Deglutologist Practices and Perceptions of the Penetration-Aspiration Scale: A Survey Study.

Successful dysphagia management requires accurate, succinct diagnosis and characterization of swallowing safety impairments. However, the Penetration-Aspiration Scale (PAS) remains the only available tool developed exclusively for assessment of airway protection. To best support efforts to advance the field's understanding of swallowing safety, it is crucial to understand current clinician practice patterns, perceptions, and accuracy regarding the PAS. A 46-item survey was developed and distributed to deglutologists internationally examining: (1) Demographics; (2) Scale Practices; (3) Swallowing Safety Priorities; (4) Scale Perceptions; and (5) Accuracy. The first four sections consisted of questionnaires. In the optional fifth section, respondents were asked to score five videos of swallows collected via videofluoroscopy and previously PAS-scored by two trained raters. In total, 335 responses were analyzed. The majority of respondents self-reported PAS training (84%); 90% of untrained respondents were receptive to training. Respondents reported using the PAS "always" (40%) or "frequently" (29%), and that the PAS carries "a great deal of" weight in assessment (40%). Reported application of the PAS was heterogeneous, with the most common approach being "single worst score per unique presentation" (45%). Most respondents (64%) prioritized a parameter not captured by the PAS. Untrained respondents were significantly more confident with PAS ratings than trained respondents (X2 = 7.47; p = 0.006). Of 1460 PAS ratings provided, 364 of them were accurate (25%) when compared to ratings by trained lab members. Results of this survey reflect ubiquitous use of the PAS, unmet needs for assessment of swallowing safety, low accuracy despite generally high confidence, and heterogenous training that does not correspond to confidence. This emphasizes the need for additional training in clinical application of the PAS as well as development of novel metrics to optimize assessments of swallowing safety.

Use of deep learning to segment bolus during videofluoroscopic swallow studies.

Anatomical segmentations generated using artificial intelligence (AI) have the potential to significantly improve video fluoroscopic swallow study (VFS) analysis. AI segments allow for various metrics to be determined without additional time constraints streamlining and creating new opportunities for analysis. While the opportunity is vast, it is important to understand the challenges and limitations of the underlying AI task. This work evaluates a bolus segmentation network. The first swallow of thin or liquid bolus from 80 unique patients were manually contoured from bolus first seen in the oral cavity to end of swallow motion. The data was split into a 75/25 training and validation set and a 4-fold cross validation was done. A U-Net architecture along with variations were tested with the dice coefficient as the loss function and overall performance metric. The average validation set resulted in a dice coefficient of 0.67. Additional analysis to characterize the variability of images and performance on sub intervals was conducted indicating high variability among the processes required for training the network. It was found that bolus in the oral cavity consistently degrades performance due to misclassification of teeth and unimportant residue. The dice coefficients dependence on structure size can have substantial effects on the reported value. This work shows the efficacy of bolus segmentation and identifies key areas that are detriments to the performance of the network.

Effects of Device-Facilitated Lingual Strengthening Therapy on Dysphagia Related Outcomes in Patients Post-Stroke: A Randomized Controlled Trial.

BACKGROUND: Swallowing impairments resulting from stroke have few rehabilitative options. Prior evidence suggests lingual strengthening exercise may provide some benefit, but more randomized controlled trials are required. The purpose of this study was to examine efficacy of progressive lingual resistance training on lingual pressure generative capacity and swallowing outcomes for individuals with dysphagia after stroke. METHODS: Participants with dysphagia within 6 months of acute stroke were randomly assigned to: (1) treatment: progressive resistance tongue exercise using pressure sensors for 12 weeks with usual care; or (2) control: usual care only. Outcomes were measured at baseline, 8 and 12 weeks to assess group differences in lingual pressure generation, swallow safety, efficiency, oral intake, and swallowing quality of life. RESULTS: Final sample included 19 participants [treatment (N = 9) and control (N = 10)] with 16 males and 3 females (mean age = 69.33). Functional Oral Intake Scale (FOIS) scores improved significantly (p = 0.04) in the treatment group from baseline to 8 weeks compared to usual care (control). No significant differences between treatment groups were identified for other outcomes; large effect sizes were detected for group differences in lingual pressure generative capacity from baseline to 8 weeks at the anterior sensor (d = .95) and posterior sensor (d = 0.96), and vallecular residue of liquids (baseline to 8-week d = 1.2). CONCLUSIONS: Lingual strengthening exercise resulted in significant improvements in functional oral intake for patients with post-stroke dysphagia as compared to usual care after 8 weeks. Future studies should include a larger sample size and address treatment impact on specific aspects of swallow physiology.

