Residual effect of sequential 4-channel neuromuscular electrical stimulation evaluated by high-resolution manometry.

BACKGROUND: High-resolution manometry (HRM) can quantify swallowing pathophysiology to evaluate the status of the pharynx. Sequential 4-channel neuromuscular electrical stimulation (NMES) was recently developed based on the normal contractile sequences of swallowing-related muscles. This study aimed to examine the effects of sequential 4-channel NMES for compensatory application during swallowing and to observe the residual effects after the application of NMES using HRM. RESULTS: Sequential 4-channel NMES significantly improved the HRM parameters, with respect to the maximal pressure and area of the velopharynx (VP), maximal pressure and area of the mesopharynx (MP), and upper esophageal sphincter (UES) activation and nadir duration. Furthermore, the improvement in the pressure and area variables of the VP and MP showed a tendency to maintain even when measured after NMES, but there are no significant differences. CONCLUSIONS: The present study suggests that the sequential 4-channel NMES application of the suprahyoid and infrahyoid muscles during swallowing improves the pressure, area, and time variables of the oropharynx, as measured by HRM, and it is likely that the effects may persist even after stimulation. Trial Registration Clinicaltrials.gov, registration number: NCT02718963 (initial release: 03/20/2016, actual study completion date: 06/24/2016, last release: 10/20/2020).

Exploring predictors of dysphagia in survivors of head and neck cancer: A cross-sectional study.

PURPOSE: To evaluate the prevalence of dysphagia in survivors of head and neck cancer (sHNC) and to identify the predictors contributing to the development of dysphagia. METHODS: We enrolled 62 sHNC in a cross-sectional study to check the prevalence of dysphagia in sHNC and to evaluate which factors were influencing the presence of this side effect. Besides dysphagia, sociodemographic and clinical characteristics, oral symptoms, maximal mouth opening (MMO), sleep quality and physical condition were evaluated, and a linear regression analysis was performed to verify which of these outcomes impact dysphagia. RESULTS: Among all the sHNC, 85.5% presented dysphagia. The linear regression analysis confirmed that 44.9% of the variance in dysphagia was determined by coughing, MMO and sleep quality, being MMO the most powerful predictor, followed by coughing and sleep quality. CONCLUSION: Dysphagia affected the great majority of sHNC. Moreover, symptoms as coughing, reduced MMO and sleep disorders may act as predictors contributing to the development of dysphagia. Our results emphasize the importance of an early and proper identification of the symptoms as well as an adequate treatment strategy to address the cluster of symptoms that sHNC undergo.

Measurement of surface electromyography activity during swallowing in paediatrics: a scoping literature review.

Surface electromyography (sEMG) could be used for diagnostic and therapeutic purposes in various health conditions. For example, sEMG biofeedback is shown to be beneficial in adults with swallowing disorders (dysphagia), whereas there are no easily identifiable studies to support such evidence in paediatrics. The current review aimed to evaluate the feasibility of implementing sEMG during swallowing tasks in paediatric populations with various diagnoses. Additionally, the review aimed to describe findings in publications involving participants with cerebral palsy (CP) and dysphagia. Paediatric-related publications were sourced using English keywords and phrases across the following seven databases: PubMed, EMBASE, CINAHL, Web of Science, PsycINFO, and ProQuest Dissertations and Theses Global. The search included all available publications without language and date restrictions. Publications using sEMG during chewing tasks were also accepted in the review as chewing is considered to be part of the act of swallowing. The feasibility of measuring sEMG during swallowing in children with various health conditions was supported by 116 publications (n = 6 literature reviews) that met the inclusion criteria for the final full-text review. However, a few publications described some difficulties occurring directly during the sEMG data collection sessions. The review identified 15 publications involving 177 participants with CP who underwent sEMG while swallowing (n = 1 publication focused solely on the assessment of chewing). Ten publications described studies that recruited children with dysphagia. Children with CP who had dysphagia were recruited in five of these studies. CONCLUSIONS: The acquisition of sEMG measurements while performing swallowing tasks was shown to be feasible in children with various diagnoses including those who have CP and dysphagia. Future studies should investigate the implementation of sEMG as a part of paediatric dysphagia therapy alongside biofeedback swallowing skill training. WHAT IS KNOWN: • Surface electromyography (sEMG) could be implemented for diagnostic and therapeutic purposes in various health conditions. • Biofeedback using sEMG is beneficial in adults with swallowing disorders (dysphagia). WHAT IS NEW: • Implementation of sEMG was shown to be feasible during swallowing tasks in paediatric populations with various diagnoses, including dysphagia and cerebral palsy. • The usage of sEMG biofeedback as a part of paediatric dysphagia management should be investigated in future studies.

