BACKGROUND Ischemic stroke(IS)is a widely recognized disease characterized by high preva-lence,mortality,morbidity,disability,and recurrence rates.It ranks prominently in terms of mortality,constituting 60%-80%of stro...BACKGROUND Ischemic stroke(IS)is a widely recognized disease characterized by high preva-lence,mortality,morbidity,disability,and recurrence rates.It ranks prominently in terms of mortality,constituting 60%-80%of stroke cases.AIM To explore the impact of comprehensive nursing care on the quality of life and swallowing function in individuals diagnosed with IS.METHODS This study comprised 172 patients with IS admitted to our hospital between February 2018 to March 2021.The participants were divided into two groups,namely the control group(n=80)receiving routine care and the research group(n=92)receiving comprehensive care.Various assessment scales,including the standard swallowing function assessment scale(SSA),National Institutes of Health Stroke scale(NIHSS),European stroke scale(ESS),self-rating anxiety scale(SAS),self-rating depression scale(SDS),Barthel index(BI),and the motor func-tion assessment scale(MAS),were employed to evaluate the improvement in swallowing function,neurological deficits,clinical outcomes,anxiety,depression,daily living activities,and motor function before and after care.Furthermore,the study compared the occurrence of adverse reactions during the nursing period,life quality before and after the intervention,rehabilitation compliance,and nursing satisfaction between the two groups.RESULTS After the nursing intervention,the research group exhibited significantly improved SSA and NIHSS scores compared to the control group(P<0.05).Moreover,both groups demonstrated significant reductions in SAS and SDS scores(P<0.05),with the research group showing more obvious advantages(P<0.05).Compared to the control group,the research group displayed significantly better ESS,BI,and MAS scores(P<0.05),coupled with a lower incidence of adverse reactions(P<0.05).Additionally,the research group demonstrated markedly higher levels of life quality,rehabilitation compliance,and nursing satisfaction compared to the control group(P<0.05).CONCLUSION Comprehensive nursing effectively improved swallowing function,quality of life,and patient satisfaction,high-lighting its clinical significance.展开更多
Objectives:The relationship between eating and swallowing function,and lifestyle among community-dwelling elderly people has not been extensively studied.This study aimed to analyze the characteristics of eating and s...Objectives:The relationship between eating and swallowing function,and lifestyle among community-dwelling elderly people has not been extensively studied.This study aimed to analyze the characteristics of eating and swallowing function and their association with the lifestyle among the elderly.Methods:A self-administered questionnaire survey was conducted on 419 elderly people who participated in the oral function improvement project operated by the Community Comprehensive Support Center.A total of 288 valid responses(58 males,230 females,average age 73.6 years)were analyzed.The survey items included basic demographics,health status,lifestyle,and eating and swallowing functions.The chi-square(χ2)test was used to compare for a difference in the risk of dysphagia.Results:72 patients(25.0%)were judged to be at risk for dysphagia,and 216(75.0%)were judged to be not at risk for dysphagia using the revised dysphagia risk assessment scale.The mean score for oral preparatory dysphagia was the highest,while the mean score for pharyngeal dysphagia was the lowest.The group at risk of dysphagia had significant difficulty in chewing and had bad sleep quality as compared to the group that was not at risk.Conclusion:Concerning the risk of dysphagia,there is a need to maintain and improve masticatory function.In addition,improving the swallowing function of the elderly may prevent insomnia and improve sleep quality.展开更多
This article summarizes the current rehabilitation treatment methods for dysphagia after stroke,including feeding-swallowing function treatment,acupuncture treatment,neuromuscular electrical stimulation,balloon cathet...This article summarizes the current rehabilitation treatment methods for dysphagia after stroke,including feeding-swallowing function treatment,acupuncture treatment,neuromuscular electrical stimulation,balloon catheter dilatation,etc.,all of which have many clinical applications,hoping to play a guiding role in future research.展开更多
Introduction: Laryngeal carcinoma accounts for 13.9% of head and neck tumors, and squamous cell carcinoma is the main pathological type. At present, the treatment of laryngeal cancer is mainly surgical treatment or po...Introduction: Laryngeal carcinoma accounts for 13.9% of head and neck tumors, and squamous cell carcinoma is the main pathological type. At present, the treatment of laryngeal cancer is mainly surgical treatment or postoperative radiotherapy. The surgery is delicate, complex, time-consuming and traumatic. Postoperative patients are prone to dysphagia, leading to an increase in the incidence of malnutrition. Malnutrition can cause a series of negative effects, including weight loss, increased incidence of infection, reduced tolerance of anti-tumor treatment, and extended length of hospital stay. Therefore, how to effectively improve the nutritional status of laryngeal cancer patients through nursing intervention has become an important topic of nursing research. Objective: Investigate the effect of individualized nutrition intervention care combined with swallowing training on postoperative nutritional status in patients with laryngeal cancer. Methods: A total of 120 consecutive patients who underwent laryngeal surgery at our hospital for the first time between May 2018 and May 2021 were selected for the study and equally divided into the control group and the study group by the random number table method, with 60 patients in each group. Patients in the control group were given swallowing function training and health counseling, and the study group adopted individualized nutrition intervention care based on the control group. The nutritional status, swallowing function, and quality of life (QOL) of the patients were assessed using the Patient-generated Subjective Global Assessment (PG-SGA), MD Anderson Dysphagia Inventory (MDADI), and Quality of Life Questionnaire-Core30 (QLQ-C30) before the intervention and three months after the intervention. Results: Before the intervention, the scores of MDADI, PG-SGA, and QLQ-C30 were not significantly different between the two groups (P > 0.05), and three months after the intervention, the scores of MDADI and QLQ-C30 increased and the score of PG-SGA decreased in the study group, with significant differences (P 0.05). At three months after the intervention, patients in the study group had higher scores on MDADI, QLQ-C30 and lower scores on PG-SGA than the control group, with significant differences (P Conclusion: Combining individualized nutrition intervention care with swallowing training improves the postoperative nutritional status, swallowing function, and QOL of patients with laryngeal cancer.展开更多
