Lateral needling at Lianquan (CV 23) for post-stroke dysphagia: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of lateral needling at Lianquan (CV 23) for post-stroke dysphagia, and explore its mechanism.@*METHODS@#A total of 64 patients with post-stroke dysphagia were randomly divided into an observation group and a control group, 32 cases in each group. Both groups were treated with conventional basic treatment. The observation group was treated with lateral needling at CV 23, without needle retaining, once a day. The control group was treated with swallowing rehabilitation training, once a day. Both groups were treated for 5 days a week, with 2 days interval, 1 week as one course and 4 courses were required. Before and after treatment, the Kubota water swallowing test grade and standardized swallowing assessment (SSA) score were compared in the two groups. Before and after treatment, the video fluoroscopic swallowing study (VFSS) was used to measure the hyoid bone movement displacement and pharyngeal delivery time in the observation group.@*RESULTS@#Compared before treatment, the Kubota water swallowing test grade after treatment was improved in the two groups (P<0.05), and the observation group was superior to the control group (P<0.05); the SSA scores after treatment were decreased in the two groups (P<0.05), and the observation group was lower than the control group (P<0.05). Compared before treatment, the hyoid bone movement displacement was increased and pharyngeal delivery time was shortened after treatment in the observation group (P<0.05).@*CONCLUSION@#Lateral needling at CV 23 could improve dysphagia symptoms in patients with post-stroke dysphagia, its mechanism may be related to the increasing of hyoid bone movement displacement and shortening of pharyngeal delivery time.

Acupoint injection combined with Vitalstim electrical stimulation for post-stroke dysphagia:a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of acupoint injection combined with Vitalstim electrical stimulation for post-stroke dysphagia.@*METHODS@#A total of 98 patients with dysphagia after first stroke were randomized into an acupoint injection group (35 cases, 2 cases dropped off), an electrical stimulation group (31 cases, 3 cases dropped off) and a combination group (32 cases, 3 cases dropped off). Injection of mecobalamin into Tunyan point, Vitalstim electrical stimulation and the combination of injection of mecobalamin into Tunyan point and Vitalstim electrical stimulation were applied respectively in the 3 groups, once a day, 10 times as one course, 2 courses were required. Before and after treatment, the tongue muscle thickness and video fluoroscopic swallowing study (VFSS) score were observed in the 3 groups.@*RESULTS@#After treatment, the tongue muscle thickness was decreased (P<0.05), the VFSS scores were increased (P<0.05) compared with before treatment in the 3 groups, and the variation of tongue muscle thickness and VFSS score in the combination group was greater than the acupoint injection group and the electrical stimulation group (P<0.05).@*CONCLUSION@#Both acupoint injection of mecobalamin and Vitalstim electrical stimulation have therapeutic effect on dysphagia after stroke, and the two have synergistic effect.

Therapeutic effect of nape cluster acupuncture combined with swallowing function training on post-stroke dysphagia / 中国针灸

OBJECTIVE@#To observe the effect on swallowing function in patients with post-stroke dysphagia treated with nape cluster acupuncture and the immediate effect of acupuncture at Fengchi (GB 20).@*METHODS@#A total of 60 patients with post-stroke dysphagia were randomized into an observation group and a control group, 30 cases in each one.On the basis of conventional western medication treatment, swallowing function training was applied in the control group, once a day.On the base of the treatment as the control group, nape cluster acupuncture was applied at Fengchi (GB 20), Tianzhu (BL 10), Wangu (GB 12), Lianquan (CV 23), Panglianquan (Extra), Jinjin (EX-HN 12) and Yuye (EX-HN 13) in the observation group, once a day. Additionally, pricking blood was applied at Jinjin (EX-HN 12) and Yuye (EX-HN 13), 2 times a week. The treatment was given 30 min each time, a week as one course and 4 courses were required. Before and after treatment, the standardized swallowing assessment (SSA) score and video fluoroscopic swallowing study (VFSS) score were compared in the two groups. The ultrasonic diagnostic device of swallowing and surface electromyography were used to observe the immediate effect on swallowing related muscles of acupuncture at Fengchi (GB 20).@*RESULTS@#Compared before treatment, the SSA scores were reduced after treatment in the two groups (<0.05), and the change of the observation group was larger than the control group (<0.05). Compared before treatment, the VFSS scores were increased after treatment in the two groups (<0.05), and the change of the observation group was larger than the control group (<0.05). Acupuncture at Fengchi (GB 20) immediately increased the amplitude of submental muscles and infrahyoid muscles in the observation group (<0.05), the geniohyoid muscle movement time was reduced and geniohyoid muscle displacement was increased (<0.05).@*CONCLUSION@#On the base of the routine treatment, nape cluster acupuncture could improve swallowing function in patients with post-stroke dysphagia. Acupuncture at Fengchi (GB 20) could immediately affect swallowing related muscles, improve muscle amplitude and reduce swallowing time.

