How a personalised transportable folding device for seating impacts dysphagia

Abstract

Purpose A personalised transportable folding device for seating (DATP) on a standard seat was developed by an occupational therapist at the Toulouse University Hospital Centre (patent no. WO 2011121249 A1) based on the hypothesis that the use of a seat to assist with better positioning on any chair during meals modifies the sitting posture and has an impact on cervical statics which increases the amplitude of movements of the axial skeleton (larynx and hyoid bone) and benefits swallowing. The aim of this work is to demonstrate that an improvement in sitting posture with the help of the DATP, through Hyoid bone motion, has an impact on the quality of swallowing in a dysphagic population which benefits from the device in comparison to a dysphagic population which does not benefit from the device after 1 month of care. The secondary endpoints concern the evaluation of the impact on other characteristics of swallowing, posture, the acceptability of the device and the quality of life. Methodology This is a randomised comparative clinical trial. The blind was not possible for the patients but the examiner who evaluated the outcome criterion was blinded to the group to which the patient belonged. The outcome criterion was the measurement of the hyoid bone movement during swallowing. The other criteria were collected during the videofluoroscopic examination of swallowing and by use of a questionnaire. Fifty-six (56) patients were included: 30 in the group without device (D−) and 26 in the group with the device (D+). All the patients benefited from a training course on seating. Only the D+ patients participated in this course where the use of the device was explained and the device was then kept for use at home for 1 month. Results A significant improvement was noted in the postural criteria before and after use, in favour of a better posture for the two groups (p < 0.001) and more hyoid bone motion in the D+ group. The difference was significant in the bivariate analysis for horizontal movement (p = 0.04). After adjustment of potential factors of confusion, we noted a significant mean difference for the three distances in the D+ group in comparison to the D− group, of + 0.33 (95% CI [+ 0.17; + 0.48]) for horizontal movement, + 0.22 (95% CI [+ 0.03; + 0.40]) for vertical movement and + 0.37 (95% CI = [+ 0.20; + 0.53]) for horizontal movement. However, the other parameters, and notably the other swallowing markers were not significantly modified by the use of the device. Conclusion The personalised transportable folding device for seating developed to reduce dysphagia has an action on hyoid bone motion during swallowing. However, this positive effect on an intermediate outcome criterion of the quality of swallowing was not associated with an improvement in swallowing efficiency in the study population. The diversity of diseases with which the patients in this study were afflicted is a factor to be controlled in future studies with this device.

Behavioural Interventions in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Clinical Trials

“…Two studies included a mixed patient population with Parkinson's disease or dementia [38], and stroke or head and neck cancer patients after chemoradiation [40]. Five studies did not provide further details on diagnoses [28,38,49,54,55]. The most frequent method for confirming OD was VFSS (n = 17), with only four studies using FEES (n = 4) [20,31,38,40].…”

“…The most frequent method for confirming OD was VFSS (n = 17), with only four studies using FEES (n = 4) [20,31,38,40]. Seven studies used non-instrumental clinical assessments, five studies used a screening tool [28,29,39,48,56], and four studies used patient self-reported dysphagia [49,52,54,55]. The included studies were conducted across fifteen countries, with studies most frequently conducted in Korea (n = 13), USA (n = 6), China (n = 3) and Japan (n = 3).…”

“…Nine studies did not specify disciplines involved in providing the interventions. The intervention dosage varied greatly, ranging from one training session [54] to exercise 3 times daily, 7 days per week for 42 days [25].…”

“…Twenty-one studies were included in the meta-analyses [21,22,24,25,[28][29][30][31]34,35,[40][41][42][43][44][45][46]49,51,52,54]. All study groups were categorised into compensatory interventions, rehabilitative interventions, combined compensatory and rehabilitative interventions, and no dysphagia intervention.…”

“…Between-study heterogeneity was significant (Q(35) = 152.938, and p < 0.001), with I 2 showing heterogeneity accounted for 77.115% of variation in effect sizes across studies. [21,22,24,25,[28][29][30][31][40][41][42][43][44][45][46]49,51,52,54,56]. Note.…”