Weakened capability of eating and swallowing is common among elderly population,affecting negatively on their health and well-being.This work measured occlusal force and tongue muscle strength of elderly patients and ...Weakened capability of eating and swallowing is common among elderly population,affecting negatively on their health and well-being.This work measured occlusal force and tongue muscle strength of elderly patients and then assessed whether correlations existed between oral physiological properties and the eating and swallowing capability.A total of 26 elderly patients with potential swallow disorder were recruited in this work.Participants’denture status and daily diet texture were determined by a pre-questionnaire analysis.Their swallowing capability was assessed and rated by water drinking test.Maximum tongue pressure,incisor occlusal force and hand gripping force were measured for each subject.It was observed that participating subjects have on average a significantly lower biting force and maximum tongue pressure than that of normal adults.The swallowing grades assessed by water drinking test showed significant correlations with both the biting force(r=−0.498,P<0.05)and the tongue muscle strength(r=−0.544,P<0.05).The biting force of dysphagia participants correlates significantly with dental conditions(P<0.05).The observed correlation between tongue pressure and diet texture indicates that tongue muscle strength could be used as a reliable indicator of the eating and swallowing capability for elderly people.展开更多
Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materi...Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.展开更多
Aim: To compare the chewing process and swallowing threshold parameters of subjects with complete dentures and overdentures with data obtained from subjects with complete natural dentitions. Metho-dology: The chewing ...Aim: To compare the chewing process and swallowing threshold parameters of subjects with complete dentures and overdentures with data obtained from subjects with complete natural dentitions. Metho-dology: The chewing process in terms of swallowing threshold parameters of four groups of subjects with complete dentures (all females) was quantified by sieving particles after chewing of an artificial test ‘food’ and compared with that of subjects with com-plete natural dentitions as a reference group (33 sub-jects). All subjects (except those of the reference group) had a complete denture in the upper jaw. Regarding the lower jaw two groups with complete dentures (with high (24 subjects), respectively low mandible (12 subjects)) and two groups with overdentures (implant-retained (22 subjects), respectively natural root supported (19 subjects)) were composed. Results: The ‘overdenture-implants’ group needed significantly more chewing cycles and time (mean: 45 cycles in 32 seconds) until ‘swallowing’ compared to the group with complete natural dentitions (mean: 26 cycles in 19 seconds until ‘swallowing’). Also the ‘complete denture-low mandible’ group needed sig-nificantly more cycles and time (mean: 52 cycles in 44 seconds) until ‘swallowing’ than the complete dentition group. In the ‘overdenture-natural roots’ group these outcomes (33 cycles in 24 seconds) were not significantly different compared with the complete dentition group. The ‘complete denture-high mandi-ble’ group (32 cycles in 26 seconds) needed not sig-nificantly more cycles until ‘swallowing’, however time until ‘swallowing’ was significantly longer com-pared to the complete dentition group. All denture groups had significantly larger mean particle sizes when ‘swallowing’ (sizes in the order of 3 mm) than the natural dentition group (about 2 mm). Conclusion: Despite efforts to compensate for a reduced chewing efficiency, subjects with complete dentures (including overdentures) had 50% larger median particle sizes when ‘swallowing’ compared to subjects with complete natural dentitions.展开更多
<b><span style="font-family:"">Objective</span></b><span style="font-family:"">: Oral diadochokinesis (ODK) has been shown to be associated with oral frailty...<b><span style="font-family:"">Objective</span></b><span style="font-family:"">: Oral diadochokinesis (ODK) has been shown to be associated with oral frailty. In this study, we investigate the relationship between physical function, swallowing function, nutritional evaluation, and each syllable of ODK. <b>Methods</b>: The subjects are 26 elderly people living in an area where <span>they can walk. ODK, tongue pressure, modified water swallowing test, EAT-10,</span> grip strength, MNA-SF, skeletal muscle index, height, weight, and BMI were evaluated. For statistical analysis based on ODK values, the subjects were divided into two groups on the basis of the number of times the syllables /pa/, /ta/, and /ka/ were repeated: 1) The first group with >6 repetitions exceeded six</span><span style="font-family:"">;</span><span style="font-family:""> 2) the second group with ≤5 repetitions. Both groups were compared using the Mann-Whitney U test (Model 1). In addition, the syllables /pa/, /ta/, and /ka/ were also divided among the groups and a comparison was performed (Model 2). <b>Results</b>: In Model 1, the tongue pressure value was significantly higher in the good group (p < 0.01). In Model 2, the good group showed significantly higher values for the syllables /pa/ (p < 0.01) and /ta/ (p < 0.05). There was no significant difference in the values for the syllable /ka/. <b>Conclusion</b>: In community-dwelling elderly people, tongue pressure was positively associated with ODK values for the syllables /pa/ and /ta/, suggesting that tongue pressure may be associated with strength of the lip and tongue tip muscles. Furthermore, it was suggested that the ODK values may even be lower than normal values in the elderly who maintain skeletal muscle mass and thus have adequate tongue pressure;therefore, these indicators may be used as a guideline to assess oral frailty.展开更多