Selection of Head Turn Side on Pharyngeal Dysphagia in Hemiplegic Stroke Patients: a Preliminary Study

The objective of this preliminary study is to investigate the effects of various head turn in hemiplegic stroke patients with pharyngeal dysphagia. Twenty hemiplegic stroke patients with dysphagia participated in this study. A patient with dysphagia from an upper esophageal sphincter disorder was excluded. All participants underwent a videofluoroscopic swallow study (VFSS) with a 3 mL liquid diet, and their heads were randomly turned to a neutral position, toward the weaker side, toward the stronger side, or to a chin tuck posture. To assess patient swallowing function with VFSS, the videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) were conducted by a physiatrist blinded to the participant's characteristics. No significant improvements in the VDS and PAS were observed in patients with heads rotated toward the weaker or stronger side when compared with heads in the neutral position. However, there was a significant improvement in the VDS for heads in the chin tuck position when compared with those in the neutral position (p < 0.05). These preliminary results revealed that the head turn practice without VFSS, as a compensatory strategy, could not improve dysphagia in hemiplegic stroke patients. Therefore, compensatory postures might be re-considered with in hemiplegic stroke patients with pharyngeal dysphagia.

Predictors of Long Term Prognosis of Dysphagia in Tonsil Cancer Patients / 대한연하장애학회지

OBJECTIVE: To evaluate the factors affecting long-term prognosis for dysphagia in tonsil cancer patients, after treatment. METHOD: This was a retrospective study of subjects who underwent a videofluoroscopic swallowing study (VFSS) following treatment for stage 3 or 4 tonsil cancer. Data including sex, age, cancer characteristics, and methods of cancer treatment were collected. To evaluate the swallowing-related outcome, we collected data including findings regarding the last VFSS, method of feeding, and history of aspiration pneumonia requiring in-patient care. We evaluated the correlation between these data and the characteristics of cancer and treatment methods. RESULT: Among 32 subjects included in this study, eight had aspiration or penetration confirmed by the last VFSS. There were no significant differences in swallowing-related factors according to the presence of aspiration or penetration in the last VFSS. Patients who underwent curative tonsillectomy retained more residues on the last VFSS than those who did not. CONCLUSION: Among subjects with tonsil cancer, history of curative tonsillectomy was correlated with more pharyngeal residue. However, other cancer- or treatment-related factors did not affect the outcome of swallowing.

The Correlation Between Clinical Characteristics and Radionuclide Salivagram Findings in Patients With Brain Lesions: A Preliminary Study

OBJECTIVE: To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions. METHODS: The medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed. RESULTS: Eleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625–0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689–0.953; p < 0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%). CONCLUSION: In patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.