Efficacy of leuprorelin in spinal and bulbar muscular atrophy: a 3-year observational study.

OBJECTIVE: This study aimed to investigate the long-term effects and functional outcomes of androgen suppression therapy using leuprorelin among Korean patients with spinal and bulbar muscular atrophy (SBMA). METHODS: This observational study enrolled patients with genetically confirmed SBMA who provided informed consent. Leuprorelin was administered via subcutaneous injection every 12 weeks. The primary outcome measure was the change in total Spinal and Bulbar Muscular Atrophy Functional Rating Scale (SBMAFRS) scores. RESULTS: A total of 48 SBMA patients were evaluated in this study. Among them, 39 patients underwent androgen suppression therapy over a 3-year period. The total SBMAFRS score decreased from 41.72 ± 5.55 to 36.74 ± 7.74 (p < 0.001) in patients who completed their treatment. The subgroup with a baseline SBMAFRS score of ≥ 42 had a significantly lower decline in SBMAFRS score than did those with a baseline SBMAFRS score of ≤ 41. We determined that at a baseline, SBMAFRS cutoff value of 41.5 could predict good prognosis, with a corresponding area under the curve of 0.689. CONCLUSION: Despite androgen suppression therapy, all enrolled participants exhibited a decrease in the overall SBMAFRS score. However, those with a baseline SBMAFRS of ≥ 42 showed a mild decrease in scores, indicating a more favorable prognosis. These findings suggest that a higher baseline motor function was a key prognostic indicator in SBMA treatment and that initiating early leuprorelin treatment in patients with high baseline function may lead to good clinical outcomes.

Postextubation dysphagia management in Danish intensive care units: A national survey.

BACKGROUND: Postextubation dysphagia (PED) is a common complication to endotracheal intubation in critically ill patients and may lead to pneumonia, prolonged ventilation, longer hospital stays, and increased mortality. Recognizing dysphagia is paramount to preventing adverse events. The aim of this study was to describe PED management by investigating practice in Danish intensive care units (ICUs) focusing on current practice in 2023 (screening, prevention, and treatment), perceived best practice (barriers and facilitators), and when possible, to compare practice in 2017 and 2023. METHODS: Self-reported, cross-sectional survey of dysphagia practice in Danish ICUs administered from April to May 2023. In addition, data were compared with the 2017 Dysphagia in Intensive Care Evaluation study, when possible. RESULTS: Only half of Danish ICUs reported to have a PED protocol, and less than half routinely screen patients for dysphagia after extubation. Most common screening methods were the oral mechanism examination, water test, and Facio-oral tract therapy. Nurses and physicians often relied on an overall physical assessment of the patient. Best treatment methods were uniformly agreed to be patient positioning, modification of food and fluids, use of ergonomic utensils, and compensatory maneuvers. Key barriers to dysphagia management were lack of specialized staff, under-recognition of dysphagia as a health issue, and lack of standardized protocols. CONCLUSION: Awareness of PED is increasing and identification, prevention, and treatment is slowly improving, but systematic implementation of protocols for dysphagia screening and treatment could enhance dysphagia management in Danish ICUs.

Implications of the Consciousness State on Decannulation in Patients With a Prolonged Disorder of Consciousness.