This study aimed to evaluate the quality of healthcare services pertaining to the dietary intake and swallowing functions of residents, nutrition management practices, and performance of residents at long-term care fa...This study aimed to evaluate the quality of healthcare services pertaining to the dietary intake and swallowing functions of residents, nutrition management practices, and performance of residents at long-term care facilities. We investigated outcome indicators, such as changes in dietary intake and swallowing function levels of residents, and clarified which structural and process indicators were associated with the outcome indicators. This was a retrospective study, analyzing information on healthcare services from 1067 long-term care facilities during the fiscal year 2012, sampled from among those registered with the Welfare, Health and Medical Care Information Network of the Welfare and Medical Service Agency in Japan. Five outcome indicators were identified. Next, we examined the relationships between the outcome indicators and structural or process indicators using a multivariate linear regression model, adjusting for facility type. The findings showed how the five outcome indicators were used in long-term care facilities over a period of one year and determined the independent predictors of these outcome indicators. The amplification of dietary function 1 was associated with “assessment of oral functions using a feeding and swallowing assessment checklist every three months”, “holding care conferences related to ingestion and swallowing every three months”, and “maintaining a 1:2 ratio for meal-time assistants to residents”. To improve the quality of care, it is necessary to increase the number of staff (e.g., to provide meal assistance to residents) and to understand changes in the residents’ status through accurate assessment and monitoring.展开更多
Introduction: It is well known that humans have an increased sense of taste and consume more food when eating with others. This effect is called social facilitation of eating. We previously reported that self-images a...Introduction: It is well known that humans have an increased sense of taste and consume more food when eating with others. This effect is called social facilitation of eating. We previously reported that self-images also have the effect of social facilitation of eating. In the present study, we investigated the effect of a head-mounted display (HMD) as a means of presenting self-images. Methods: Fourteen healthy adults (7 females and 7 males) were included in the study. The mean age of the participants was 20.4 years. The experimental conditions were as follows: the presentation conditions include the SG condition, in which an image was projected on the smart glasses, and the MT condition, in which an image was projected on the monitor. The stimulation conditions include the self-image condition (Self condition), in which the participant’s own image was projected, and the background image condition (Background condition), in which the background image was projected. Participants were asked to consume green tea jelly three times under the four conditions, which consisted of combinations of the presentation and stimulation conditions. Electromyography (EMG) and electroencephalography (EEG) were used to measure the muscle activity of the suprahyoid muscle group and brain activity, respectively. Results: The EMG of the “SG-Self” condition was significantly higher than that of “SG-Background” and “MT-Background” conditions. The EMG of the “MT-Self” condition was significantly higher than that of the “MT-Background” condition. In the EEG before the start of swallowing, “SG-Self” was significantly lower in the alpha band and higher in the beta band than “MT-Background”. The beta-alpha ratio was significantly higher for “SG-Self” than for “SG-Background” and “MT-Background” and higher for “MT-Self” than for “MT-Background”. Conclusion: These results suggest that self-images influence muscle and brain activities during swallowing, regardless of the presentation conditions, such as HMD or monitor.展开更多
Objective: The objective is to assess patients complaining of dysphagia with fibreoptic endoscopic evaluation of swallowing [FEES]. Study design: It is a prospective study. Setting: The study is conducted at Tertiary ...Objective: The objective is to assess patients complaining of dysphagia with fibreoptic endoscopic evaluation of swallowing [FEES]. Study design: It is a prospective study. Setting: The study is conducted at Tertiary referral hospital. Methods: In our study, twenty patients with complaints of dysphagia were evaluated with fibreoptic endoscopic evaluation of swallowing. Patients with pharyngeal cause of dysphagia were identified and recommended dietary modifications or positional manoeuvre. Results: A total of twenty patients were evaluated with FEES. Patients were categorised into two groups based on the etiological factor: neurological and non-neurological patients. In eleven of the neurological patients, premature spillage was seen in four patients. Pooling for solids was seen in one patient and for liquids in four patients, pooling for both solids and liquids was seen in six patients, penetration was seen in 1 patient and aspiration in one patient. All these patients were diagnosed to have a pharyngeal cause of dysphagia. In the nine of the non-neurological group, pooling of liquids was seen in four patients, and aspiration was seen in one patient. None of the patients of this group had spillage. One patent had penetration. Five patients had pharyngeal cause of dysphagia. Remaining four patients had normal study. These patients with pharyngeal cause were advised dietary modification or positional manoeuvre or a combination of both. Conclusion: FEES is an effective and valuable tool for evaluating pharyngeal dysphagia, and is helpful in guiding the patients for diet and rehabilitation. It is essential to assess the safety of swallowing in patients to prevent silent aspiration and aspiration pneumonia.展开更多