The Correlation Between Clinical Characteristics and Radionuclide Salivagram Findings in Patients With Brain Lesions: A Preliminary Study

OBJECTIVE: To evaluate the correlation between radionuclide salivagram findings and clinical characteristics in dysphagic patients with brain lesions. METHODS: The medical records of 35 dysphagic patients with brain lesions who simultaneously underwent both a videofluoroscopic swallowing study (VFSS) and radionuclide salivagram were analyzed retrospectively. The subjects were divided into two groups according to the presence of aspiration on a salivagram (group A, patients with aspiration on the salivagram; group B, patients with no aspiration on the salivagram). The differences between clinical characteristics and VFSS findings (penetration-aspiration scale [PAS]) between the two groups were analyzed. RESULTS: Eleven out of 35 patients displayed salivary aspiration on the radionuclide salivagram. There were no significant differences between the two groups according to age, sex, disease duration, PAS on VFSS and feeding methods (p≥0.05). The incidence of aspiration pneumonia was significantly higher in group A. In a multivariate logistic regression analysis with forward stepwise method, the Mini-Mental State Examination (MMSE) score was the only significant parameter in predicting positive findings in salivagrams (odds ratio=0.760; 95% confidence interval [CI], 0.625–0.923; p=0.006). The area under the receiver operating characteristic curve (AUC) of the MMSE score for positive detection in salivagrams was 0.855 (95% CI, 0.689–0.953; p < 0.0001). The optimal cut-off value was 7 for the MMSE score (sensitivity 72.73%, specificity 100%). CONCLUSION: In patients with brain lesions who complain of dysphagia, the MMSE score was correlated with salivary aspiration. If patients present with a score of 7 or less on the MMSE, performing a radionuclide salivagram may helpful for early detection of patients at high risk of aspiration pneumonia induced from salivary aspiration.

Clinical Observation of Acupuncture-activating Method for Deglutition Disorder Due to Pseudobulbar Palsy After Cerebral Stroke / 上海针灸杂志

Objective To observe the clinical efficacy of ZHU Lian's acupuncture-activatingmethod in treating deglutition disorder due to pseudobulbar palsy after cerebral stroke.Method Sixty patients with deglutition disorder due to pseudobulbar palsy after cerebral stroke in acute stage were randomized into an observation group and a control group, 30 cases in each group. The two groups both received symptomatic neurological treatment. In the two groups, acupoints including Lianquan (CV23), Huiyan (Extra), Baihui (GV20), and bilateral Shuaigu (GB8), Wangu (GB12), Zhaohai (KI6), Lieque (LU7),and Yinlingquan (SP9) were selected. The observation group was intervened by ZHU Lian's acupuncture-activating method; the control group was intervened by ordinary needling method plus G6805 therapeutic appliance with sparse-dense wave for 20 min. Prior tothe treatment and after 10 treatment courses, the two groups were evaluated by using Videofluoroscopic Swallowing Study (VFSS) and Kubota's water drinking test for swallowing function.Result After 10 treatment courses, the total effective rate was 96.7%in the observation group versus 83.3% in the control group, and the between-group difference was statistically significant (P<0.05); the VFSS score in the observation group was significantly different from that in the control group (P<0.01); the water drinking test score in the observation group was significantly different from that in the control group (P<0.01). The results indicated that the therapeutic efficacy was more significant in the observation group compared to that in the control group.Conclusion ZHU Lian's acupuncture-activating method can produce a more significant efficacy in treating deglutition disorder due to pseudobulbar palsy after cerebral stroke in acute stage compared with sparse-dense-wave electroacupuncture.

Clinical Observation of Acupuncture plus Rehabilitation Training for Post-stroke Deglutition Disorder / 上海针灸杂志

