ABSTRACT
The International Classification of Functioning, Disability, and Health (ICF) is an internationally recognized framework which allows its user to describe the consequences of a health condition on an individual in the context of their environment. With growing recognition that dysphagia can have broad ranging physical and psychosocial impacts, the aim of this paper was to identify the ICF domains and categories that describe the full functional impact of dysphagia following non-surgical head and neck cancer (HNC) management, from the perspective of the person with dysphagia. A secondary analysis was conducted on previously published qualitative study data which explored the lived experiences of dysphagia of 24 individuals with self-reported swallowing difficulties following HNC management. Categories and sub-categories identified by the qualitative analysis were subsequently mapped to the ICF using the established linking rules to develop a set of ICF codes relevant to the impact of dysphagia following HNC management. The 69 categories and sub-categories that had emerged from the qualitative analysis were successfully linked to 52 ICF codes. The distribution of these codes across the ICF framework revealed that the components of Body Functions, Activities and Participation, and Environmental Factors were almost equally represented. The findings confirm that the ICF is a valuable framework for representing the complexity and multifaceted impact of dysphagia following HNC. This list of ICF codes, which reflect the diverse impact of dysphagia associated with HNC on the individual, can be used to guide more holistic assessment and management for this population.
Subject(s)
Deglutition Disorders/classification , Head and Neck Neoplasms/complications , International Classification of Functioning, Disability and Health , Activities of Daily Living , Adult , Aged , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Deglutition Disorders/psychology , Disability Evaluation , Female , Head and Neck Neoplasms/therapy , Humans , Interpersonal Relations , Male , Middle AgedABSTRACT
Introducción. El concepto trastornos oromotores engloba al conjunto de enfermedades que afectan de forma predominante a las estructuras que intervienen en la movilidad facial y orofaríngea, y que son imprescindibles para una correcta mecánica de la alimentación y para la articulación del lenguaje y la expresividad facial. La alteración de estas funcionespuede afectar significativamente a la calidad de vida y a la integración social de estos pacientes. Pacientes y métodos. Estudio descriptivo retrospectivo de 64 pacientes diagnosticados de trastornos oromotores, controlados en el Servicio de Neurología Pediátrica del Hospital Universitari Vall dHebron. De cada uno de ellos, detallamos: etiología, edad de presentación, información acerca del trastorno de la alimentación, de la articulación del lenguaje y de posibles manifestaciones asociadas, y evolución durante el período de seguimiento de los diferentes aspectos clínicos. Resultados. La revisión de la casuística delservicio nos ha permitido clasificar a los enfermos afectos de trastornos oromotores en función de la localización de la lesión y su enfermedad de base, distribuyéndolos en cuatro grupos principales: pacientes con síndromes polimalformativos, con afectación cortical perisilviana, con disgenesia troncoencefálica y con afectación del sistema nervioso periférico. Conclusiones. La clasificación de los pacientes afectos de trastornos oromotores y el estudio de la evolución natural de cada uno de los grupos facilitan el abordaje y permiten optimizar el manejo y realizar una prevención adecuada de las posibles complicaciones de este tipo de pacientes
Introduction. The term oro-motor disorders refers to a group of diseases that predominantly affect sensory inputs, motor systems and movement organization involved in sucking, chewing, swallowing, speech articulation and facial nonverbal communication. Loss of any of the aforementioned functions results in poor social integration and significant quality of life reduction. Patients and methods. Retrospective, observational study of 64 patients with oro-motor disorders diagnosed andfollowed-up at the Child Neurology Service of Vall dHebron University Hospital. The oro-motor disorder cause, age at the beginning of symptoms, type of feeding difficulties, type of speech disorders and other associated clinical manifestations were investigated in all patients. Changes in clinical manifestations throughout the period of follow-up in this cohort wereanalyzed as well. Results. Classification of oro-motor disorders in childhood can be achieved combining the etiology and the anatomical location of the underlying disease. Four main groups can be distinguished: due to dysmorphological syndromes; secondary to bilateral perisylvian cortical dysplasias; due to brainstem dysgenesis, and secondary to congenital musculardiseases. Conclusions. Establishing the origin, nervous system location and pathophysiology of diseases leading to oro-motor disorders provides clues to natural history and permits anticipation in terms of treatment and care provision
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Motor Neuron Disease/classification , Deglutition Disorders/classification , Motor Neuron Disease/diagnosis , Clinical Evolution , Abnormalities, Multiple/classification , Abnormalities, Multiple/diagnosis , Deglutition Disorders/diagnosisABSTRACT
Between 1993 and 2001, 106 patients with esophageal cancer were reviewed at a multidisciplinary clinic and treated with palliative intent by chemoradiation therapy. This study assesses the palliative benefit on dysphagia and documents the toxicity of this treatment. The study population comprised 72 men and 34 women with a median age of 69 years. Patients were treated with a median radiation dose of 35 Gy in 15 fractions with a concurrent single course of 5 FU-based chemotherapy. Dysphagia was measured at the beginning and completion of treatment and at monthly intervals until death, using a modified DeMeester (4-point) score. Treatment was well tolerated, with only 5% of patients failing to complete therapy. The treatment-related mortality was 6%. The median survival for the study population was 7 months. The median baseline score at presentation was 2 (difficulty with soft food). Following treatment, 49% of patients were assessed as having a dysphagia score of 0 (no dysphagia). Seventy-eight per cent had an improvement of at least one grade in their dysphagia score after treatment. Only 14% of patients showed no improvement with treatment. Fifty-one per cent maintained improved swallowing until the time of last follow-up or death. This single-institution study shows that chemoradiation therapy administered for the palliation of malignant dysphagia is well tolerated and produces a sustainable normalization in swallowing for almost half of all patients.