OBJECTIVE: To prospectively investigate the evolution of the consciousness state and the cannula-weaning progression in patients with prolonged disorders of consciousness. DESIGN: Nonconcurrent cohort study. SETTING: A rehabilitation unit. PARTICIPANTS: Adult patients (N=144) with prolonged disorders of consciousness after a severe acquired brain injury admitted between June 2020 and September 2022. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Consciousness state was assessed by repeated Coma Recovery Scale-Revised (CRS-R) questionnaire administration at admission and weekly afterward. The dates of the first improvement of consciousness state and the achievement of decannulation were recorded. Decannulation followed an internal protocol of multiprofessional rehabilitation. RESULTS: One hundred forty-four patients were included: age, 69 years; 64 (44.4%) with hemorrhagic etiology; time post onset, 40 days, CRS-R score at admission, 9, median length of stay, 90 days. Seventy-three (50.7%) patients were decannulated. They showed a significantly higher CRS-R (P<.001) and states of consciousness (P<.001) at admission, at the first improvement of the consciousness state (P=.003), and at discharge (P<.001); a lower severity in the Cumulative Illness Rating Scale at admission (P=.01); and a lower rate of pulmonary infections with recurrence (P=.021), compared with nondecannulated patients. Almost all decannulated patients (97.3%) improved their consciousness before decannulation. Consciousness states at decannulation were as follows: unresponsive wakefulness syndrome, 0 (0%); minimally conscious state (MCS) minus, 4 (5.5%); MCS plus, 7 (9.6%); and emergence from MCS, 62 (84.9%). Kaplan-Meier analysis showed a significant divergence between the curves with a higher probability of decannulation in patients who improved consciousness (P<.001). CONCLUSIONS: This study showed that the presence of signs of consciousness, even subtle, is a necessary condition for decannulation, suggesting that consciousness may influence some of the components implied in the decannulation process.

The Effect of Oropharyngeal Resting Tremor on Swallowing Function in a Clinical Cohort of People with Parkinson's Disease.

Parkinson's Disease (PD) is a progressive neurodegenerative disease, with hallmark symptomology typically consisting of tremor, bradykinesia, and rigidity. Though the classic "pill-rolling" rest tremor in the hand or upper limb are often the most salient, it can occur throughout the body including the lower limbs, jaw, face, or tongue. There have been investigations into other motor related phenomena potentially affecting swallow function in PwPD previously. However, there have been no investigations of how oropharyngeal resting tremor in structures such as the tongue or larynx explicitly affects swallowing physiology. A retrospective analysis of previously conducted VFSS on 34 patients diagnosed with idiopathic PD (IPD) was performed to examine how individuals that displayed resting tremor during VFSS (Tremor +) and those who did not (Tremor-) differ in swallowing function. Measures of swallowing function including timing intervals of key swallow events, post-swallow residue, and penetration-aspiration scale (PAS) scores were recorded, and key demographic information including time since diagnosis and medication status were extracted from the medical records available. Multivariate models were used to identify differences between tremor groups for timing intervals and post-swallow residue, and chi-squares were computed for differences in PAS score distribution by group and bolus. Sixty-eight percent (23/34) of this sample displayed oropharyngeal resting tremor in at least one structure during VFSS. There were no instances of other tremor types observed in this sample. All participants were taking medication to manage PD symptomology. Significant effects of tremor group were observed for swallow timing intervals related to airway closure (p < 0.001), post-swallow residue (p < 0.05), and swallow safety at the bolus level in the Tremor + group (p < 0.001). These results suggest that PwPD who present with resting tremor in oropharyngeal structures may manifest with different variations in swallowing physiology, including altered timings of swallow events, increased pharyngeal residue, and greater associations of airway invasion with thinner and larger volume boluses. This study highlights the need for substantially more research into how motor fluctuations and phenotypes of PwPD contribute to alterations in swallowing function.

Impact of Varying Transcutaneous Electrical Stimulation Pulse Frequency on Swallow Timing Measures in Healthy Adults.

The impaired swallow timing subsequent to dysphagia or aging can potentially endanger swallowing safety and efficiency. Preliminary evidence has suggested that transcutaneous electrical stimulation (TES) may have the potential to affect swallow timing. However, limited knowledge exists regarding which TES parameters can optimize swallow timing. Pulse frequency is one of the primary TES parameters that can affect the quality of muscle contraction. Yet, no clear information exists regarding how changing pulse frequency impacts the timing of swallowing events. This study aimed to investigate the varying effects of submental TES pulse frequency on swallowing events during and post-15-min TES administration. Twenty-six healthy individuals between the ages of 20 and 54 participated in this study and were assigned to high pulse frequency (HPF) (80 Hz) or low pulse frequency (LPF) (30 Hz) groups. Videofluoroscopic swallowing study (VFSS) was used to record swallowing. Three trials of 10 mL pureed mixed with barium sulfate were presented under three different conditions, including pre-TES, during TES, and post-TES, in which measures were taken following 15 min of TES delivery. The swallow timing events that were measured in each condition were time to maximum hyoid elevation, time to maximum laryngeal elevation, laryngeal vestibule closure reaction time (LVCrt), laryngeal vestibule closure duration (LVCd), time to maximum pharyngeal constriction, and pharyngoesophageal segment (PES) opening duration. No significant pulse frequency effect was found on any swallow timing measures during or after 15 min of TES. Both protocols decreased the duration of some swallowing events during TES including time to maximum hyoid elevation [p < 0.017, ηp2 = 0.185], LVCrt [p < 0.032, ηp2 = 0.158], and time to maximum pharyngeal constriction [p < 0.034, ηp2 = 0.155]. None of the significant TES effects were continued when TES ceased after 15 min. Overall, both protocols have comparable immediate effects on shortening the duration of some swallowing events during TES. Future clinical trials should examine whether these physiologic timing changes can lead to safer and more efficient swallows in patients with dysphagia.

