximum isometric anterior and posterior tongue pressures (MIPA and MIPP) and on anterior and posterior tongue strength during an effortful saliva swallow (PswalA and PswalP). METHOD: Twenty healthy adults were randomly assigned to two exercise groups, training 3 (EX3, n = 10) or 5 (EX5, n = 10) times per week with the Iowa Oral Performance Instrument. MIPA, MIPP, PswalA, and PswalP were measured at baseline, after 4 and 8 weeks of training and 4 and 8 weeks after the last training session to document detraining effects. Descriptive statistics, linear mixed model effects, and post hoc analyses were calculated. RESULTS: Significant increases in MIPA, MIPP, PswalA, and PswalP were measured for training both 3 and 5 times per week. No significant differences on any parameter were found between EX3 and EX5 groups. No significant detraining effects were found after 4 or 8 weeks in any treatment arm either for MIPs or for effortful swallow pressures. CONCLUSION: This randomized study demonstrated a positive effect of TSE on MIP and Pswal in healthy older adults, without detraining effects. No superiority of exercise frequency was identified based on significance testing, although some trends are discussed.

The Influence of Age, Sex, Visual Feedback, Bulb Position, and the Order of Testing on Maximum Anterior and Posterior Tongue Strength in Healthy Belgian Children.

Tongue strength and its role in the pathophysiology of dysphagia in adults are well accepted and studied. An objective and reliable measurement of tongue strength in children necessitates equally good methodology, knowledge of influencing factors, and normative data. Only limited data on testing tongue strength in children are available thereby limiting its potential use. The present study examined tongue strength and several parameters known to be important in adults in the largest sample of healthy children from 3 to 11 years old to date using the Iowa Oral Performance Instrument with standard bulbs. Tongue strength increases markedly for children between 6 and 7 years, with slower increases before and after this age. Unlike adults, no influence of sex or location was found on the maximum tongue strength in children, and visual feedback was found to be counterproductive in obtaining the highest tongue pressures. The normative data obtained can be used for objective assessment of tongue weakness and subsequent therapy planning in dysphagic children.

Tongue-Strengthening Exercises in Healthy Older Adults: Does Exercise Load Matter? A Randomized Controlled Trial.

Tongue-strengthening exercises (TSE) are based on the principles of exercise and motor learning, including intensity. Intensity is manipulated by gradually adjusting the resistive load. This randomized controlled trial (RCT) investigates the effect of three different values resistive load during TSE in healthy older adults. Sixty subjects completed 8 weeks of TSE while exercising with Iowa Oral Performance Instrument (IOPI). They were randomly distributed to 4 different treatment arms: 3 exercise groups (EG1: n = 15; EG2: n = 16, EG3: n = 16) and 1 control group performing lip-strengthening exercises (CG: n = 13). Values of resistive load for EG1, EG2, and EG3 were 100, 80, and 60% 1RM, respectively. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, after 4 and 8 weeks of training and 4 weeks post-training. MIPA and MIPP in the EG were significantly higher than in the CG at all time points, except baseline. No significant differences between EG were found, but some trends were observable. Anteriorly, the higher the resistive load, the higher the increase in MIP. Posteriorly, 100% 1RM caused the highest values, followed by 60% and 80% 1RM. No detraining effects were measured. The degree of exercise load had a significant negative effect on the registered success rate. This RCT confirms the efficacy of TSE in healthy older adults. For MIPA and MIPP, TSE at a resistive load of 100% 1RM are the most efficient choice in this population, while lowering the resistive load will lead to an increased success rate. No detraining effects were registered.

Tongue-Strengthening Exercises in Healthy Older Adults: Specificity of Bulb Position and Detraining Effects.

Clinical tongue-strengthening therapy programs are generally based on the principles of exercise and motor learning, including the specificity paradigm. The aim of this study was to investigate the specific effect of anterior and posterior tongue-strengthening exercises (TSE) on tongue strength (TS) in healthy older adults and to measure possible detraining effects. Sixteen healthy elderly completed 8 weeks of TSE by means of the Iowa Oral Performance Instrument (IOPI). They were distributed in two different treatment arms and performed either exclusively anterior or posterior TSE (ATSE, n = 9 or PTSE, n = 7) depending on the treatment arm. Anterior and posterior maximal isometric pressures (MIPA, MIPP) were measured at baseline, halfway, and after completion of the training sessions. Detraining was measured by repeating MIPA and MIPP measures 4 weeks after the last session of TSE. MIPA and MIPP increased significantly in both treatment arms. MIPA was significantly higher in the ATSE group compared to the PTSE group across all measures in time. No significant differences were observed in MIPP between the ATSE and PTSE groups. Regardless of treatment arm, there was no significant detraining effect measured 4 weeks after the last TSE session. This study suggests that TSE show partial specificity concerning bulb position. We conclude that especially anterior training results in higher anterior TS in comparison with posterior exercises. Furthermore, we found no detraining effects, independent of bulb location.

