Georgia A Malandraki1, Akila Rajappa2, Cagla Kantarcigil3, Elise Wagner2, Chandra Ivey4, Kathleen Youse2. 1. Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY; Dysphagia Clinic, Evangelismos Hospital, National and Kapodistrian University of Athens, Greece. Electronic address: malandraki@purdue.edu. 2. Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY. 3. Department of Speech, Language and Hearing Sciences, Purdue University, West Lafayette, IN; Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY. 4. Department of Otolaryngology/Head and Neck Surgery, Columbia University, New York, NY.
Abstract
OBJECTIVE: To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia. DESIGN: Intervention study; before-after trial with 4-week follow-up through an online survey. SETTING: Outpatient university clinics. PARTICIPANTS: A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study. INTERVENTIONS: Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45 min/d. MAIN OUTCOME MEASURES: Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey). RESULTS: The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (P<.05, η(2)=.8146 and P<.05, η(2)=.799708, respectively) and level of oral intake (P<.005, Cohen d=-1.387). Of the 5 patients who were feeding tube dependent initially, 2 progressed to total oral nutrition, and 2 progressed to partial oral nutrition. One patient remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% confidence interval, 6.38-14.5; P<.00), but not at the posttreatment. No adverse effects were observed/reported. CONCLUSIONS: The Intensive Dysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied.
OBJECTIVE: To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia. DESIGN: Intervention study; before-after trial with 4-week follow-up through an online survey. SETTING:Outpatient university clinics. PARTICIPANTS: A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study. INTERVENTIONS:Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45 min/d. MAIN OUTCOME MEASURES: Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey). RESULTS: The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (P<.05, η(2)=.8146 and P<.05, η(2)=.799708, respectively) and level of oral intake (P<.005, Cohen d=-1.387). Of the 5 patients who were feeding tube dependent initially, 2 progressed to total oral nutrition, and 2 progressed to partial oral nutrition. One patient remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% confidence interval, 6.38-14.5; P<.00), but not at the posttreatment. No adverse effects were observed/reported. CONCLUSIONS: The Intensive Dysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied.
Authors: Cagla Kantarcigil; Min Ku Kim; Taehoo Chang; Bruce A Craig; Anne Smith; Chi Hwan Lee; Georgia A Malandraki Journal: J Speech Lang Hear Res Date: 2020-09-10 Impact factor: 2.297
Authors: Nasser H Kashou; Irfaan A Dar; Mohamed A El-Mahdy; Charles Pluto; Mark Smith; Ish K Gulati; Warren Lo; Sudarshan R Jadcherla Journal: Front Pediatr Date: 2017-04-10 Impact factor: 3.418