Changes in the Activation Level of the Floor of the Mouth Muscles during Pressing and Swallowing Tasks According to the Degree of Tongue Pressure.

The suprahyoid muscles play an important role in protecting the airway by elevating both the hyoid bone and larynx superior-anteriorly during swallowing. However, providing systematic external resistance when performing exercises to improve suprahyoid muscle strength is practically difficult. This study attempted to confirm whether systematic resistance can be provided to the suprahyoid muscles using the Iowa Oral Performance Instrument (IOPI)-a representative tongue pressure measurement device. Thirty-one healthy adults participated in this study (20.6 ± 0.96 y, 19 females). The participants performed 16 exercise tasks using the IOPI three times each in random order (Anterior/posterior tongue × pressing/swallowing task × 40/60/80/100% maximum tongue pressure). Furthermore, the floor of the mouth (FOM) muscle activity during exercise was simultaneously measured using surface electromyography. During the pressing task, there were significant differences in FOM maximal muscle activity among the four exercise intensities for both the anterior and posterior oral tongue. For the swallowing task, a significant difference was found in FOM muscle activity among the four exercise intensities for the anterior tongue. For the posterior tongue, significant differences were identified among all conditions except for the comparison between 80% and 100% maximum tongue pressure. Significant correlations between the degree of tongue pressure and maximal FOM muscle activity were found in both the pressing and swallowing tasks at the anterior and posterior oral tongue. Overall, these results indicate that objective and systematic external resistance can be applied using the IOPI-a standard tongue pressure measurement device-during the program to improve suprahyoid muscle function.

The Impact of Videofluoroscopic Pulse Rate on Duration and Kinematic Measures in Infants and Adults with Feeding and Swallowing Disorders.

This investigation assessed the impact of temporal resolution during a videofluoroscopic evaluation of swallowing (VFSS) on measures of duration and kinematics. Thirty adult and ten infant swallow studies, all acquired at 30 frames and 30 pulses per second, were obtained from a New Mexico hospital. All swallow studies were altered to simulate 15 and 5 pulses per second. Duration measures included pharyngeal response time, duration of upper esophageal sphincter (UES) opening, velopharyngeal closure duration and total swallow duration. Kinematic measures were assessed in adults only and included peak hyoid position and extent of UES opening during the swallow. Analysis of outcome measures was performed and compared across the three temporal resolutions (30, 15, and 5 pulses per second). For data points where normative values are available, we evaluated the impact of temporal resolution on clinical determination (i.e., did a change in pulse rate alter the clinical classification). Kinematic and duration measures were altered with changes in pulse rate and these changes increased as temporal resolution decreased. For outcome measures where normative values are available, accuracy of clinical determination decreased with decreased pulse rate. Temporal resolution impacts duration and kinematic measures. However, the direction of these changes is unpredictable, indicating sensitivity and specificity are both affected. Without a predictable impact, the use of lower pulse rates may alter clinical impressions and treatment recommendations yielding inappropriate treatment goals and treatment duration.

Reliability of Measuring Geniohyoid Cross-Sectional Area with B-Mode Ultrasound.

B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique. This study examined three methods of transducer placement in the coronal plane by two examiners to determine the reliability of measurement of CSA of the geniohyoid muscle. Forty healthy adults participated in the study. Each participant's geniohyoid muscles were imaged using B-mode ultrasound under three transducer placement conditions in the coronal plane by two examiners. Geniohyoid CSA was measured from each ultrasound image. A three-way mixed-methods ANOVA was used to determine whether there were significant differences in geniohyoid CSA among transducer position conditions, trials, and examiners. There were significant differences among the transducer placement conditions, indicating that each condition was measuring a different portion of the muscle. There were no significant differences among repeated trials nor between examiners within each method of transducer placement. All three conditions of transducer placement were reliable at measuring geniohyoid CSA across trials and examiners. This study emphasizes the need for consistency of placement, whichever method is selected. It also highlights the need for researchers to provide a precise description of methods for positioning the transducer so that placement is reproducible.

