Preliminary evidence of the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) on swallowing functions in post-stroke individuals with chronic dysphagia.

BACKGROUND: There is growing evidence of potential benefits of repetitive transcranial magnetic stimulation (rTMS) in the rehabilitation of dysphagia. However, the site and frequency of stimulation for optimal effects are not clear. AIMS: The aim of this pilot study is to investigate the short-term effects of high-frequency 5 Hz rTMS applied to the tongue region of the motor cortex on swallowing functions and the quality of life of post-stroke individuals with dysphagia. METHODS & PROCEDURES: Two male and two female participants were assigned randomly to active and sham groups. The participants in the active group received 10 sessions of active rTMS for 2 weeks, whereas the sham participants received 10 sessions of sham rTMS for 2 weeks. Each participant received a total of 3000 pulses of 5 Hz active or sham rTMS per day for 10 days. Outcome measures were taken at baseline, 1 week and 1 month post-rTMS. OUTCOMES & RESULTS: Participants who received active rTMS had improved swallowing functions and swallowing-related quality of life at 1 week and 1 month post-stimulation. CONCLUSIONS & IMPLICATIONS: The study showed that excitatory rTMS applied over the tongue motor cortex is a feasible approach in individuals with chronic post-stroke dysphagia. Further investigation with larger sample population is warranted to support the benefit of this stimulation protocol.

Swallowing disorders following free jejunal flap reconstruction of circumferential pharyngeal defect: Does Botox help?

OBJECTIVES: Free jejunal flap for circumferential pharyngeal reconstruction is associated with late-onset dysphagia, regurgitation and prolonged transit time. This study aims to assess the feasibility and efficacy of Botulinum toxin A (Botox) in alleviating such swallowing dysfunction. MATERIALS AND METHODS: Twenty-six consecutive patients underwent free jejunal flap for circumferential pharyngeal reconstruction between January 2012 and December 2018. Outcomes were compared at 6, 12 and 24 months. RESULTS: In the non-Botox group (n = 13), video-fluoroscopic and manometry studies demonstrated asynchronous contractions and retrograde propulsion. All patients complained of nasal regurgitation on thin fluids at 6, 12 and 24 months. Bolus residue accumulation along jejunal mucosal folds resulted in prolonged transit time. In the Botox group (n = 13), amplitude of asynchronous contractions were lower: 25.4 mmHg vs. 52.1 mmHg (p = 0.037) for thin fluids at 12 months. Three patients complained of nasal regurgitation on thin fluids at 6 months. All 3 were asymptomatic at 12 months. Transit time was shortened overall. Functional Oral Intake Scale was higher. MD Anderson Dysphagia Inventory global (72.5% vs 45.7%, p = 0.003) and functional (62.0% vs 40.6%, p = 0.012) subscales were significantly improved at 24 months. CONCLUSION: Botox safely and effectively alleviates swallowing dysfunction associated with free jejunal flap for circumferential pharyngeal reconstruction.

Validation of the Mandarin Chinese Version of the Pediatric Voice-Related Quality of Life (pVRQOL).

OBJECTIVES: The purposes of this study were to adapt and validate the English version of the pediatric Voice-Related Quality of Life questionnaire into Mandarin Chinese, and to determine the cutoff point for screening children with and without voice disorders. METHODS: A total of 377 parents were enrolled from May 2016 to June 2017, including 195 parents of children with voice disorder (patient group) and 182 parents of children without voice disorder (control group). The internal consistency, test-retest, contents and clinical validity, and sensitivity and specificity were analyzed. The clinical cutoff point was determined. RESULTS: The questionnaire showed strong internal consistency in the patient group (α = 0.89 for the total score, α = 0.88 for the social-emotional domain, and α = 0.81 for the physical functioning domain) and good test-retest reliability (intra-class correlation coefficient = 0.93), as well as moderate to strong contents validity (r = 0.72-0.95). The total score and subscales scores in the patient group were significantly higher than the control group (P < 0.001). The mean score of the physical functioning domain was lower than that of the social-emotional domain in the patient group. The clinical cutoff point was 96.25 (sensitivity = 78.0%, specificity = 100.0%). CONCLUSION: The Mandarin Chinese version of pediatric Voice-related Quality of Life questionnaire was a valid and reliable questionnaire, which can be used as a screening test for the pediatric population with and without voice disorders.

Comparison and correlation between the pediatric Voice Handicap Index and the pediatric voice-related quality-of-life questionnaires.