AIM: To determine swallowing outcomes and hyolaryngeal mechanics associated with post radiation therapy head and neck cancer(rt HNC) patients using videofluoroscopic swallow studies. METHODS: In this retrospective coh...AIM: To determine swallowing outcomes and hyolaryngeal mechanics associated with post radiation therapy head and neck cancer(rt HNC) patients using videofluoroscopic swallow studies. METHODS: In this retrospective cohort study, video-fluoroscopic images of rt HNC patients(n = 21) were compared with age and gender matched controls(n = 21). Penetration-aspiration of the bolus and bolus residue were measured as swallowing outcome variables. Timing and displacement measurements of the anterior and posterior muscular slings elevating the hyolaryngeal complex were acquired. Coordinate data of anatomical landmarks mapping the action of the anterior muscles(suprahyoid muscles) and posterior muscles(long pharyngeal muscles) were used to calculate the distance measurements, and slice numbers were used to calculate time intervals. Canonical variate analysis with post-hoc discriminant function analysis was performed on coordinate data to determine multivariate mechanics of swallowing associated with treatment. Pharyngeal constriction ratio(PCR) was also measured to determine if weak pharyngeal constriction is associated with post radiation therapy.RESULTS: The rt HNC group was characterized by poor swallowing outcomes compared to the control group in regards to: Penetration-aspiration scale(P < 0.0001), normalized residue ratio scale(NRRS) for the valleculae(P = 0.002) and NRRS for the piriform sinuses(P = 0.003). Timing and distance measurements of the anterior muscular sling were not significantly different in the two groups, whereas for the PMS time of displacement was abbreviated(P = 0.002) and distance of excursion was reduced(P = 0.02) in the rt HNC group. A canonical variate analysis shows a significant reduction in pharyngeal mechanics in the rt HNC group(P < 0.0001). The PCR was significantly higher in the test group than the control group(P = 0.0001) indicating reduced efficiency in pharyngeal clearance. CONCLUSION: Using videofluoroscopy, this study shows rt HNC patients have worse swallowing outcomes associated with reduced hyolaryngeal mechanics and pharyngeal constriction compared with controls.展开更多
To the Editor:In the last recent years,significant progress has been achieved in research on dysphagia.This is important because approximately 50% of patients with dysphagia after acute stroke still have a slow functi...To the Editor:In the last recent years,significant progress has been achieved in research on dysphagia.This is important because approximately 50% of patients with dysphagia after acute stroke still have a slow functional recovery,and the duration of disease may last for several months or the whole life.The ultimate aim of dysphagia treatment is for patients to be able to eat again and to examine if the influence of eating conditions is inevitable in dysphagia research.展开更多
OBJECTIVE:To evaluate the effect of acupuncture therapies administered in combination with swallowing training on the quality of life of laryngeal cancer patients with dysphagia after surgery.METHODS:Seventy-one posto...OBJECTIVE:To evaluate the effect of acupuncture therapies administered in combination with swallowing training on the quality of life of laryngeal cancer patients with dysphagia after surgery.METHODS:Seventy-one postoperative patients with laryngeal cancer participated in this study.The patients diagnosed with swallowing dysfunction by video fluoroscopic swallowing examination(VFSE)were randomly divided into experimental group(n=36)and control group(n=35).Patients in both groups were provided swallowing training and rehabilitation consultation.Patients in the experimental group were additionally provided with acupuncture therapies.All patients were evaluated using VFSE and MD Anderson dysphagia inventory(MDADI)and Quality of Life Questionnaire-core 30(QLQ-c30)score immediately after surgery and three months later.RESULTS:The effective rate of 97.1%(n=35)and the complete remission rate of 36.1%(n=13)in the experimental group were higher than those in the control group of 60%(n=21)and 14.3%(n=5)(P<0.01).The scores of VFSE,MDADI and QLQ-c 30 in the experimental group and the control group at three months after therapies were significantly improved compared with those before therapies(P<0.05).The scores of VFSE,MDADI and QLQ-c30 in the experimental group at three months after therapies were significantly improved compared with the control group.The improvement in the intervention group was significantly better than that in the control group.There were no adverse reactions in two groups.CONCLUSIONS:Acupuncture therapies combined with swallowing training can improve the swallowing function and the quality of life of laryngeal cancer patients with dysphagia after surgery.展开更多
This review article provides an overview of the physiology and biomechanics of food oral processing,with a wider view towards the development of wellness foods that facilitate proper chewing and safe swallowing.The co...This review article provides an overview of the physiology and biomechanics of food oral processing,with a wider view towards the development of wellness foods that facilitate proper chewing and safe swallowing.The complexity of food oral processing is well recognized,involving food-mouth-gut-brain interplay.This process requires precise coordination of chewing,oro-sensing,neural control,saliva secretion,bolus formation,swallowing and respiration,involving central and peripheral nervous systems,sensors and muscles of the oral cavity,pharynx,larynx and oesophagus.Oral processing of an ingested food leads to its fragmentation,hydration,breakdown,transformation and reconstruction,and provides simultaneous oro-sensory perception and preliminary food digestion via mechanical fracture and chemical/enzymatic reactions.There exists a complex food structure-property-processing relationship from the first bite of a food through to bolus formation for swallowing.Achieving maximal deformability of a bolus is a key criterion for successful swallow-aided food development.Food structure is the main variable affecting food breakdown,food sensory perception and bolus formation.More research is needed to better understand the food structure-oral processing relationship,which guides the tailoring of foods/diets for individuals with chewing and swallowing difficulties to achieve balanced nutrition and an enjoyable eating experience.展开更多
Dysphagia has been classified as a“geriatric syndrome”and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide.A characteristic age-related cha...Dysphagia has been classified as a“geriatric syndrome”and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide.A characteristic age-related change in swa-llowing is defined as“presbyphagia.”Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing.However,there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging.Our review provides an overview of presbyphagia,which has been a neglected health problem for a long time.Attention and awareness of dysphagia in the elderly population should be strengthened,and targeted intervention measures should be actively imple-mented.展开更多