Objective To observe the clinical efficacy of needling a group of acupoints for choke plus rehabilitation training in treating post-stroke deglutition disorder.Method Ninety patients with post-stroke deglutition disorder were randomized into a treatment group and a control group, 45 cases in each group. In addition to the conventional treatment, the control group also received swallowing rehabilitation training, and the treatment group received acupuncture ata group of acupoints for chokeas the major intervention(Aqiang point, Zhiqiang point, Tunyan point, Tiyan point and Fayin point, all extra) besides the intervention given to the control group, both for 3 successive treatment courses. Before and after theintervention, the National Institute of Health Stroke Scale (NIHSS), Videofluoroscopic Study (VFSS), post-stroke swallowing scale of traditional Chinese medicine (TCM) (TCM scale for short), and the occurrence rate of relevant complications were comparedbetween the two groups.Result The total effective rate was 97.8% in the treatment group, significantly higher than 84.4% in the control group (P<0.05); the scores of NIHSS, VFSS and TCM scale in the treatment group were superior to those in the control group (P<0.05);the NIHSS, VFSS and TCM scale scores in the treatment group were superior to those in the control group after the intervention (P<0.05);24 cases in the control group presented complications versus 8 cases in the treatment group (P<0.05).Conclusion Acupuncture at the points group for chokepredominantlyplus rehabilitation training can effectively improve post-stroke deglutition disorder and reduce the occurrence of complications, with satisfactory safety and consistency.

Validation of Questionnaire for Chewing and Swallowing Function of the Elderly / 대한연하장애학회지

OBJECTIVE: This study aims to develop a new screening dysphagia questionnaire for elderly people. METHOD: Initial questionnaire for mastication and swallowing function of elderly people were composed of 20 questions. Total of 30 experts were invited to participate in the Delphi survey, including physiatrists, occupational therapists and dietitians. Modified Delphi method was performed into two rounds. Twenty young adults and twenty elderly volunteers were tested with these items and were compared with other pre-existing tests. Also, validity of selected evaluating items was tested using VFSS. RESULT: For the first round of surveys, a consensus was reached on 72.5% of the questionnaire. Final agreement was reached on 98% of the questionnaire. The results of the first round survey with the 20 evaluation items and second round showed that the content validity ratio (CVR) and stability were high enough and met the criteria of consistent agreement from a group of specialists. The final round survey following the 1st and 2nd round survey was implemented, which finally reduced to 14 items from initial 20 items. The researcher allocated the items into the 3 categories. The score of the developed item were highly correlated with that of the pre-existing screening questionnaire and time parameters of the VFSS showing a significant difference according to the score. CONCLUSION: We developed a screening tool for evaluation of chewing nad swallowing function for the elderly people. Though it is necessary to be verified through large scale clinical studies, it may be simply applicable to the elderly people with mastication and swallowing dysfunction or could be evaluated by caregivers.

The Relationship Between Tongue Pressure and Oral Dysphagia in Stroke Patients

OBJECTIVE: To evaluate the relationships between tongue pressure and different aspects of the oral-phase swallowing function. METHODS: We included 96 stroke patients with dysphagia, ranging in age from 40 to 88 years (mean, 63.7 years). Measurements of tongue pressure were obtained with the Iowa Oral Performance Instrument, a device with established normative data. Three trials of maximum performance were performed for lip closure pressure (LP), anterior hard palate-to-tongue pressure (AP), and posterior hard palate-to-tongue pressure (PP); buccal-to-tongue pressures on both sides were also recorded (buccal-to-tongue pressure, on the weak side [BW]; buccal-to-tongue pressure, on the healthy side [BH]). The average pressure in each result was compared between the groups. Clinical evaluation of the swallowing function was performed with a videofluoroscopic swallowing study. RESULTS: The average maximum AP and PP values in the intact LC group were significantly higher than those in the inadequate lip closure group (AP, p=0.003; PP, p<0.001). AP and PP showed significant relationships with bolus formation (BF), mastication, premature bolus loss (PBL), tongue to palate contact (TP), and oral transit time (OTT). Furthermore, LP, BW, and BH values were significantly higher in the groups with intact mastication, without PBL and intact TP. CONCLUSION: These findings indicate that the tongue pressure appears to be closely related to the oral-phase swallowing function in post-stroke patients, especially BF, mastication, PBL, TP and OTT.