Validation of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QoL) and the adjusted DSWAL-QoL (aDSWAL-QoL) using item analysis with the Rasch model: a pilot study.

BACKGROUND: The Swallowing Quality-of-Life Questionnaire (SWAL-QoL) is considered the gold standard for assessing health-related QoL in oropharyngeal dysphagia. The Dutch translation (DSWAL-QoL) and its adjusted version (aDSWAL-QoL) have been validated using classical test theory (CTT). However, these scales have not been tested against the Rasch measurement model, which is required to establish the structural validity and objectivity of the total scale and subscale scores. Thus, the purpose of this study was to examine the psychometric properties of these scales using item analysis according to the Rasch model. METHODS: Item analysis with the Rasch model was performed using RUMM2030 software with previously collected data from a validation study of 108 patients. The assessment included evaluations of overall model fit, reliability, unidimensionality, threshold ordering, individual item and person fits, differential item functioning (DIF), local item dependency (LID) and targeting. RESULTS: The analysis could not establish the psychometric properties of either of the scales or their subscales because they did not fit the Rasch model, and multidimensionality, disordered thresholds, DIF, and/or LID were found. The reliability and power of fit were high for the total scales (PSI = 0.93) but low for most of the subscales (PSI < 0.70). The targeting of persons and items was suboptimal. The main source of misfit was disordered thresholds for both the total scales and subscales. Based on the results of the analysis, adjustments to improve the scales were implemented as follows: disordered thresholds were rescaled, misfit items were removed and items were split for DIF. However, the multidimensionality and LID could not be resolved. The reliability and power of fit remained low for most of the subscales. CONCLUSIONS: This study represents the first analyses of the DSWAL-QoL and aDSWAL-QoL with the Rasch model. Relying on the DSWAL-QoL and aDSWAL-QoL total and subscale scores to make conclusions regarding dysphagia-related HRQoL should be treated with caution before the structural validity and objectivity of both scales have been established. A larger and well-targeted sample is recommended to derive definitive conclusions about the items and scales. Solutions for the psychometric weaknesses suggested by the model and practical implications are discussed.

Feasibility of tongue strength measurements during (chemo)radiotherapy in head and neck cancer patients.

PURPOSE: The aim of this study was to investigate the feasibility of tongue strength measures (TSMs) and the influence of bulb location, sex, and self-perceived pain and mucositis in head and neck cancer (HNC) patients during chemoradiotherapy (CRT). METHODS: Twenty-six newly diagnosed HNC patients treated with CRT performed anterior and posterior maximal isometric tongue pressures by means of the Iowa Oral Performance Instrument (IOPI). The Oral Mucositis Weekly Questionnaire (OMWQ) and a Visual Analogue Scale (VAS) for pain during swallowing were completed weekly from baseline to 1 week post CRT. RESULTS: Feasibility of TSMs during CRT declines significantly from 96 to 100% at baseline to 46% after 6 weeks of CRT. But post-hoc analyses reveal only significant differences in feasibility between baseline and measurements after 4 weeks of treatment. No effect of gender or bulb location was established, but feasibility is influenced by pain and mucositis. CONCLUSIONS: Feasibility of TSMs declines during CRT and is influenced by mucositis and pain. For the majority of subjects, TSMs were feasible within the first 4 weeks, which provides a window of scientific and clinical opportunities in this patient population.

Feasibility and Psychometric Properties of the Adjusted DSWAL-QoL Questionnaire for Dysphagic Patients with Additional Language and/or Cognitive Impairment: Part I.