Background:Post-stroke dysphagia is one of the common clinical symptoms in the rehabilitation department of primary hospitals,which seriously affects the quality of life of patients and their families.Majority of medi...Background:Post-stroke dysphagia is one of the common clinical symptoms in the rehabilitation department of primary hospitals,which seriously affects the quality of life of patients and their families.Majority of medical workers have comprehensively studied post-stroke dysphagia as it easily induces inhalation pneumonia,asphyxia,and many other complications.At present,many methods for post-stroke dysphagia have been proved to be effective.With regard to comprehensive treatment effect,patient compliance,technology promotion difficulty,grassroots hospital operability,and other factors,we found that acupoint injection combined with nerve electrical stimulation is a good method worthy of promotion.Methods:A total of 130 patients with dysphagia after stroke were randomly divided into nerve electrical stimulation group(n=41),acupoint injection group(n=40),and comprehensive treatment group(nerve electrical stimulation plus acupoint injection,n=49).The therapeutic effect in each group was evaluated before treatment and 20 days after treatment using the improved water swallow test,video fluoroscopic swallowing study,and standardized swallowing assessment.Results:After 20 days of treatment,significant differences were noted in each group.The scores of improved water swallow test decreased from 4.10±0.74 to 2.12±0.95 in the nerve electrical stimulation group,4.00±0.78 to 2.28±1.04 in the acupoint injection group,and 4.16±0.77 to 1.73±0.79 in the comprehensive treatment group;video fluoroscopic swallowing study scores increased from 3.71±2.16 to 5.05±2.111 in the nerve electrical stimulation group,3.80±1.94 to 5.20±1.942 in the acupoint injection group,and 3.73±2.22 to 6.24±2.21 in the comprehensive treatment group;and standardized swallowing assessment scores of the three groups also decreased from 35.13±3.38 to 28.17±3.42,34.66±3.46,and 34.48±3.26 to 26.39±3.86,respectively.The overall scores of each group after treatment were significantly different from those before treatment(P<0.05),indicating that both nerve electrical stimulation and acupoint injection were effective for post-stroke dysphagia;the scores of nerve electrical stimulation group and acupoint injection group were similar,but those of the comprehensive treatment group were significantly better than the single treatments(P<0.05).It shows that the two treatment methods have synergistic effect,and combined treatments have more benefits.Conclusion:Nerve electrical stimulation and acupoint injection have a synergistic therapeutic effect on post-stroke dysphagia.The combined treatment is more beneficial to patients with post-stroke dysphagia than the single treatments.展开更多
Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the co...Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.展开更多
AIM: To determine the accuracy of 2-channel surface electromyography(sE MG) for diagnosing oropharyngeal dysphagia(OPD) in patients with cerebral palsy.METHODS: Participants with cerebral palsy and OPD between 5 and 3...AIM: To determine the accuracy of 2-channel surface electromyography(sE MG) for diagnosing oropharyngeal dysphagia(OPD) in patients with cerebral palsy.METHODS: Participants with cerebral palsy and OPD between 5 and 30 years of age and age- and sexmatched healthy individuals received s EMG testing during swallowing. Electrodes were placed over the submental and infrahyoid muscles, and s EMG recordings were made during stepwise(starting at 3 mL) determination of maximum swallowing volume. Outcome measures included submental muscle group maximum amplitude, infrahyoid muscle group maximum amplitude(IMGMA), time lag between the peak amplitudes of 2 muscle groups, and amplitude difference between the 2 muscle groups.RESULTS: A total of 20 participants with cerebral palsy and OPD(OPD group) and 60 age- and sex-matched healthy volunteers(control group) were recruited. Among 20 patients with OPD, 19 had Dysphagia Outcome and Severity Scale records. Of them, 8 were classified as severe dysphagia(level 1), 1 was moderate dysphagia(level 3), 4 were mild to moderate dysphagia(level 4), 3 were mild dysphagia(level 5), and 3 were within functional limits(level 6). Although the groups were matched for age and sex, participants in the OPD group were significantly shorter, weighed less and had lower body mass index than their counterparts in the control group(both, P < 0.001). All s EMG parameter values were significantly higher in the OPD group compared with the control group(P < 0.05). Differences were most pronounced at the 3 mL swallowing volume. IMGMA at the 3 mL volume was the best predictor of OPD with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 85.0%, 90.0%, 73.9%, 94.7% and 88.8%, respectively.展开更多
More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obliga...More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria that produce a potent neurotoxin. Eight different Clostridium botulinum neurotoxins have been described(A-H) and 5 of those cause disease in humans. These toxins cause paralysis by blocking the presynaptic release of acetylcholine at the neuromuscular junction. Advantage can be taken of this blockade to alleviate muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. The Food and Drug Administration first approved botulinum toxin(BT) type A in 1989 for the treatment of strabismus and blepharospasm associated with dystonia in patients 12 years of age or older. Ever since, therapeutic applications of BT have expanded to other systems, including the gastrointestinal tract. Although only a single fatality has been reported to our knowledge with use of BT for gastroenterological conditions, there are significant complications ranging from minor pain, rash and allergic reactions to pneumothorax, bowel perforation and significant paralysis of tissues surrounding the injection(including vocal cord paralysis and dysphagia). This editorial describes the clinical experience and evidence for the use BT in gastrointestinal motility disorders in children.展开更多
基金This study was approved by the Ethics Committee of Hengyang Maternal and Child Health Hospital(No.202001151).