Diagnosis of Spasmodic Dysphonia Manifested by Swallowing Difficulty in Videofluoroscopic Swallowing Study

Spasmodic dysphonia is defined as a focal laryngeal disorder characterized by dystonic spasms of the vocal cord during speech. We described a case of a 22-year-old male patient who presented complaining of idiopathic difficulty swallowing that suddenly developed 6 months ago. The patient also reported pharyngolaryngeal pain, throat discomfort, dyspnea, and voice change. Because laryngoscopy found no specific problems, an electrodiagnostic study and videofluoroscopic swallowing study (VFSS) were performed to find the cause of dysphagia. The VFSS revealed continuous twitch-like involuntary movement of the laryngeal muscle around the vocal folds. Then, he was diagnosed with spasmodic dysphonia by VFSS, auditory-perceptual voice analysis, and physical examination. So, we report the first case of spasmodic dysphonia accompanied with difficulty swallowing that was confirmed by VFSS.

Inter-rater Reliability of Videofluoroscopic Dysphagia Scale

OBJECTIVE: To investigate the inter-rater agreement using the Videofluoroscopic Dysphagia Scale (VDS). METHOD: The present study was designed as a multicenter, single-blind trial. A Videofluoroscopic Swallowing Study (VFSS) was performed using the protocol described by J.A Logemann. Thick-fluid, pureed food, mechanically altered food, regularly textured food, and thin-fluid boluses were sequentially swallowed. Each participant received a 3 ml bolus followed by a 5 ml bolus of each food material, in the order mentioned above. All study procedures were video recorded. Discs containing these video recordings in random order were distributed to interpreters who were blinded to the participant information. The video recordings were evaluated using a standardized VDS sheet and the inter-rater reliability was calculated. RESULTS: In total, 100 patients participated in this study and 10 interpreters analyzed the findings. Inter-rater reliability was fair in terms of lip closure (kappa: 0.325), oral transit time (0.253), delayed triggering of pharyngeal swallowing (0.300), vallecular residue (0.275), laryngeal elevation (0.345), pyriform sinus residue (0.310), coating of the pharyngeal wall (0.310), and aspiration (0.393). However, other parameters of the oral phase were lower than those of the pharyngeal phase (0.06-0.153). Moreover, the summation of VDS reliability (intraclass correlation coefficient: 0.556) showed moderate agreement. CONCLUSION: VDS shows a moderate rate of agreement for evaluating the swallowing function. However, many of the parameters demonstrated a lower rate of agreement, particularly the oral phase parameters.

Rick Factors Associated with Aspiration in Patients with Head and Neck Cancer

OBJECTIVE: To determine the major risk factors and abnormal videofluoroscopic swallowing study (VFSS) findings associated with aspiration in patients with head and neck cancer (HNC). METHOD: Risk factors associated with aspiration were investigated retrospectively in 241 patients with HNC using medical records and pre-recorded VFSS. Age, gender, lesion location and stage, treatment factors, and swallowing stage abnormalities were included. RESULTS: Aspiration occurred in 50.2% of patients. A univariate analysis revealed that advanced age, increased duration from disease onset to VFSS, higher tumor stage, increased lymph node stage, increased American Joint Committee on Cancer (AJCC) stage, operation history, chemotherapy history, and radiotherapy history were significantly associated with aspiration (p<0.05). Among them, advanced age, increase AJCC stage, operation history, and chemotherapy history were significantly associated with aspiration in the multivariate analysis (p<0.05). Delayed swallowing reflex and reduced elevation of the larynx were significantly associated with aspiration in the multivariate analysis (p<0.05). CONCLUSION: The major risk factors associated with aspiration in patients with HNC were advanced age, higher AJCC stage, operation history, and chemotherapy history. A VFSS to evaluate aspiration is needed in patients with NHC who have these risk factors. Delayed swallowing reflex and reduced elevation of the larynx were major abnormal findings associated with aspiration. Dysphagia rehabilitation should focus on these results.

