Functional Dysphagia Therapy and PEG Treatment in a Clinical Geriatric Setting

Becker, R.; Nieczaj, R.; Egge, K.; Moll, A; Meinhardt, Miriam; Schulz, Ralf-Joachim

doi:10.1007/s00455-009-9270-8

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…During their prior inpatient rehabilitation stay, all patients received standard dysphagia therapy based on their clinical dysphagia assessment as described in Section 2.2 (Bartolome and Schröter-Morasch, 2010, Becker et al, 2011). At the start of the therapy, adaptive procedures were employed, such as specification of safe food type and consistency.…”

Section: Methodsmentioning

confidence: 99%

Brain imaging correlates of recovered swallowing after dysphagic stroke: A fMRI and DWI study

Mihai

Otto

Domín

et al. 2016

NeuroImage: Clinical

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Neurogenic dysphagia frequently occurs after stroke and deglutitive aspiration is one of the main reasons for subacute death after stroke. Although promising therapeutic interventions for neurogenic dysphagia are being developed, the functional neuroanatomy of recovered swallowing in this population remains uncertain. Here, we investigated 18 patients post-stroke who recovered from dysphagia using an event related functional magnetic resonance imaging (fMRI) study of swallowing. Patients were characterized by initial dysphagia score (mild to severe), lesion mapping, white matter fractional anisotropy (FA) of the pyramidal tracts, and swallowing performance measurement during fMRI scanning. Eighteen age matched healthy participants served as a control group. Overall, patients showed decreased fMRI-activation in the entire swallowing network apart from an increase of activation in the contralesional primary somatosensory cortex (S1). Moreover, fMRI activation in contralesional S1 correlated with initial dysphagia score. Finally, when lesions of the pyramidal tract were more severe, recovered swallowing appeared to be associated with asymmetric activation of the ipsilesional anterior cerebellum. Taken together, our data support a role for increased contralesional somatosensory resources and ipsilesional anterior cerebellum feed forward loops for recovered swallowing after dysphagia following stroke.

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Section: Methodsmentioning

confidence: 99%

Brain imaging correlates of recovered swallowing after dysphagic stroke: A fMRI and DWI study

Mihai

Otto

Domín

et al. 2016

NeuroImage: Clinical

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“…Issues also arise in non-terminally ill patients, for instance where individuals or families decide not to follow recommendations. [97][98][99]169 Careful charting and outcome measurement in such instances helps to further the evidence base around decision making and management. Guideline documents and discussions are available around palliative care and people with dementia.…”

Section: Ethical Considerationsmentioning

confidence: 99%

Dysphagia: implications for older people

Miller

Patterson

2013

Rev. Clin. Gerontol.

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Dysphagia represents a salient concern in many conditions prevalent in older people. There are direct implications for morbidity and mortality. The importance of recognizing and managing dysphagia in hospital and the community also extends to psychosocial impact and quality of life, as well as health, economic and ethical-legal issues. This review outlines reasons for the importance of recognizing and treating dysphagia. It then proceeds to look at recent developments in our understanding of the nature, assessment and management of dysphagia in older people. Whilst there are wellestablished practices in assessment and management, ongoing work continues to challenge the validity and reliability of many methods. These concerns are covered and directions for future developments highlighted.

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“…Studies have examined general prognostic indicators of swallowing function in different diseases. These indicators include: age [20,21]; severity of the disease [22-24]; cognitive status [18,25]; dysphagia severity level at hospital admission and/or discharge [22,26-28]; presence of feeding tube [29]; time to achieve oral feeding status [14,17,30]; time to tracheostomy weaning [14,31]; ventilator status [17,25]; amount of treatment [14,18,26]; and length of hospital stay [12,32]. …”

Section: Introductionmentioning

confidence: 99%

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

et al. 2013

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IntroductionThe development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. However, there are relatively few studies with specific outcomes that focus on the follow-up of these patients until hospital discharge. The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI).MethodsWe conducted a retrospective, observational cohort study from 2010 to 2012 of all patients over 18 years of age admitted to a university hospital ICU who were submitted to prolonged OTI and subsequently received a bedside swallow evaluation (BSE) by a speech pathologist. The prognostic factors analyzed included dysphagia severity rate at the initial swallowing assessment and at hospital discharge, age, time to initiate oral feeding, amount of individual treatment, number of orotracheal intubations, intubation time and length of hospital stay.ResultsAfter we excluded patients with neurologic diseases, tracheostomy, esophageal dysphagia and those who were submitted to surgical procedures involving the head and neck, our study sample size was 148 patients. The logistic regression model was used to examine the relationships between independent variables. In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes.ConclusionsStudies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder. Additionally, this study stresses the importance of the initial assessment ratings.

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Functional Dysphagia Therapy and PEG Treatment in a Clinical Geriatric Setting

Cited by 12 publications

References 23 publications

Brain imaging correlates of recovered swallowing after dysphagic stroke: A fMRI and DWI study

Brain imaging correlates of recovered swallowing after dysphagic stroke: A fMRI and DWI study

Dysphagia: implications for older people

Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

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