Dysphagia Management in Stroke Rehabilitation

Johnson, Danielle N.; Herring, Hannah J.; Daniels, Stephanie K.

doi:10.1007/s40141-014-0059-9

Cited by 31 publications

(26 citation statements)

References 81 publications

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“…Reports suggest differences in hyoid and laryngeal displacement but are mixed (Table 1) [11, 15–18]. A more comprehensive understanding of covariant swallowing mechanics including hyoid and laryngeal movement, tongue base retraction, pharyngeal shortening, and head and neck extension could not only highlight the dysfunction underlying stroke-associated penetration and aspiration, but also suggest which treatment goals would be more salient [19, 20]. …”

Section: Introductionmentioning

confidence: 99%

Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke

May

Pisegna

Marchina

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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Goals Computational Analysis of Swallowing Mechanics is a method that utilizes multivariate shape change analysis to uncover covariant elements of pharyngeal swallowing mechanics associated with impairment using videofluoroscopic swallowing studies. The goals of this preliminary study were to (1) characterize swallowing mechanics underlying stroke related dysphagia, (2) decipher the impact of left and right hemispheric stroke on pharyngeal swallowing mechanics, and (3) determine pharyngeal swallowing mechanics associated with penetration-aspiration status. Materials and Methods Videofluoroscopic swallowing studies of 18 dysphagic patients with hemispheric infarcts and age and gender matched controls were selected from well-controlled data sets. Patient data including laterality, and penetration-aspiration status was collected. Coordinates mapping muscle group action during swallowing were collected from videos. Multivariate morphometric analyses of coordinates associated with stroke, affected hemisphere, and penetration-aspiration status were performed. Findings Pharyngeal swallowing mechanics differed significantly in the following comparisons: stroke vs. controls (D=2.19, p<.0001); right hemispheric stroke vs. controls (D=3.64, p<.0001); left hemispheric stroke vs. controls (D=2.06, p<.0001); right hemispheric stroke vs. left hemispheric stroke (D=2.89, p<.0001); and penetration-aspiration vs. within normal limits (D=2.25, p<.0001). Differences in pharyngeal swallowing mechanics associated with each comparison were visualized using eigenvectors. Conclusion While current literature focuses on timing changes in stroke-related dysphagia, this data suggests that mechanical changes are also functionally important. Pharyngeal swallowing mechanics differed by affected hemisphere and penetration-aspiration status. Computational Analysis of Swallowing Mechanics can be used to identify patient specific swallowing impairment associated with stroke injury that could help guide rehabilitation strategies to improve swallowing outcomes.

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Section: Introductionmentioning

confidence: 99%

Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke

May

Pisegna

Marchina

et al. 2017

Journal of Stroke and Cerebrovascular Diseases

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“…VitalStim Therapy (VST) also known as Neuromuscular electrical stimulation (NMES) has been used for neuromuscular re-education in cases with oropharyngeal dysphagia. 19,20 The oral/facial electrical stimulation is applied to restore muscle function and Deep Pharyngeal Neuromuscular Stimulation (DPNS) for restoring reflexes within the pharynx. FDA (USA) protocol for dysphagia recommends use of electrode positioning on submental musculature.…”

Section: Discussionmentioning

confidence: 99%

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

Saqulain

Mumtaz

2020

JIMDC

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Swallowing and breathing are complex and highly coordinated functions. These functions depend on well-coordinated work of many organs with larynx and nervous system playing a critical role. Disturbance in one of these functions negatively affects the other. Surgical airways like tracheostomies are required in a number of situations, including but not limited to major head and neck procedures, cases with decreased lung function, excessive bronchial secretions and cases requiring neuro-rehabilitation when prolonged airway is required for mechanical ventilation. Extensive neuro-rehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and/or aspiration with a very high prevalence, which can pose a threat to life. This article reviews the current status of the diagnostic and therapeutic modalities for swallowing difficulties with special emphasis on current neuro-rehabilitative strategies. Electronic databases including Medline, Web-of-science, Cochrane Library, and Google scholar were used for literature search. Downloaded articles were subsequently assessed independently by two researchers to determine suitability for inclusion in the study.Key words: Neurorehabilitation, Tracheostomy, Transcranial direct current stimulation, Transcranial magnetic stimulation, swallowing difficulty

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“…Compensatory swallowing strategies include maneuvers, postures, and stimulation techniques used to improve swallowing efficiency and safety for a particular diet texture that would, without the use of strategies, be considered unsafe [22]. One study reported using multiple compensatory swallowing strategies in addition to tube feeding for swallowing intervention [11].…”

Section: Discussionmentioning

confidence: 99%

A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population

2016

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Dysphagia is reported to be a common secondary complication for individuals with traumatic spinal injuries. Different etiologies of traumatic spinal injuries may lead to different profiles of swallowing impairment. We conducted a systematic review to determine the characteristics of dysphagia after traumatic spinal injury and to describe interventions currently used to improve swallowing function in this population. A comprehensive multi-engine literature search identified 137 articles of which 5 were judged to be relevant. These underwent review for study quality, rating for level of evidence, and data extraction. The literature describing dysphagia after traumatic spinal injury was comprised predominantly of low level evidence and single case reports. Aspiration, pharyngeal residue, and decreased/absent hyolaryngeal elevation were found to be common characteristics of dysphagia in this population. The most commonly used swallowing interventions included tube feeding, compensatory swallowing strategies, and steroids/antibiotics. Improvement in swallowing function following swallowing intervention was reported in all studies, however there was no control for spontaneous recovery. The results demonstrate a need for high-quality research to profile the pathophysiology of dysphagia after traumatic spinal injury and controlled studies to demonstrate the efficacy of swallowing interventions in this population.

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Dysphagia Management in Stroke Rehabilitation

Cited by 31 publications

References 81 publications

Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke

Pharyngeal Swallowing Mechanics Secondary to Hemispheric Stroke

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

A Review of Dysphagia Presentation and Intervention Following Traumatic Spinal Injury: An Understudied Population

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