Effects of Food and Liquid Properties on Swallowing Physiology and Function in Adults.

Foods and liquids have properties that are often modified as part of clinical dysphagia management to promote safe and efficient swallowing. However, recent studies have questioned whether this practice is supported by the evidence. To address this, a scoping review was conducted to answer the question: "Can properties of food and liquids modify swallowing physiology and function in adults?" Online search in six databases yielded a set of 4235 non-duplicate articles. Using COVIDENCE software, two independent reviewers screened the articles by title and abstract, and 229 full-text articles were selected for full-text review. One-hundred eleven studies met the inclusion criteria for qualitative synthesis and assessment of risk of bias. Three randomized controlled trials and 108 non-randomized studies were analyzed. Large amounts of variability in instrumental assessment, properties of food and liquids, and swallowing measures were found across studies. Sour, sweet, and salty taste, odor, carbonation, capsaicin, viscosity, hardness, adhesiveness, and cohesiveness were reported to modify the oral and pharyngeal phase of swallowing in both healthy participants and patients with dysphagia. Main swallow measures modified by properties of food and liquids were penetration/aspiration, oral transit time, lingual pressures, submental muscle contraction, oral and pharyngeal residue, hyoid and laryngeal movement, pharyngeal and upper esophageal sphincter pressures, and total swallow duration. The evidence pooled in this review supports the clinical practice of food texture and liquid consistency modification in the management of dysphagia with the caveat that all clinical endeavors must be undertaken with a clear rationale and patient-specific evidence that modifying food or liquid benefits swallow safety and efficiency while maintaining quality of life.

The Relationship Between Menopause and Dysphagia: A Scoping Review.

Purpose: Menopause marks the end of fertility and rapid decline of ovarian hormones in the female body, which corresponds to a myriad of changes to bodily systems, including the upper aerodigestive tract. Despite substantial evidence that menopause negatively impacts oral health, bones, and skeletal muscles, little research has examined these effects as they relate to swallowing. The purpose of this scoping review was to compile and summarize the existing literature investigating the relationship between menopause and swallowing-related structures and physiology. Methods: Search terms were selected for three databases (PubMed, Scopus, and CINAHL) to gather relevant literature evaluating the relationship between menopause and swallowing-related anatomy as well as swallowing functions in both human and animal models. Relevant articles were reviewed, collated, and summarized to synthesize findings, identify gaps in the literature, and provide suggestions for future directions. Results: This scoping review yielded 204 studies with the majority of these studies relating to one or more of the following categories: oral health, saliva, mandibular structures, and taste. Common oral symptoms reported in the literature included xerostomia, hyposalivation, tooth decay, inflammation of oral mucosa, and oral pain. Although literature supports that menopause adversely affects oral health, saliva, mandibular structures, and alters taste, a dearth of information was evident regarding how these hormone-dependent changes can adversely affect swallowing. Conclusions: The relationship between menopause and swallowing has been overlooked by field of speech-language pathology. By identifying the major gaps in the literature, these results will inform future investigations evaluating relationships among ovarian hormones and swallowing.

Percepción de un grupo de adultos mayores con presbifagia sobre el fenómeno de la alimentación y las propiedades organolépticas de los alimentos / Perception of feeding phenomenon and organoleptic properties of food by a group of elderly people with presbyphagia

El envejecimiento conlleva cambios fisiológicos y no fisiológicos que afectan la percepción del adulto mayor sobre el fenómeno de la alimentación, sin embargo, las investigaciones internacionales podrían no representar a la población chilena, existiendo escasa información acerca de la percepción del adulto mayor con presbifagia y los factores que influyen en su alimentación. El objetivo del presente estudio cualitativo y de diseño fenomenológico es conocer la percepción de los adultos mayores con presbifagia sobre el fenómeno de la alimentación, abarcando factores fisiológicos y no fisiológicos, junto a las propiedades organolépticas de los alimentos que prefieren. Para ello se aplicó una entrevista semiestructurada a ocho adultos mayores con presbifagia asistentes a un Centro de Actividades Prácticas (muestreo por saturación). El discurso se procesó mediante codificación axial en dos niveles: formación de códigos (a través de citas del entrevistado), memos (conceptos de los investigadores) y la codificación selectiva, mediante la integración de los códigos en familias, aplicando el método de comparaciones constantes, utilizando Atlas.ti 6. Los resultados indican que en la alimentación intervienen factores sociales y psicológicos. Las propiedades organolépticas que influyen en la percepción del adulto mayor son: tamaño, consistencia, sabor, temperatura e intensidad del color, las cuales afectan la elección de los alimentos. En conclusión la percepción del adulto mayor con presbifagia sobre la alimentación, está influenciada por factores fisiológicos y no fisiológicos, los cuales determinan la preferencia de propiedades organolépticas y elección de alimentos. Además de encontrarse influenciada por hábitos alimentarios adquiridos y ubicación geográfica(AU)