The Swallowing Quality-of-Life questionnaire (SWAL-QoL) is considered the gold standard for assessing health-related quality of life in people with dysphagia. However, many dysphagic patients struggle to complete this questionnaire because of additional functional sequelae such as language impairment and cognitive disorders. In this study, we sought to develop an adjusted Dutch version of the SWAL-QoL (aDSWALQoL) and to evaluate its psychometric properties and feasibility compared with the original questionnaire. We developed the aDSWAL-QoL based on recommendations from previous literature. The feasibility, internal consistency, test-retest reliability, and criterion validity of the aDSWAL-QoL were evaluated in 78 dysphagic patients, among whom 43 had additional language and/or cognitive impairments (DysLC). Statistical analyses were performed using SPSS 20.0. The aDSWAL-QoL had a higher degree of feasibility for the DysLC group. We obtained high Cronbach's α coefficients for total scale and for almost all subscales. Total aDSWAL-QoL scores showed excellent testretest agreement and good criterion validity with respect to the DSWAL-QoL. Almost all subscales showed significantly moderate to good test-retest agreement and criterion validity. However, the psychometric properties of the 'Food selection' subscale were inadequate. The aDSWAL-QoL is a feasible, reliable, and valid tool for use with DysLC patients. Conversion of the aDSWAL-QoL into an audio computer-assisted self-administered format should be investigated. The construct validity of the aDSWAL-QoL will be evaluated in a separate report.

The validation and psychometric properties of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QOL).

The aim of this work was to evaluate the psychometric properties of the Dutch version of the Swallowing Quality-of-Life Questionnaire (DSWAL-QOL). A cross-sectional survey of 295 dysphagic patients and 124 healthy controls was studied to evaluate the validity and reliability of the DSWAL-QOL, and 50 patients were recruited for the test-retest reliability. Construct validity was validated through principal component analysis and a correlation study between the DSWAL-QOL and the SF-36. The psychometric properties of the DSWAL-QOL were found to be largely similar to those of the original SWAL-QOL, except the Sleep scale; the composite Symptoms score reaffirms its validity in this study. The DSWAL-QOL was able to differentiate between dysphagic and nondysphagic patients and is sensitive to disease severity as measured by known-groups validity, based on different food and liquid textures. The DSWAL-QOL is a clinically valid and reliable tool for assessing the quality of life in Dutch-speaking dysphagic patients, regardless of the cause or severity of the dysphagia.

The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy belgian adults.

This study collected data on the maximum anterior and posterior tongue strength and endurance in 420 healthy Belgians across the adult life span to explore the influence of age, sex, bulb position, visual feedback, and order of testing. Measures were obtained using the Iowa Oral Performance Instrument (IOPI). Older participants (more than 70 years old) demonstrated significantly lower strength than younger persons at the anterior and the posterior tongue. Endurance remains stable throughout the major part of life. Gender influence remains significant but minor throughout life, with males showing higher pressures and longer endurance. The anterior part of the tongue has both higher strength and longer endurance than the posterior part. Mean maximum tongue pressures in this European population seem to be lower than American values and are closer to Asian results. The normative data can be used for objective assessment of tongue weakness and subsequent therapy planning of dysphagic patients.

Construction of an Anchor and Training Sample Set for Auditory-Perceptual Voice Evaluation With the GRBAS-scale.

OBJECTIVE: The aim of this study is to construct a representative and comprehensive set of reliable anchor and training voice samples for all parameters and grades of the GRBAS-scale, in order to develop a standardized online training tool for perceptual voice evaluation. METHODS: 140 voice samples varying from normal to severely dysphonic, consisting of the vowel /a/ and a Dutch standard text, were recorded. Samples were duplicated and added to a data folder in random order. A panel of five highly experienced judges rated GRBAS parameters for each voice sample. Intra- and interrater reliability were determined using intraclass correlation coefficient (ICC) and percentage agreement. Samples with agreement percentages of >0.90 for at least one parameter were qualified as anchor voices, whereas samples with a percentage agreement between 0.70 and 0.80 were considered valid training samples. RESULTS: Intrarater reliability was moderate to good for all raters and parameters. Interrater reliability was good for parameter G and moderate for R, B, A and S. 83 samples were found to be valid anchor samples with 90-100% expert agreement for at least one parameter, covering all of the GRBAS parameter/score combinations. An additional 37 samples fulfilled the criteria for adoption in the online tool as a training sample, showing 70-80% agreement for one or more parameters. CONCLUSION: Based on well-defined and stringent selection criteria, this study identifies a substantial number of valid anchor and training voices that qualify for implementation in a standardized multi-level training tool for the auditory-perceptual evaluation of voice by means of the GRBAS scale.