Clinical Usefulness of Schedule for Oral-Motor Assessment (SOMA) in Children with Dysphagia

OBJECTIVE: To investigate the clinical usefulness of the Schedule for Oral-Motor Assessment (SOMA) in children with dysphagia by comparing findings of SOMA with those of the videofluoroscopic swallowing study (VFSS). METHOD: Both SOMA and VFSS were performed in 33 children with dysphagia (21 boys and 12 girls; mean age 17.3+/-12.1 months) who were referred for oropharyngeal evaluation. Ratings of oral-motor functions indicated by SOMA were based upon the cutting score of each specific texture of food (puree, semi-solids, solids, cracker, liquid-bottle, and liquid-cup). Abnormalities of either the oral phase, or the pharyngeal phase as indicated by VFSS were assessed by a physician and a speech-language pathologist. RESULTS: There was significant consistency between the findings of SOMA and the oral phase evaluation by VFSS (Kappa=0.419, p=0.023). SOMA reached 87.5% sensitivity, 66.6% specificity, and 95.4% positive predictive value when compared with the oral phase of the VFSS. We were able to evaluate oral-motor function by using SOMA in 6 children who were unable to complete the oral phase evaluation by VFSS, due to fear and crying during the study. The findings of SOMA failed to show any consistency with the pharyngeal phase evaluation by VFSS (Kappa=-0.105, p=0.509). CONCLUSION: These results suggest that SOMA is a reliable method for evaluation of oral-motor function in children with dysphagia. In particular, SOMA is recommended for children that were unable to complete the oral phase evaluation by VFSS due to poor cooperation.

The Effect of Balloon Dilatation through Video-Fluoroscopic Swallowing Study (VFSS) in Stroke Patients with Cricopharyngeal Dysfunction

OBJECTIVE: To evaluate an effect of balloon catheter dilatation on post-swallow laryngeal elevation, total pharyngeal transit time and pharyngeal remnant in stroke patients with cricopharyngeal dysfunction. METHOD: The 20 stroke patients with cricopharyngeal dysfunction in videofluoroscopic swallow study were recruited for the study. Using 16 Fr foley catheter, balloon was positioned across the upper esophageal sphincter under video-fluoroscopy. Balloon catheter dilatation was done for 3 minutes and each ballooning was repeated 6 times for a minute. We compared pre-balloon dilatation and post-balloon dilatation values. 3 factors were evaluated, which were laryngeal elevation, total pharyngeal transit time, and post-swallow pharyngeal remnant. RESULTS: There was no significant difference in laryngeal elevation after balloon dilatation. However, total pharyngeal transit time (p<0.01) and pharyngeal remnant (p<0.001) were significantly reduced after balloon dilatation. CONCLUSION: There were significant decrements of post-swallow total pharyngeal transit time and pharyngeal remnant after balloon dilation procedure. Balloon dilation of upper esophageal sphincter can produce relief of dysphagia in stroke patients with cricopharyngeal dysfunction.

The Diagnostic Usefulness of the Fiberoptic Endoscopic Evaluation of Swallowing

OBJECTIVE: To investigate if adding fiberoptic endoscopic evaluation of swallowing (FEES) to the videofluoroscopic swallowing study (VFSS) will improve the detection of abnormalities related to swallowing and pharyngolaryngeal structures. METHOD: Sixty-nine subjects (47 men, aged 64.8+/-12.0 years) with dysphagia were evaluated using VFSS and FEES simultaneously. VFSS and FEES were independently interpreted by two different examiners, who were blinded to the results of the other study. The foods that were examined were a 5-ml semi-blended diet (SBD), plain yogurt, boiled rice (NRD), and 2-ml (small fluid, SF) and 5-ml (large fluid, LF) diluted liquid barium. The detection rates of penetration or aspiration and of the pharyngeal residues in VFSS and FEES were compared. RESULTS: Combining FEES with VFSS raised the detection rates of penetration (p=0.008 for SF and LF; p<0.001 for SBD, yogurt, and NRD) and of the pharyngeal residues (p<0.001 for SF, SBD, yogurt, and NRD; p=0.001 and 0.002 for LF in the vallecula and pyriform sinus, respectively) in all the food types. Adding FEES also improved the detection of fluid aspiration (p=0.03 and 0.02 for SF and LF, respectively). Oral and pharyngeal lesions such as candidiasis, and other mucosal abnormalities, were also detected by FEES. CONCLUSION: Combining FEES with VFSS raised the diagnostic sensitivities of penetration, aspiration, and pharyngeal residues compared to the evaluation using VFSS alone. It also enabled the visualization of the abnormal structural changes in the pharyngolarynx. FEES can be performed safely by physiatrists.