Aging involves physiological and non-physiological changes that affect the perception of the elderly on the phenomenon of food, however, international investigations could not represent the Chilean population, because of the little information about the perception of the elderly with presbyphagia and the factors that influence their diet. The purpose of this qualitative study with phenomenological design is to know the perception of older adults with presbyphagia about food phenomenon, considering physiological and non-physiological factors along with the organoleptic properties of foods that they prefer. For this, a semistructured interview was applied to eight older adults with presbyphagia attending at the Practical Activities Center (sampling by saturation). The speech was processed through axial coding in two levels: formation of codes (through appointments of the interviewee), memos (concepts of researchers) and selective coding, through the integration of family codes, applying the method of constant comparisons, using Atlas.ti 6. The results indicate that social and psychological factors are involved in feeding. Organoleptic properties that influence the perception of the elderly are: size, consistency, taste, temperature and intensity of the color, which affect the choice of food. In conclusion the perception of the elderly with presbyphagia food, is influenced by physiological and non-physiological factors which determine the preference of organoleptic properties and food choices. In addition to being influenced by acquired habits and geographic location(AU)

Asociación entre el patrón postural cefálico y la inteligibilidad articulatoria del habla / Relationship between postural cephalic pattern and speech intelligibility

RESUMEN Objetivo: el propósito de este estudio fue establecer un factor asociativo que relacione la morfología del sistema cráneo - cervical con el nivel de inteligibilidad articulatoria del habla en sujetos jóvenes. Métodos: estudio transversal, consideró una muestra de 42 jóvenes universitarios de un universo de 140, ambos sexos, sin antecedentes mórbidos y con un rango de edad entre 18 y 21 años. Se evalúo: a) inteligibilidad articulatoria mediante el coeficiente de variación periódica diadococinética, b) parámetros posturales estáticos tradicionales mediante método fotogramétrico y c) patrón postural cefálico mediante radiografía cefalométrica lateral. Resultados: se encontraron 36 sujetos con inteligibilidad adecuada y 6 alterada, donde la variable rotación cráneo cervical antero-posterior presentó diferencias estadísticamente significativas (p= 0,009) entre el grupo con inteligibilidad normal respecto al grupo con inteligibilidad alterada. El análisis de regresión lineal evidenció que sujetos que presentan rotación posterior de cabeza sobre cuello presentan mayor variabilidad en la emisión silábica del rendimiento diadocinético del habla (Sq r lineal = 0,128). Conclusión: se establece que la postura cefálica con presencia de rotación posterior de la cabeza sobre el cuello se asocia a la pérdida de inteligibilidad del habla en la muestra estudiada.

ABSTRACT Purpose: the objective of this study was to establish an associative factor that connects the morphology of the craniocervical system with the articulatory speech intelligibility level in young subjects. Methods: a cross-sectional study which considered a sample of 42 university students from a universe of 140, both male and female, without morbid background ranging between 18 and 21 years of age. Evaluated aspects: a) articulatory intelligibility by the diadochokinetic periodic variation coefficient, b) traditional static postural parameters using the photogrammetric method, and c) cephalic postural pattern by lateral cephalometry (X-ray) Results: 36 subjects with adequate intelligibility and 6 with altered intelligibility where the anteroposterior cranio-cervical rotation variable showed significant differences (p = 0.009) between the group with normal intelligibility and the group with impaired intelligibility. The linear regression analysis demonstrated that subjects with posterior head-neck rotation exhibited more variability in the syllable emission of diadochokinetic speech performance (Sq r linear = 0.128). Conclusion: it is established that the cephalic position with subsequent posterior head-neck rotation is associated with the loss of speech intelligibility in the studied sample.

