Contribution of Wireless Wi-Fi Intraoral Cameras to the Assessment of Swallowing Safety and Efficiency.

BACKGROUND: Clinical evaluation of swallowing provides important clinical information but is limited in detecting penetration, aspiration, and pharyngeal residue in patients with suspected dysphagia. Although this is an old problem, there remains limited access to low-cost methods to evaluate swallowing safety and efficiency. PURPOSE: The purpose of this technical report is to describe the experience of a single center that recently began using a wireless Wi-Fi intraoral camera for transoral endoscopic procedures as an adjunct to clinical swallowing evaluation. We describe the theoretical structure of this new clinical evaluation proposal. We present descriptive findings on its diagnostic performance in relation to videofluoroscopic swallowing study as the gold standard in a cohort of seven patients with dysphagia following head and neck cancer. We provide quantitative data on intra- and interrater reliability. Furthermore, this report discusses how this technology can be applied in the clinical practice of professionals who treat patients with dysphagia and provides directions for future research. CONCLUSIONS: This preliminary retrospective study suggests that intraoral cameras can reveal the accumulated oropharyngeal secretions and postswallow pharyngolaryngeal residue in patients with suspected dysphagia. Future large-scale studies focusing on validating and exploring this contemporary low-cost technology as part of a clinical swallowing evaluation are warranted.

Designing equitable speech-language pathology services in the Maldives to achieve Sustainable Development Goals 10 and 4.

PURPOSE: The United Nations adopted 17 Sustainable Development Goals (SDGs) in 2015 as a universal plan to address challenges experienced around the globe. SDG 4 focuses on inclusive and equitable education while SDG 10 aims to reduce inequality within and among countries. To achieve these goals for children with communication disabilities living in underserved communities, equitable access to services is required. Service delivery should be tailored to the unique characteristics of specific communities to best cater to the needs of the population. This commentary presents the Context-specific Service Delivery Framework (CSDF) that can be used to explore contexts systematically and identify suitable speech-language pathology service delivery approaches. CSDF focuses on the three dimensions of sustainability that are emphasised in the SDGs: environmental, social and economic. RESULT: We present how CSDF was developed in the case of one Majority world country, the Maldives. Five studies were conducted to complete CSDF and the findings were used to derive recommendations for service delivery approaches that could help achieve SDG 4 and SDG 10. These included, building capacity by using asset-based approaches, collaborating with service providers and the community, using population-based methods to focus on prevention of communication disabilities and using available technology to provide support. CONCLUSION: Other underserved communities could also benefit from using CSDF to design equitable services for children with communication disabilities in their countries. This commentary paper focuses on SDG 4 and SDG 10.

Information and Communication Technology in Schools: Its Contribution to Equitable Speech-Language Therapy Services in an Underserved Small Island Developing State.

Purpose Access to speech-language therapy services for children with communication difficulties is limited in vulnerable countries within the Majority world, such as Small Island Developing States. The use of information and communication technology (ICT) has been identified as a possible solution to provide equitable access to services in Minority world countries. This study explored ICT-related conditions in remote schools of the Maldives, a Small Island Developing State, in order to identify potential service delivery approaches. Method A mixed methods approach was used, involving (a) an online survey of 107 teachers, (b) observational data from four schools, (c) interviews with 31 teachers and the four principals of participating schools, and (d) 13 relevant online documents. Content analysis was used to analyze and integrate data from all sources. Results Teachers' access to ICT devices and fixed broadband Internet varied across schools. The government had limited funds to provide adequate fixed broadband Internet for them. However, favorable prospects were also discovered, including high access to 4G mobile broadband Internet in islands, high levels of confidence among teachers to use ICT, a variety of ICT uses currently employed by teachers, and the presence of financial aid for students with special education needs. Conclusions The findings of the study support the potential for using mobile broadband Internet, available ICT devices, and teachers as agents of service delivery in remote schools to enhance speech-language therapy service delivery in the Maldives. The creation of relevant digital educational content for teachers could further support children with communication difficulties in the country. Supplemental Material https://doi.org/10.23641/asha.14143910.

Assessment, Diagnosis, and Treatment of Dysphagia in Patients Infected With SARS-CoV-2: A Review of the Literature and International Guidelines.