Hyoid Bone Movement During Swallowing in Female Thyroidectomy Patients: A Kinematic Ultrasound Study.

The aim of this study was to investigate the measures of displacement, time and velocity of hyoid bone movement in female thyroidectomy patients. Fifty-eight ultrasound videos of 29 women during swallowing were analyzed. The sample was divided into experimental group (EG), composed of 12 women following total or partial thyroidectomy; and control group (CG) of 17 healthy women. The kinematic measures of displacement, time and velocity of hyoid bone displacement were tracked during swallowing of 10 ml of liquid (water) and 10 ml of thickened liquid (honey) in both groups for comparisons. Additional analysis included bolus consistency effect and relationship with clinical characteristics. Ultrasound videos were analyzed according to a standardized protocol using ImageJ software. Displacement, time and velocity of hyoid movement during swallowing of 10 ml of liquid or thickened liquid were not statistically different between female thyroidectomy patients and healthy women. There is no bolus consistency effect on kinematic measures in both groups, but among thyroidectomy patients, velocity of hyoid bone movement is significantly faster in those with swallowing complaints.

A Scoping Review on the Effects of Kinesio Taping on Oropharyngeal Function Related to Swallowing and Feeding.

Following the expansion of interdisciplinary communication among rehabilitative service providers, new techniques have been introduced for treating swallowing disorders. Kinesio taping (KT) is one of the recently noticed techniques in the rehabilitation of swallowing and feeding disorders. Given the novelty of this technique in research and practice, the present scoping review aimed to summarize the available evidence on the effects of KT on the oropharyngeal function related to swallowing, and to identify current knowledge gaps to guide future studies. The initial comprehensive search was conducted in the six databases in November 2022 and then was updated in June 2023. Studies were independently reviewed by two authors to exclude all types of reviews and study protocols, studies published only in an abstract form and also studies that used KT for improving voice and dysarthria symptoms. The methodology of the included studies was also critically appraised using Joanna Briggs Institute (JBI) standard tools by two authors. The results of the studies were categorized and reported based on their overall objectives. In final analysis, 21 articles were described. Study designs ranged from randomized control trials (RCTs) to the case reports. The effects of KT had been investigated on drooling, oral feeding skills of infants, immediate activation of swallowing muscles, and management of dysphagia in patients with stroke or cerebral palsy (CP). Although innovative approaches to use KT as a therapeutic method in swallowing disorders have been investigated in the studies, there are many methodological limitations that affected validity of the results. In general, it seems there is not enough evidence to add KT to the usual management of feeding and swallowing disorders yet. Further studies, therefore, are required to achieve more accurate conclusions in each of the objectives summarized in this study.

Biomechanical and Cortical Control of Tongue Movements During Chewing and Swallowing.

Tongue function is vital for chewing and swallowing and lingual dysfunction is often associated with dysphagia. Better treatment of dysphagia depends on a better understanding of hyolingual morphology, biomechanics, and neural control in humans and animal models. Recent research has revealed significant variation among animal models in morphology of the hyoid chain and suprahyoid muscles which may be associated with variation in swallowing mechanisms. The recent deployment of XROMM (X-ray Reconstruction of Moving Morphology) to quantify 3D hyolingual kinematics has revealed new details on flexion and roll of the tongue during chewing in animal models, movements similar to those used by humans. XROMM-based studies of swallowing in macaques have falsified traditional hypotheses of mechanisms of tongue base retraction during swallowing, and literature review suggests that other animal models may employ a diversity of mechanisms of tongue base retraction. There is variation among animal models in distribution of hyolingual proprioceptors but how that might be related to lingual mechanics is unknown. In macaque monkeys, tongue kinematics-shape and movement-are strongly encoded in neural activity in orofacial primary motor cortex, giving optimism for development of brain-machine interfaces for assisting recovery of lingual function after stroke. However, more research on hyolingual biomechanics and control is needed for technologies interfacing the nervous system with the hyolingual apparatus to become a reality.

The Prevalence of Oropharyngeal Dysphagia in Adults: A Systematic Review and Meta-analysis.