The aim of this study was to investigate differences and correlations between the pediatric Voice Handicap Index (pVHI) and the pediatric Voice-Related Quality-of-life (pVRQOL) questionnaires in children with and without voice disorders. This was a cross-sectional study.A total of 418 parents with children aged 2 to 14 years participated in this study from May 2016 to July 2017. This included 221 parents of children with voice disorders (dysphonic group) and 197 parents of children without voice disorders (control group). The scores for the pVHI and the pVRQOL were compared, and correlation analysis was performed.Compared with the control group, the dysphonic group had a significantly higher total score and subscale scores for the pVHI (P < .001), and significantly lower pVRQOL scores (P < .001). The pVHI showed greater differences in subscale scores among the three dysphonic subgroups than the pVRQOL. The Spearman correlation coefficient between the pVHI and pVRQOL was -0.844 (P < .001). The total scores for the pVHI and pVRQOL also correlated significantly for each diagnostic category (P < .001).Voice-related quality of life was poorer in children with voice disorders than in those without voice disorders. The pVHI and pVRQOL scores were moderately- to strongly correlated. These may be useful tools for assessing the voice-related quality of life in children. The pVHI may provide more useful details about the effects of different types of voice disorders on the voice-related quality of life than the pVRQOL.

Adaptation and validation of Mandarin Chinese version of the pediatric Voice Handicap Index (pVHI).

OBJECTIVE: The aim of this study was to adapt and validate the English version of pediatric voice handicap index (pVHI) into Mandarin Chinese. METHODS: A cross-sectional study was performed from May 2016 to April 2017. A total of 367 parents participated in this study, and 338 parents completed the translated questionnaire without missing data, including 213 parents of children with voice disorders (patients group), and 125 parents of children without voice disorders (control group). The internal consistency, test-retest reliability, contents validity, construct validity, clinical validity, and cutoff point were calculated. RESULTS: The most common voice disorder in the patients group was vocal fold nodules (77.9%), followed by chronic laryngitis (18.8%), and vocal fold polyps (3.3%). The prevalence for voice disorders was higher in boys (67.1%) than girls (32.9%). The most common vocal misuse and abuse habit was shouting loudly (n = 186, 87.3%), followed by speaking for a long time (n = 158, 74.2%), and crying loudly (n = 99, 46.5%). The internal consistency for the Mandarin Chinese version of pVHI was excellent in patients group (Cronbach α = 0.95). The inter-class correlation coefficient indicated strong test-retest reliability (ICC = 0.99). The principal-component analysis demonstrated three-factor eigenvalues greater than 1, and the cumulative proportion was 66.23%. The mean total scores and mean subscales scores were significantly higher in the patients group than the control group (p < 0.05). The physical domain had the highest mean score among the three subscales (functional, physical and emotional) in the patients group. The optimal cutoff point of the Mandarin Chinese version of pVHI was 9.5 points with a sensitivity of 80.3% and a specificity of 84.8%. CONCLUSION: The Mandarin Chinese version of pVHI was a reliable and valid tool to assess the parents' perception about their children's voice disorders. It is recommended that it can be used as a screening tool for discriminating between children with and without dysphonia.

Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia: A randomized controlled study.

OBJECTIVE: There are potential benefits of repetitive transcranial magnetic stimulation (rTMS) in improving swallowing functions after stroke; however, few studies have been performed in the chronic stroke population. This study aims to distil the key effects of rTMS on swallowing functions and swallowing-related quality of life. METHODS: Twenty-two participants with chronic post-stroke dysphagia were randomly assigned into active or sham rTMS groups. Seven participants withdrew from the study, thus data from 15 participants (mean age 64.6 years) were analysed. Participants received 3,000 pulses of 5 Hz rTMS (active: n = 11; sham: n = 4) on the tongue area of the motor cortex for 10 days over a period of 2 weeks. All participants were assessed 1 week before, and 2 months, 6 months and 12 months after stimulation. Outcomes were measured by a videofluoroscopic swallowing study, swallowing-related quality-of-life questionnaire and Iowa Oral Performance Instrument. RESULTS: No statistically significant effects were identified for any outcome measures. CONCLUSION: This study indicates that 5 Hz rTMS applied over the tongue area of the motor cortex is not effective for improving swallowing function in individuals with chronic post-stroke dysphagia. Possible explanations for these non-significant results are dis cussed. Future studies should explore the potential of the current protocol in conjunction with conventional dysphagia therapy.