Purpose Speech-language pathologists are playing a crucial role in the assessment and management of patients infected with severe acute respiratory syndrome coronavirus 2. Our goal was to synthesize peer-reviewed literature and association guidelines from around the world regarding dysphagia assessment and management for this specific population. Method A review of publications available in the PubMed database and official guidelines of international groups was performed on May 23, 2020. The information was synthesized and categorized into three content areas for swallowing: clinical evaluation, instrumental assessment, and rehabilitation. Results Five publications were identified in the PubMed database. Following title, abstract, and full-text review, only three publications met inclusion criteria: two reviews and one narrative report. Additionally, 19 international guidelines were reviewed. To assess swallowing, a modified clinical evaluation was recommended and only following a risk assessment. Instrumental assessments were often considered aerosol generating, especially transnasal procedures such as endoscopy and manometry. For this reason, many associations recommended that these examinations be performed only when essential and with appropriate personal protective equipment. Guidelines recommended that intervention should focus on compensatory strategies, including bolus modification, maneuvers/postural changes, and therapeutic exercises that can be conducted with physical distancing. Respiratory training devices were not recommended during rehabilitation. Conclusions International associations have provided extensive guidance regarding the level of risk related to the management of dysphagia in this population. To date, there are no scientific papers offering disease and/or recovery profiling for patients with dysphagia and coronavirus disease 2019. As a result, research in this area is urgently needed.

Economic costs of dysphagia among hospitalized patients.

OBJECTIVES/HYPOTHESIS: Difficulties swallowing may lead to aspiration pneumonia and death. In a hospital setting where patients are admitted for other causes, we hypothesized that the additional burden of a swallow problem would increase length of stay, rate of pneumonia, cost, readmissions, and morbidity compared to those without dysphagia. STUDY DESIGN: Retrospective parallel cohort study. METHODS: A study of patients admitted to the hospital with hip/femur fracture was completed. Two groups were identified and compared: those with a coded diagnosis of dysphagia (n = 165) in addition to hip/femur fracture (HF + D), and a group with hip fracture alone (HF-D) (n = 2,288) (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification). Number of inpatient days, cost per patient, diagnosis of pneumonia, 30-day readmission, and mortality rates were compared. RESULTS: For those in the HF + D group, mean age was 85 years compared to 78 years in the HF-D group (P < .05); length of stay was 32 days, more than twice that of the HF-D group (14 days) (P < .05). Mortality within 30 days of admission was significantly higher (18% vs. 4%,respectively) but 30-day readmission rate was similar (8% vs. 11%, respectively). Rate of aspiration pneumonia was 14 times greater in HF + D (9.7%) compared with HF-D (0.7%). Average admission cost was NZD$36,913 (HF + D) compared with NZD$22,222 (HF-D) (P < .05). CONCLUSIONS: Complaint of dysphagia, in addition to hip fracture, increases a patient's average admission cost by 60%. It is associated with increased aspiration pneumonia and greater mortality. Dysphagia screening at admission to hospital would allow early identification of swallow compromise and may prevent complications and reduce costs. LEVEL OF EVIDENCE: 3b Laryngoscope, 130:974-979, 2020.

Evaluating the effectiveness of implementation intentions in a pedometer worksite intervention.

BACKGROUND: Pedometer-based worksite interventions have been found to be successful in increasing physical activity (PA) but adherence is challenging. OBJECTIVE: To examine the use of Implementation Intentions (II), a self-regulatory skill, with self-monitoring with a pedometer to initiate behavior change as well as post-intervention adherence in a worksite wellness intervention. METHODS: University employees (N = 54) participated in an 8-week pedometer-based intervention. A 2-arm randomized trial was used to compare the effectiveness of 1) only pedometers (PED) (n = 28) and 2) pedometers and II (PED+II) (n = 26) on PA. RESULTS: Significant differences were observed between time points (p < .0001) but not between groups. Post-hoc pairwise comparisons between the time points revealed difference between Baseline and Week 4 (mean difference: 2446.9 steps/ day; p < 0.001), Week 4 and 12 (mean difference: 2956.3 steps/ day; p < 0.001), and Week 8 and 12 (mean difference: 2228.8 steps/ day; p = 0.005). CONCLUSION: The PED+II group had higher step increases during the intervention indicating that the behavioral strategy was effective. However, participants in both groups had a significant decrease in steps from the end of the intervention to the delayed-post assessment highlighting the challenge to maintain behavioral changes post-intervention.

Occupational voice is a work in progress: active risk management, habilitation and rehabilitation.

PURPOSE OF REVIEW: The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018-July 2019). RECENT FINDINGS: Our understanding of the prevalence of voice disorders and work-related vocal use, vocal load and vocal ergonomics (environmental and person influences) across different occupations is continuing to build. There is encouraging evidence for the value of intervention programs for occupational voice users, particularly of late with performers, teachers and telemarketers. Education and prevention programs are emerging for other 'at risk' occupations. SUMMARY: Occupational health and workforce legislation does not adequately acknowledge and guide educational, preventive and intervention approaches to occupational voice disorders. Voice disorders are prevalent in certain occupations and there is an urgent need for research to support occupational voice health and safety risk measurement, prevention and intervention. Large population-based studies are required with a focus on the health and economic burden of occupational voice disorders.