文摘BACKGROUND Ischemic stroke(IS)is a widely recognized disease characterized by high preva-lence,mortality,morbidity,disability,and recurrence rates.It ranks prominently in terms of mortality,constituting 60%-80%of stroke cases.AIM To explore the impact of comprehensive nursing care on the quality of life and swallowing function in individuals diagnosed with IS.METHODS This study comprised 172 patients with IS admitted to our hospital between February 2018 to March 2021.The participants were divided into two groups,namely the control group(n=80)receiving routine care and the research group(n=92)receiving comprehensive care.Various assessment scales,including the standard swallowing function assessment scale(SSA),National Institutes of Health Stroke scale(NIHSS),European stroke scale(ESS),self-rating anxiety scale(SAS),self-rating depression scale(SDS),Barthel index(BI),and the motor func-tion assessment scale(MAS),were employed to evaluate the improvement in swallowing function,neurological deficits,clinical outcomes,anxiety,depression,daily living activities,and motor function before and after care.Furthermore,the study compared the occurrence of adverse reactions during the nursing period,life quality before and after the intervention,rehabilitation compliance,and nursing satisfaction between the two groups.RESULTS After the nursing intervention,the research group exhibited significantly improved SSA and NIHSS scores compared to the control group(P<0.05).Moreover,both groups demonstrated significant reductions in SAS and SDS scores(P<0.05),with the research group showing more obvious advantages(P<0.05).Compared to the control group,the research group displayed significantly better ESS,BI,and MAS scores(P<0.05),coupled with a lower incidence of adverse reactions(P<0.05).Additionally,the research group demonstrated markedly higher levels of life quality,rehabilitation compliance,and nursing satisfaction compared to the control group(P<0.05).CONCLUSION Comprehensive nursing effectively improved swallowing function,quality of life,and patient satisfaction,high-lighting its clinical significance.
文摘Objectives:The relationship between eating and swallowing function,and lifestyle among community-dwelling elderly people has not been extensively studied.This study aimed to analyze the characteristics of eating and swallowing function and their association with the lifestyle among the elderly.Methods:A self-administered questionnaire survey was conducted on 419 elderly people who participated in the oral function improvement project operated by the Community Comprehensive Support Center.A total of 288 valid responses(58 males,230 females,average age 73.6 years)were analyzed.The survey items included basic demographics,health status,lifestyle,and eating and swallowing functions.The chi-square(χ2)test was used to compare for a difference in the risk of dysphagia.Results:72 patients(25.0%)were judged to be at risk for dysphagia,and 216(75.0%)were judged to be not at risk for dysphagia using the revised dysphagia risk assessment scale.The mean score for oral preparatory dysphagia was the highest,while the mean score for pharyngeal dysphagia was the lowest.The group at risk of dysphagia had significant difficulty in chewing and had bad sleep quality as compared to the group that was not at risk.Conclusion:Concerning the risk of dysphagia,there is a need to maintain and improve masticatory function.In addition,improving the swallowing function of the elderly may prevent insomnia and improve sleep quality.
基金Supported by Hospital-level Project of Shiyan Taihe Hospital(2019JJXM117)。
文摘This article summarizes the current rehabilitation treatment methods for dysphagia after stroke,including feeding-swallowing function treatment,acupuncture treatment,neuromuscular electrical stimulation,balloon catheter dilatation,etc.,all of which have many clinical applications,hoping to play a guiding role in future research.
文摘Introduction: Laryngeal carcinoma accounts for 13.9% of head and neck tumors, and squamous cell carcinoma is the main pathological type. At present, the treatment of laryngeal cancer is mainly surgical treatment or postoperative radiotherapy. The surgery is delicate, complex, time-consuming and traumatic. Postoperative patients are prone to dysphagia, leading to an increase in the incidence of malnutrition. Malnutrition can cause a series of negative effects, including weight loss, increased incidence of infection, reduced tolerance of anti-tumor treatment, and extended length of hospital stay. Therefore, how to effectively improve the nutritional status of laryngeal cancer patients through nursing intervention has become an important topic of nursing research. Objective: Investigate the effect of individualized nutrition intervention care combined with swallowing training on postoperative nutritional status in patients with laryngeal cancer. Methods: A total of 120 consecutive patients who underwent laryngeal surgery at our hospital for the first time between May 2018 and May 2021 were selected for the study and equally divided into the control group and the study group by the random number table method, with 60 patients in each group. Patients in the control group were given swallowing function training and health counseling, and the study group adopted individualized nutrition intervention care based on the control group. The nutritional status, swallowing function, and quality of life (QOL) of the patients were assessed using the Patient-generated Subjective Global Assessment (PG-SGA), MD Anderson Dysphagia Inventory (MDADI), and Quality of Life Questionnaire-Core30 (QLQ-C30) before the intervention and three months after the intervention. Results: Before the intervention, the scores of MDADI, PG-SGA, and QLQ-C30 were not significantly different between the two groups (P > 0.05), and three months after the intervention, the scores of MDADI and QLQ-C30 increased and the score of PG-SGA decreased in the study group, with significant differences (P 0.05). At three months after the intervention, patients in the study group had higher scores on MDADI, QLQ-C30 and lower scores on PG-SGA than the control group, with significant differences (P Conclusion: Combining individualized nutrition intervention care with swallowing training improves the postoperative nutritional status, swallowing function, and QOL of patients with laryngeal cancer.