Factores asociados a la disfagia orofaríngea postictus / Factors associated with post-stroke oropharingeal dysphagia

Introducción. La disfagia neurógena es una secuela del ictus que en ocasiones pone en riesgo la vida del paciente. La magnitud del daño cerebral generado por el ictus comúnmente ocasiona la aparición de otros trastornos que acompañan a la disfagia y agravan la salud del paciente. Objetivo. Analizar posibles asociaciones entre trastornos de la comunicación, factores propios de la enfermedad, demográficos y comórbidos con disfagia en pacientes que sufrieron un ictus durante el ingreso hospitalario entre los años 2009 y 2011. Pacientes y métodos. Se estudiaron 1.519 historias clínicas de pacientes que presentaron ictus entre los años 2009 y 2011. Resultados. De los registros analizados, 206 presentaron disfagia (13,6%). El 80,1% de los casos de disfagia se concentró en pacientes de 60-89 años. El 66% de ellos permaneció hospitalizado durante más de 11 días. La edad (odds ratio = 2,36; p < 0,001), afasia (odds ratio = 4,47; p < 0,001), disartria (odds ratio = 4,95; p < 0,001), tiempo de hospitalización (odds ratio = 3,65; p < 0,001) e hipertensión arterial (odds ratio = 1,64; p = 0,023) se asociaron estadísticamente con disfagia. Finalmente, en el 73,3% de los casos con disfagia, se presentó disfagia más afasia o disartria o apraxia del habla, mientras que sólo el 26,7% tuvo exclusivamente disfagia. Conclusiones. La disfagia neurógena parece concomitar con trastornos de la comunicación, aumentar el tiempo de hospitalización y asociarse a hipertensión arterial. Sin embargo, se requieren estudios prospectivos que consideren un gran período de tiempo para confirmar estos hallazgos (AU)

Introduction. Neurogenic dysphagia is a consequence of stroke that sometimes threatens the patient’s life. The magnitude of the brain damage commonly generated by stroke generates the emergence of other disorders that accompany dysphagia and worsen the patient’s health. Aim. To analyze possible associations between communication disorders, disease factors, demographic factors and comorbidities with post-stroke dysphagia in years 2009 to 2011. Patients and methods. We studied 1519 medical records of patients that suffered stroke between 2009 and 2011. Results. From medical records reviewed, 206 had dysphagia (13.6%). 80,1% from dysphagic patients had between 60 to 89 years old. 66% from them stayed hospitalized for more than 11 days. Age (odds ratio = 2.36; p < 0.001), aphasia (odds ratio = 4.47; p < 0.001), dysarthria (odds ratio = 4.95; p < 0.001), time of hospitalization (odds ratio = 3.65; p < 0.001) and hypertension (odds ratio = 1.64; p = 0.023) were statistically associated with dysphagia. Finally, 73,3% from dysphagic patients they had dysphagia with aphasia or dysarthria or apraxia of speech, however, 26,7% only had dysphagia. Conclusion. Neurogenic dysphagia seems to be associated with communication disorders, increase the time of hospitalization and associated with a hypertension. However, prospective studies consider a great time to confirm these findings are required (AU)

[Factors associated with post-stroke oropharingeal dysphagia]. / Factores asociados a la disfagia orofaringea postictus.

INTRODUCTION: Neurogenic dysphagia is a consequence of stroke that sometimes threatens the patient's life. The magnitude of the brain damage commonly generated by stroke generates the emergence of other disorders that accompany dysphagia and worsen the patient's health. AIM: To analyze possible associations between communication disorders, disease factors, demographic factors and comorbidities with post-stroke dysphagia in years 2009 to 2011. PATIENTS AND METHODS: We studied 1519 medical records of patients that suffered stroke between 2009 and 2011. RESULTS: From medical records reviewed, 206 had dysphagia (13.6%). 80,1% from dysphagic patients had between 60 to 89 years old. 66% from them stayed hospitalized for more than 11 days. Age (odds ratio = 2.36; p < 0.001), aphasia (odds ratio = 4.47; p < 0.001), dysarthria (odds ratio = 4.95; p < 0.001), time of hospitalization (odds ratio = 3.65; p < 0.001) and hypertension (odds ratio = 1.64; p = 0.023) were statistically associated with dysphagia. Finally, 73,3% from dysphagic patients they had dysphagia with aphasia or dysarthria or apraxia of speech, however, 26,7% only had dysphagia. CONCLUSION: Neurogenic dysphagia seems to be associated with communication disorders, increase the time of hospitalization and associated with a hypertension. However, prospective studies consider a great time to confirm these findings are required.