To determine the global prevalence of oropharyngeal dysphagia (OD) in adults. Six electronic databases (Embase, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science) were searched, in addition to gray literature (ASHA, Google Scholar, ProQuest Dissertation, and Theses). A random-effects model for meta-analysis of proportions was conducted, and heterogeneity was evaluated according to the moderator variable through subgroup analysis and meta-regression. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist and the certainty of the evidence was assessed using the GRADE tool. Thirty papers were included for qualitative and quantitative synthesis. The combined prevalence estimate was 60% [CI 95% = 50%-70%; I2 = 95%], accounting for different baseline conditions. However, the wide variation that exists between the different baseline conditions (underlying disease or risk factor) tended to overestimate this prevalence when considering the general population. Only one study evaluated healthy individuals, which showed a prevalence of 31% [CI95% = 27%-36%]. The risk of bias was considered low for all studies. None of the variables were considered predictors for the observed variance between the effect sizes of the included studies. For the prevalence of OD, the GRADE rating was considered very low. Despite the high prevalence observed, with over half of the individuals affected, the evidence regarding this outcome remains uncertain due to an overestimation of the generated estimates caused by the baseline condition of the sample.

The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review.

Swallowing is a sophisticated process involving the precise and timely coordination of the central and peripheral nervous systems, along with the musculatures of the oral cavity, pharynx, and airway. The role of the infratentorial neural structure, including the swallowing central pattern generator and cranial nerve nuclei, has been described in greater detail compared with both the cortical and subcortical neural structures. Nonetheless, accumulated data from analysis of swallowing performance in patients with different neurological diseases and conditions, along with results from neurophysiological studies of normal swallowing have gradually enhanced understanding of the role of cortical and subcortical neural structures in swallowing, potentially leading to the development of treatment modalities for patients suffering from dysphagia. This review article summarizes findings about the role of both cortical and subcortical neural structures in swallowing based on results from neurophysiological studies and studies of various neurological diseases. In sum, cortical regions are mainly in charge of initiation and coordination of swallowing after receiving afferent information, while subcortical structures including basal ganglia and thalamus are responsible for movement control and regulation during swallowing through the cortico-basal ganglia-thalamo-cortical loop. This article also presents how cortical and subcortical neural structures interact with each other to generate the swallowing response. In addition, we provided the updated evidence about the clinical applications and efficacy of neuromodulation techniques, including both non-invasive brain stimulation and deep brain stimulation on dysphagia.

Training to Analyze Functional Parameters with Fiberoptic Endoscopic Evaluation of Swallowing: A Scoping Review.

Analyzing fiberoptic endoscopic evaluation of swallowing (FEES) is challenging and requires training to ensure the proficiency of health professionals and improve reliability. This scoping review aims to identify and map the available evidence on training health professionals to analyze FEES functional parameters. The method proposed by the Joanna Briggs Institute and the PRISMA-ScR guidelines were followed. The search was performed in MEDLINE, Cochrane Library, Embase, Web of Science, Scopus, CINAHL databases, and in the gray literature. Two blinded independent reviewers screened articles by title and abstract. Then, they read the full text of the included reports, considering the eligibility criteria. Data were extracted using a standardized form. Six studies met the established eligibility criteria, published between 2009 and 2022, with few participants. All these studies addressed training as part of the process to validate a rating scale. No standardized criteria were observed regarding the selection of experts and participants, training structure, and outcome measures to assess participants' competence. The reviewed literature indicates that training must be developed to equip students and health professionals who treat dysphagia, enabling them to analyze the functional parameters of the FEES, considering variables that may influence the participants' performance.

Prevalence of Dysphagia and Risk of Malnutrition in Elderly Living in Nursing Homes.

Swallowing difficulties commonly co-occur with malnutrition in the elderly. However, there is no consensus on which assessment tools to use, and thus reported prevalence varies. The aim of this study was to survey the prevalence of dysphagia and risk of malnutrition in elderly people in nursing homes, evaluate the possible associations between swallowing function and malnutrition and survey whether there were associations between self-perceived function and the results of a screening of dysphagia. A total of 35 residents (aged 67-100 years old) without serious cognitive impairment in the general wards of two nursing homes in Gothenburg were investigated. Swallowing ability was assessed with the Gugging Swallowing Screen (GUSS) test, self-rated swallowing ability with the 4QT and the Swedish Eating Assessment Tool-10 (S-EAT-10) and risk of malnutrition with the Minimal Eating Observation and Nutrition Form-Version 2 (MEONF-II). Eleven participants (31.4%) exhibited dysphagia according to the GUSS and 10 participants (29.4%) showed moderate or high risk of malnutrition. In total 16 (46%) participants reported abnormal swallowing on 4QT and 14 (40%) participants reported abnormal swallowing on S-EAT-10. However, less than half of these had dysphagia according to the GUSS. No association was found between swallowing ability measured by the GUSS and risk of malnutrition, although a tendency towards a weak association was noted, or self-rated swallowing ability measured by the 4QT and S-EAT-10. The study found that approximately one-third of the tested participants presented with signs of dysphagia as measured with the screening instrument GUSS, even though only a few were known to have any difficulties prior to testing. This highlights that dysphagia is probably more prevalent than patients themselves and caregivers are aware of, thus, screening is of importance, to enable safer nutritional intake.