Current approaches to instrumental assessment of swallowing in children.

PURPOSE OF THE REVIEW: This article reviews recent developments in the instrumental assessment of swallowing in children with a specific focus on research published between January 2017 and June 2018. RECENT FINDINGS: Instrumental swallowing assessments reported in the time period included: videofluoroscopic study of swallowing, digital cervical auscultation, dynamic ultrasound, high-resolution impedance manometry, nasal airflow thermistry and respiratory inductance plethysmography. Several studies were found exploring tools to objectively quantify videofluoroscopic study of swallowing data; swallowing from the mouth through to stomach was addressed including approaches to analysing mastication as well as evaluating oesophageal motility disorders. SUMMARY: Even though a vast range of instrumentation were studied, lack of clarity on clinical feasibility and objective measures that facilitate medical decision-making in practice mean further research is required to provide guidance on implementation. Promising novel approaches to aid the quantification of swallowing physiology from the mouth, pharynx and through to the oesophagus are emerging.

Assessment of videofluoroscopic swallow study findings before and after cricopharyngeal myotomy.

BACKGROUND: Cricopharyngeal myotomy is a treatment for obstructive cricopharyngeal bar and Zenker's diverticulitis. Little is reported regarding contrast study findings and their correlation with patient symptoms. METHODS: All patients treated by cricopharyngeal myotomy underwent a preoperative and postoperative videofluoroscopic swallow study (VFSS) and completed the self-reported Eating Assessment Tool (EAT-10). Studies were analyzed quantitatively. RESULTS: Forty cricopharyngeal myotomies were performed (mean age 76 years; SD 8.72) all for dysphagia. Symptomatic improvement (change in EAT-10 scores) occurred in 95% (38/40). Presurgical versus postsurgical VFSS demonstrated significantly improved pharyngoesophageal segment opening, pharyngeal constriction ratio, and pouch residue (P < .01). Symptomatic improvement was unrelated to the presence of retained barium. CONCLUSION: Both symptomatic and objective improvement in swallowing measures occurs after cricopharyngeal myotomy. Pouch remnants and retained barium are seen postoperatively but do not correlate with reported symptoms. Routine follow-up barium studies may be needed to establish a new baseline and allow for comparison if future symptom recurrence occurs.

Cost and culture: Factors influencing worksite physical activity across three universities.

BACKGROUND: Physical inactivity is a leading cause of morbidity and mortality. Worksites provide an ideal environment for physical activity (PA) interventions. Colleges and universities are a unique work venue, with institutions of higher education of varying scope within every state of the United States and worldwide. OBJECTIVE: To explore the institutional influences on worksite PA across multiple universities. PARTICIPANTS: Employees from two large, universities (Midwestern and Southern) and a mid-size, university (Midwestern) participated in exploratory research in March/April 2010 and 2013. METHODS: The Nominal Group Technique (NGT) methodology and the Health Belief Model (HBM) were used to assess perceived influences on employees' engagement in worksite PA. RESULTS: The findings demonstrate that university employees experienced similar factors that influence PA as employees across the different institutions. Specifically, there was an interesting relationship between opportunities for PA and lack of a supportive work culture to promote it. CONCLUSIONS: Emphasis on immediate perceived threats to PA inactivity may improve the utility of the HBM for interventions within this context. Further, campus worksite interventions for employees should address barriers such as cost of campus recreation centers and administrative support for engaging in worksite PA as possible cues to action.

Comparison of cough reflex test against instrumental assessment of aspiration.

BACKGROUND: Silent aspiration is associated with pneumonia and mortality, and is poorly identified by traditional clinical swallowing evaluation (CSE). The aim of this study was to validate cough reflex testing (CRT) for identification of silent aspiration against aspiration confirmed by instrumental assessment. METHODS: Cough reflex threshold testing was completed on all patients using inhaled, nebulised citric acid. Within an hour, 80 patients underwent videofluoroscopic study of swallowing (VFSS) and 101 patients underwent fibreoptic endoscopic evaluation of swallowing (FEES). All tests were recorded and analysed by two researchers blinded to the result of the alternate test. RESULTS: Significant associations between CRT result and cough response to aspiration on VFSS (X(2) (2)=11.046, p=.003) and FEES (X(2) (2)=34.079, p<.001) were identified. Sensitivity and specificity were optimised at 0.6mol/L in patients undergoing VFSS (71%, 60% respectively) and at 0.4mol/L in patients undergoing FEES (69%, 71% respectively). A concentration of 0.8mol/L had the highest odds ratio (OR) for detecting silent aspiration (8 based on VFSS; 7 based on FEES). CONCLUSION: CRT results are significantly associated with aspiration response on instrumental assessment. Lower concentrations of citric acid provide a better predictive measure of silent aspiration.