基金Authors acknowledge a grant support from Chinese Nutrition Society for this project(2015 Chinese Nutrition Society(CNS)Nutrition Research Foundation—DSM Research Fund,grant number:cws201506913).
文摘Weakened capability of eating and swallowing is common among elderly population,affecting negatively on their health and well-being.This work measured occlusal force and tongue muscle strength of elderly patients and then assessed whether correlations existed between oral physiological properties and the eating and swallowing capability.A total of 26 elderly patients with potential swallow disorder were recruited in this work.Participants’denture status and daily diet texture were determined by a pre-questionnaire analysis.Their swallowing capability was assessed and rated by water drinking test.Maximum tongue pressure,incisor occlusal force and hand gripping force were measured for each subject.It was observed that participating subjects have on average a significantly lower biting force and maximum tongue pressure than that of normal adults.The swallowing grades assessed by water drinking test showed significant correlations with both the biting force(r=−0.498,P<0.05)and the tongue muscle strength(r=−0.544,P<0.05).The biting force of dysphagia participants correlates significantly with dental conditions(P<0.05).The observed correlation between tongue pressure and diet texture indicates that tongue muscle strength could be used as a reliable indicator of the eating and swallowing capability for elderly people.
文摘Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.
文摘Aim: To compare the chewing process and swallowing threshold parameters of subjects with complete dentures and overdentures with data obtained from subjects with complete natural dentitions. Metho-dology: The chewing process in terms of swallowing threshold parameters of four groups of subjects with complete dentures (all females) was quantified by sieving particles after chewing of an artificial test ‘food’ and compared with that of subjects with com-plete natural dentitions as a reference group (33 sub-jects). All subjects (except those of the reference group) had a complete denture in the upper jaw. Regarding the lower jaw two groups with complete dentures (with high (24 subjects), respectively low mandible (12 subjects)) and two groups with overdentures (implant-retained (22 subjects), respectively natural root supported (19 subjects)) were composed. Results: The ‘overdenture-implants’ group needed significantly more chewing cycles and time (mean: 45 cycles in 32 seconds) until ‘swallowing’ compared to the group with complete natural dentitions (mean: 26 cycles in 19 seconds until ‘swallowing’). Also the ‘complete denture-low mandible’ group needed sig-nificantly more cycles and time (mean: 52 cycles in 44 seconds) until ‘swallowing’ than the complete dentition group. In the ‘overdenture-natural roots’ group these outcomes (33 cycles in 24 seconds) were not significantly different compared with the complete dentition group. The ‘complete denture-high mandi-ble’ group (32 cycles in 26 seconds) needed not sig-nificantly more cycles until ‘swallowing’, however time until ‘swallowing’ was significantly longer com-pared to the complete dentition group. All denture groups had significantly larger mean particle sizes when ‘swallowing’ (sizes in the order of 3 mm) than the natural dentition group (about 2 mm). Conclusion: Despite efforts to compensate for a reduced chewing efficiency, subjects with complete dentures (including overdentures) had 50% larger median particle sizes when ‘swallowing’ compared to subjects with complete natural dentitions.
文摘<b><span style="font-family:"">Objective</span></b><span style="font-family:"">: Oral diadochokinesis (ODK) has been shown to be associated with oral frailty. In this study, we investigate the relationship between physical function, swallowing function, nutritional evaluation, and each syllable of ODK. <b>Methods</b>: The subjects are 26 elderly people living in an area where <span>they can walk. ODK, tongue pressure, modified water swallowing test, EAT-10,</span> grip strength, MNA-SF, skeletal muscle index, height, weight, and BMI were evaluated. For statistical analysis based on ODK values, the subjects were divided into two groups on the basis of the number of times the syllables /pa/, /ta/, and /ka/ were repeated: 1) The first group with >6 repetitions exceeded six</span><span style="font-family:"">;</span><span style="font-family:""> 2) the second group with ≤5 repetitions. Both groups were compared using the Mann-Whitney U test (Model 1). In addition, the syllables /pa/, /ta/, and /ka/ were also divided among the groups and a comparison was performed (Model 2). <b>Results</b>: In Model 1, the tongue pressure value was significantly higher in the good group (p < 0.01). In Model 2, the good group showed significantly higher values for the syllables /pa/ (p < 0.01) and /ta/ (p < 0.05). There was no significant difference in the values for the syllable /ka/. <b>Conclusion</b>: In community-dwelling elderly people, tongue pressure was positively associated with ODK values for the syllables /pa/ and /ta/, suggesting that tongue pressure may be associated with strength of the lip and tongue tip muscles. Furthermore, it was suggested that the ODK values may even be lower than normal values in the elderly who maintain skeletal muscle mass and thus have adequate tongue pressure;therefore, these indicators may be used as a guideline to assess oral frailty.