Effect of Tracheostomy Tube on Swallowing in Patients with Stroke

OBJECTIVE: To investigate the characteristics and severity of swallowing difficulties among stroke patients with a tracheostomy tube, compared to those without. METHOD: A retrospective study was performed on two groups of 17 stroke patients with a tracheostomy tube (58.8 years) and without a tracheostomy tube (69.8 years) fed by Levine tube or a gastrostomy tube. There were no differences in the FIM (functional independence measure) score and brain lesions between the two groups. We evaluated the functional dysphagia scale (FDS) and aspiration; classified before, during, and after swallowing aspiration and silent aspiration. The swallowing task consisted of 2 ml of fluid and a videofluoroscopic swallowing study. RESULTS: There were no significant differences between the oral preparatory, oral and pharyngeal phase for the two groups in FDS. However, frequency of silent aspiration (p=0.007) and the total frequency of aspiration (p=0.038) were significantly higher in patients with tracheostomy. CONCLUSION: Patients with stroke who underwent tracheostomy showed no meaningful difference in FDS. However, there were significant differences in terms of silent aspiration and the total frequency of aspiration; caused by laryngopharyngeal desensitization and the anterior tethering effect on the tracheostomy tube. We have to pay more attention to the treatment and care of patients with tracheostomy tubes.

The effects of balloon dilatation on swallowing dysfunction in patients with dysphagia / 中华物理医学与康复杂志

Objective To study the effect of balloon dilatation therapy on dysphagia caused by cricopharyn- geal achalasia.Methods Ten cases of dysphagia were diagnosed as cricopharyngeal achalasia by videofluoroscopic swallowing study(VFSS).A 14~* urethral catheter was inserted into the esophagus and an amount of water was injec- ted into the balloon of the urethral catheter to make it turgid.Then the catheter was pulled upwards and passed through the stricture of esophagus to dilatate the cricopbarygeus muscle.Meanwhile,low frequency electrical stimula- tion was used and combined with functional training of the organs related to deglutition and ingestion.The results be- fore and after the treatment were evaluated.Results After 19.7 times of dilatation therapy,the content of water in- jected into the balloon was increased from 2.65?0.91 ml to 8.20?0.92 ml.Cricopharyngeal achalasia was alle- viated significantly(P

Digital Image Motion Analysis of the Pharyngeal Movement during Swallowing in Dysphagia Patients

OBJECTIVE: To reveal basic mechanism regarding the swallowing difficulty in stroke and inflammatory myopathy patients, and to compare this with normal persons. METHOD: Five volunteers without any swallowing problems, three inflammatory myopathy patients and five stroke patients with swallowing difficulty and a similar movement of the hyoid bone were included in this study. Videofluoroscopic swallowing studies were performed in all subjects, and their videofluoroscopic motions were analyzed through 2-dimensional motion analysis using the APAS (Ariel Performance Analysis System). RESULTS: The motions of the hyoid bone and the epiglottis of the inflammatory myopathy patients were much smaller than those of the volunteers but their pattern was similar to the volunteers. Although the difference in the displacement of the hyoid bone and epiglottis between the stroke patients and volunteers was low, the movement pattern between them was different. During an excursion of the hyoid bone, there was an interruption in its motion, which may be due to the spasticity of the cricopharyngeal muscle. CONCLUSION: In inflammatory myopathy patients, the cause of the dysphagia is a weakness of the swallow-related muscles but in stroke patients, spasticity of the upper esophageal constrictor muscle, i.e. the cricopharyngeal muscle, may be another cause. Relieving the spasticity of the cricopharyngeal muscle as well as strengthening of the swallow-related muscles should be considered when treating stroke patients with dysphagia.