The role of transcranial direct current stimulation in diminishing the risk of pneumonia in patients with dysphagia: A double-blinded randomized clinical trial.

Background: Dysphagia can be a life-threatening issue for post-stroke patients, with aspiration pneumonia (AP) being a common risk. However, there is hope through the potential combination of transcranial direct current stimulation (tDCS) and classical behavior therapy. Our study aims to investigate the effectiveness of this combination in diminishing the risk of AP in patients with dysphagia who suffered from stroke. Methods: In this randomized, parallel-group, blinded clinical trial, 48 patients were allocated into the sham group (speech therapy + 30 seconds of tDCS) and the real group (speech therapy + 20 minutes of tDCS). We used the Mann Assessment of Swallowing Ability (MASA) as an assessment tool. We assessed patients at baseline, one day after treatment, and at a one-month follow-up. Results: Groups showed no significant difference at baseline. After treatment, the real group showed a significant difference in the severity risk of AP (P = 0.02); the same was for the follow-up (P = 0.04). The number of patients showing severe risk of AP was higher in the sham group after treatment (n = 13, 54.20%) and at follow-up (n = 4, 18.20%) than the real group (n = 4, 16.70%; n = 1, 4.50%, respectively). None of the patients reported the history of AP at any stage of assessment. Conclusion: Although the results were more promising in the real group than the sham group in reducing the risk of AP, both techniques can prevent AP. Therefore, we recommend early dysphagia management to prevent AP regardless of the treatment protocol.

Knowledge, attitude, and practice regarding stroke potential complications among stroke survivors' family members in Shiraz, Iran.

Objectives: This study aimed to evaluate stroke survivors' family members' knowledge, attitude, and practice about these sequelae. Patients and methods: In this cross-sectional survey, 105 family members (57 males, 48 females; mean age: 48.3±9.7 years; range 18 to 60 years) of stroke survivors were examined via a self-structured questionnaire between September 2019 and January 2020. Patients' medical characteristics, as well as participants' sociodemographic and opinions regarding studying variables, were surveyed. Results: The participants were mostly married and had relatively high scores in knowledge, attitude, and practice questionnaires. We found a significant correlation between participants' knowledge and practice. Moreover, data analysis revealed significantly higher knowledge scores in the employed participants and higher practice scores in the urban population. Furthermore, the relationship of patients with their family members can affect their attitude toward stroke complications. Conclusion: This study has revealed that caregivers in rural areas with lower education levels are less knowledgeable about potential stroke complications, and subsequently, the patients are more vulnerable to those sequelae. Stakeholders should consider these groups their priorities in education and empowerment processes for stroke survivors' caregivers.

Improving Swallowing Function and Ability in Post Stroke Dysphagia: A Randomized Clinical Trial.

Post-stroke dysphagia is a prevalent, life threatening condition. Scientists recommended implementing behavioral therapies with new technologies such as transcranial direct current of stimulation (TDCS). Studies showed promising TDCS effects, and scientists suggested the investigation of the effectiveness of different montages. Supramarginal gyrus (SMG) is important in swallowing function. Our study aimed to investigate the effectiveness of stimulating SMG in improving post-stroke dysphagia. Forty-four patients finished the study (a randomized, double-blind one). All of them received behavioral therapy. The real group received anodal (2 mA, 20 min) stimulation on the intact SMG, and the sham group received the same for 30 s (5 sessions). Patients were assessed with Functional Oral Intake Scale (FOIS) and Mann Assessment of Swallowing Ability (MASA) after treatment and at one-month follow-up. The results showed that the difference between groups at baseline was not significant. According to MASA both groups improved significantly during the time (p-value < 0.001). The improvement in the real group was significantly higher than in the sham group after treatment (p-value = 0.002) and after one-month follow-up (p-value < 0.001). According to FOIS, most of the patients in the real group (72.70%) reached level 6 or 7 after one-month follow-up which was significantly higher than the sham group (31.80%, p-value = 0.007). In conclusion, TDCS applied to the scalp's surface associated with SMG localization may improve swallowing function in the stroke patients with dysphagia.

Comparing the Tongue and Lip Strength and Endurance of Children with Down Syndrome with Their Typical Peers Using IOPI.