Evaluation of the Whiteout During Fiberoptic Endoscopic Evaluation of Swallowing and Examination of Its Correlation with Pharyngeal Residue and Aspiration.

To evaluate the whiteout duration (WOd) and intensity (WOi) during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and examine their correlation with each other and age, gender, bolus consistencies, residue, and aspiration. Retrospective review of 75 videorecorded FEES. The first swallow of each of the following were scored: "Empty" swallow, semisolids, solids, and liquids (International dysphagia diet standardization initiative (IDDSI) 4, 7, 0, respectively). Data scored for each swallow included WOd, WOi, Penetration and aspiration scale (PAS), Pharyngeal residue (Yale Pharyngeal Residue Severity Rating Scale, YPR-SRS), and saliva pooling (Murray Secretion scale, MSS). The highest PAS and YPR-SRS for each consistency during the entire examination were also collected. WOd was significantly longer for stronger WOi in IDDSI4 swallows (p = 0.019). WOi was weaker for IDDSI0 swallows compared to IDDSI7, IDDSI4, and empty swallows (p < 0.05). Patients with saliva pooling had significantly shorter WOd (0.81 ± 0.3 s for MSS = 0 vs. 0.62 ± 0.24 for MSS = 3, p = 0.04). Lower WOi was associated with higher mean age for IDDSI0 (mean ages of 73 ± 12, 64 ± 14, 73 ± 7, 59 ± 16 years for intensity levels 1-4 respectively, p = 0.019). Swallows with weaker WOi and longer WOd had significantly more aspirations in IDDSI7 (28.8% of PAS ≥ 6 for intensity 2 vs 0% for intensity 4, p = 0.003 and 0.77 ± 0.4 s for PAS 1-2 vs. 1.02 ± 0.08 for PAS 6-8, p = 0.049). WOi and WOd are significantly associated with each other. WOi may vary for different bolus consistencies and decreases with age. Longer WOd and weaker WOi are associated with penetration-aspiration. Shorter WOd is associated with saliva pooling.

Impact of Reducing Fluoroscopy Pulse Rate on Adult Modified Barium Swallow Studies.

Modified Barium Swallow Studies (MBSS) are a critical part of the evaluation, treatment planning, and outcome assessment for persons with swallowing disorders. Since MBSSs use ionizing radiation with associated cancer risks, many clinicians have reduced radiation exposure by reducing the fluoroscopic pulse rate. However, by reducing pulse rate, we also decrease the temporal resolution of MBSSs which has been shown in pilot studies to significantly reduce diagnostic accuracy. Two hundred MBSSs from patients routinely undergoing MBSS as standard of care conducted at 30 pulses per second (pps) using the Modified Barium Swallow Study Impairment Profile (MBSImP™) standardized administration protocol were selected. A stratified sampling method ensured that a full range of swallowing impairments (etiology, type, and severity) was represented. Recordings were down sampled from 30 pps to 15, 7.5, and 4 pps. MBSSs were rated using the MBSImP components and Penetration-Aspiration Scale (PAS) score for each swallow. Percent agreement was calculated across raters for MBSImP and PAS scores by bolus type and volume. The Least-Squares Method was used for hypothesis testing. Statistically significant and clinically meaningful changes in scores of swallowing physiology and penetration/aspiration occurred when reducing pulse rate below 30pps. These changes were evident across bolus types and volumes. Given the impact on diagnostic accuracy and the low radiation risks to adults undergoing MBSSs, reducing pulse rate to 15pps or below is not aligned with the As Low As Reasonably Achievable (ALARA) principle and should not be used as a viable method to reduce radiation exposure from MBSSs.