TITLE: Factores asociados a la disfagia orofaringea postictus.Introduccion. La disfagia neurogena es una secuela del ictus que en ocasiones pone en riesgo la vida del paciente. La magnitud del daño cerebral generado por el ictus comunmente ocasiona la aparicion de otros trastornos que acompañan a la disfagia y agravan la salud del paciente. Objetivo. Analizar posibles asociaciones entre trastornos de la comunicacion, factores propios de la enfermedad, demograficos y comorbidos con disfagia en pacientes que sufrieron un ictus durante el ingreso hospitalario entre los años 2009 y 2011. Pacientes y metodos. Se estudiaron 1.519 historias clinicas de pacientes que presentaron ictus entre los años 2009 y 2011. Resultados. De los registros analizados, 206 presentaron disfagia (13,6%). El 80,1% de los casos de disfagia se concentro en pacientes de 60-89 años. El 66% de ellos permanecio hospitalizado durante mas de 11 dias. La edad (odds ratio = 2,36; p < 0,001), afasia (odds ratio = 4,47; p < 0,001), disartria (odds ratio = 4,95; p < 0,001), tiempo de hospitalizacion (odds ratio = 3,65; p < 0,001) e hipertension arterial (odds ratio = 1,64; p = 0,023) se asociaron estadisticamente con disfagia. Finalmente, en el 73,3% de los casos con disfagia, se presento disfagia mas afasia o disartria o apraxia del habla, mientras que solo el 26,7% tuvo exclusivamente disfagia. Conclusiones. La disfagia neurogena parece concomitar con trastornos de la comunicacion, aumentar el tiempo de hospitalizacion y asociarse a hipertension arterial. Sin embargo, se requieren estudios prospectivos que consideren un gran periodo de tiempo para confirmar estos hallazgos.

Propiedades psicométricas y utilidad diagnóstica del ‘screening léxico para las afasias’ / Psychometric properties and diagnostic value of ‘lexical screening for aphasias’

Introducción. La evaluación del lenguaje en personas con lesión cerebral permite conocer si éstas requerirán o no rehabilitación de lenguaje. Debido a la importancia de una evaluación precisa, los instrumentos de evaluación deben ser válidos y fiables, con el fin de evitar diagnósticos equivocados y subjetivos. Objetivo. Validar el ‘screening léxico para las afasias’ (SLA) en una muestra de 58 individuos chilenos. Sujetos y métodos. Se construyó una prueba de lenguaje, tipo cribado, de 20 minutos de duración y basada en el modelo de procesamiento léxico de Patterson y Shewell de 1987. La muestra estuvo compuesta por dos grupos, 29 sujetos afásicos y 29 sujetos control, pertenecientes a distintos centros de salud de las regiones del Biobío y del Maule, Chile. Sus edades fluctuaban entre 24 y 79 años, y sus años de escolaridad, de 0 a 17. Se determinó validez discriminante, validez concurrente con la batería para la evaluación de los trastornos afásicos (BETA), fiabilidad, sensibilidad y especificidad. Resultados. El análisis estadístico mostró una alta validez discriminante (p < 0,001), aceptable validez concurrente media con la BETA (rs = 0,65), una alta fiabilidad media (alfa = 0,87), una moderada sensibilidad media (69%) y una alta especificidad media (86%). Conclusión. El SLA es válido y fiable para evaluar el lenguaje de personas con afasias, es sensible para detectar sujetos afásicos y es específico para descartar trastornos del lenguaje en personas con lenguaje normal (AU)

Introduction. Language assessment in persons with brain injury makes it possible to know whether they require language rehabilitation or not. Given the importance of a precise evaluation, assessment instruments must be valid and reliable, so as to avoid mistaken and subjective diagnoses. Aim. To validate ‘lexical screening for aphasias’ in a sample of 58 Chilean individuals. Subjects and methods. A screening-type language test, lasting 20 minutes and based on the lexical processing model devised by Patterson and Shewell (1987), was constructed. The sample was made up of two groups containing 29 aphasic subjects and 29 control subjects from different health centres in the regions of Biobío and Maule, Chile. heir ages ranged between 24 and 79 years and had between 0 and 17 years’ schooling. Tests were carried out to determine discriminating validity, concurrent validity with the aphasia disorder assessment battery, reliability, sensitivity and specificity. Results. The statistical analysis showed a high discriminating validity (p < 0.001), an acceptable mean concurrent validity with aphasia disorder assessment battery (rs = 0.65), high mean reliability (alpha = 0.87), moderate mean sensitivity (69%) and high mean specificity (86%). Conclusion. ‘Lexical screening for aphasias’ is valid and reliable for assessing language in persons with aphasias; it is sensitive for detecting aphasic subjects and is specific for precluding language disorders in persons with normal language abilities (AU)