Muscular hypotonia is a feature of Down syndrome (DS), and it affects the tongue and lips. A study on oral dysfunction in children with DS concluded that most of them did not have the tongue strength for completing the oral phase of swallowing. Recognizing the weakness of the oral muscles and improving its motor function positively affects mastication and swallowing, and prevents complications. This cross-sectional study aimed to measure the lip and tongue strength and endurance of children with DS and their typical peers, and compare these two groups with each other using Iowa Oral Performance Instrument (IOPI). Eight children with DS and 33 typical children aged 8-13 years were enrolled in this study. To examine the effect of age on the tongue strength and endurance, we divided the children into three groups of 8-9, 10-11, and 12-13 years old. The results showed that both anterior and posterior tongue strength were significantly lower in children with DS (p = 0.004 and 0.003). But, it was not the case with tongue endurance. Also, in 10-11 years old age group, the mean posterior tongue strength and in 12-13 years old age group the lip endurance was significantly lower in children with DS (p = 0.05 for both). Lips strength and endurance were both remarkably lower in children with DS (p = 0.004 and 0.02). In this study, tongue, and lip strength and endurance in both children with DS and typical ones were measured with IOPI for the first time. Moreover, it provided quantitative data on the strength and endurance of the muscles of the tongue and lips, which can contribute to future studies.

Letter to the Editor in Reference to the Article Entitled "Effects of Carbonated Liquids on Oropharyngeal Swallowing Measures in People with Neurogenic Dysphagia".

This letter is written according to stoichiometric calculation doubt about the article entitled "effects of carbonated liquids on oropharyngeal swallowing measures in people with neurogenic dysphagia" by Sdravou et al.

The impact of social media use on depression in multiple sclerosis patients.

Social media is a powerful tool in providing information and support for minority groups such as patients with chronic diseases. We aimed to assess the link between using online social media and depression in a sample population of Iranian Multiple Sclerosis (MS) patients. In this cross-sectional study, a number of MS patients between 18-55 years were recruited. The Persian-language version of the Beck Depression Inventory-II (BDI-II-Persian) was used to screen MS patients for depression. We selected a cut-off point of 16 to identify depressed MS patients, who answered the self-administered questionnaire designed by the authors (the validity and reliability was confirmed before). Patients, whose interaction with social networks and communication tools was limited to < 1 h/day for < 5 times/month, were allocated as controls. A two-sided p < 0.05 was considered statistically significant. We compared the depression score between patients who used internet and social media (16.38 ± 8.35) with those who did not (25 ± 13.98). We found out there was a significant difference (p = 0.046). However, there were no significant differences between the type (r = 0.098, p = 0.513) and duration (r = - 0.102, p = 0.564) of social media with depression score. Also, based on a cut-off of 3 number of social media there was no significant difference in the status of depression among patients (p = 0.921). Based on the experience of patients, it is helpful to implement a source using online social media to facilitate patients' access to rehabilitation support and establish support groups with standard supervised information delivery.

Dysphagia Management in Iran: Knowledge, Attitude and Practice of Healthcare Providers.

Despite the remarkable burden of dysphagia, appropriate multidisciplinary management is lacking in Iran and patients are often deprived of effective treatments. Obtaining a full understanding of knowledge, attitude and practice (KAP) of healthcare providers is necessary to determine the gaps in improvement of the quality of care for dysphagic patients. A questionnaire was designed covering demographic information and the parameters of KAP. Face and content validity were determined. Test-retest reliability confirmed that the questionnaire scores are stable over time (r = 0.77, p value < 0.01). Participants were healthcare providers employed in university-affiliated hospitals in three major cities of Iran; Tehran, Shiraz and Mashhad. In total, 312 healthcare professionals completed our survey. The majority (96.8%) were familiar with the term "dysphagia or swallowing disorders". Most of the participants believed their profession (88.5%), as well as other disciplines (92.3%) can play an important role in the management of dysphagia; and this problem should be recognized in a multidisciplinary manner (96.2%). Also, 60.9% had encountered a patient with dysphagia. 52.2% had used at least one assessment method, while 49.9% had applied at least one treatment method. However, very few participants were familiar with a standard test for screening and assessment of dysphagia (11.9%). 74.7% were willing to participate in a workshop on dysphagia. As the main pitfalls of care lie in diagnosis and treatment expertise, the policy of hospitals should prioritize educating and updating the skills of healthcare professionals, encourage multidisciplinary teamwork, establishing clear guidelines and facilitate access to advanced tools.