文摘This study aimed to evaluate the quality of healthcare services pertaining to the dietary intake and swallowing functions of residents, nutrition management practices, and performance of residents at long-term care facilities. We investigated outcome indicators, such as changes in dietary intake and swallowing function levels of residents, and clarified which structural and process indicators were associated with the outcome indicators. This was a retrospective study, analyzing information on healthcare services from 1067 long-term care facilities during the fiscal year 2012, sampled from among those registered with the Welfare, Health and Medical Care Information Network of the Welfare and Medical Service Agency in Japan. Five outcome indicators were identified. Next, we examined the relationships between the outcome indicators and structural or process indicators using a multivariate linear regression model, adjusting for facility type. The findings showed how the five outcome indicators were used in long-term care facilities over a period of one year and determined the independent predictors of these outcome indicators. The amplification of dietary function 1 was associated with “assessment of oral functions using a feeding and swallowing assessment checklist every three months”, “holding care conferences related to ingestion and swallowing every three months”, and “maintaining a 1:2 ratio for meal-time assistants to residents”. To improve the quality of care, it is necessary to increase the number of staff (e.g., to provide meal assistance to residents) and to understand changes in the residents’ status through accurate assessment and monitoring.
文摘Introduction: It is well known that humans have an increased sense of taste and consume more food when eating with others. This effect is called social facilitation of eating. We previously reported that self-images also have the effect of social facilitation of eating. In the present study, we investigated the effect of a head-mounted display (HMD) as a means of presenting self-images. Methods: Fourteen healthy adults (7 females and 7 males) were included in the study. The mean age of the participants was 20.4 years. The experimental conditions were as follows: the presentation conditions include the SG condition, in which an image was projected on the smart glasses, and the MT condition, in which an image was projected on the monitor. The stimulation conditions include the self-image condition (Self condition), in which the participant’s own image was projected, and the background image condition (Background condition), in which the background image was projected. Participants were asked to consume green tea jelly three times under the four conditions, which consisted of combinations of the presentation and stimulation conditions. Electromyography (EMG) and electroencephalography (EEG) were used to measure the muscle activity of the suprahyoid muscle group and brain activity, respectively. Results: The EMG of the “SG-Self” condition was significantly higher than that of “SG-Background” and “MT-Background” conditions. The EMG of the “MT-Self” condition was significantly higher than that of the “MT-Background” condition. In the EEG before the start of swallowing, “SG-Self” was significantly lower in the alpha band and higher in the beta band than “MT-Background”. The beta-alpha ratio was significantly higher for “SG-Self” than for “SG-Background” and “MT-Background” and higher for “MT-Self” than for “MT-Background”. Conclusion: These results suggest that self-images influence muscle and brain activities during swallowing, regardless of the presentation conditions, such as HMD or monitor.
文摘Objective: The objective is to assess patients complaining of dysphagia with fibreoptic endoscopic evaluation of swallowing [FEES]. Study design: It is a prospective study. Setting: The study is conducted at Tertiary referral hospital. Methods: In our study, twenty patients with complaints of dysphagia were evaluated with fibreoptic endoscopic evaluation of swallowing. Patients with pharyngeal cause of dysphagia were identified and recommended dietary modifications or positional manoeuvre. Results: A total of twenty patients were evaluated with FEES. Patients were categorised into two groups based on the etiological factor: neurological and non-neurological patients. In eleven of the neurological patients, premature spillage was seen in four patients. Pooling for solids was seen in one patient and for liquids in four patients, pooling for both solids and liquids was seen in six patients, penetration was seen in 1 patient and aspiration in one patient. All these patients were diagnosed to have a pharyngeal cause of dysphagia. In the nine of the non-neurological group, pooling of liquids was seen in four patients, and aspiration was seen in one patient. None of the patients of this group had spillage. One patent had penetration. Five patients had pharyngeal cause of dysphagia. Remaining four patients had normal study. These patients with pharyngeal cause were advised dietary modification or positional manoeuvre or a combination of both. Conclusion: FEES is an effective and valuable tool for evaluating pharyngeal dysphagia, and is helpful in guiding the patients for diet and rehabilitation. It is essential to assess the safety of swallowing in patients to prevent silent aspiration and aspiration pneumonia.
文摘AIM: To determine swallowing outcomes and hyolaryngeal mechanics associated with post radiation therapy head and neck cancer(rt HNC) patients using videofluoroscopic swallow studies. METHODS: In this retrospective cohort study, video-fluoroscopic images of rt HNC patients(n = 21) were compared with age and gender matched controls(n = 21). Penetration-aspiration of the bolus and bolus residue were measured as swallowing outcome variables. Timing and displacement measurements of the anterior and posterior muscular slings elevating the hyolaryngeal complex were acquired. Coordinate data of anatomical landmarks mapping the action of the anterior muscles(suprahyoid muscles) and posterior muscles(long pharyngeal muscles) were used to calculate the distance measurements, and slice numbers were used to calculate time intervals. Canonical variate analysis with post-hoc discriminant function analysis was performed on coordinate data to determine multivariate mechanics of swallowing associated with treatment. Pharyngeal constriction ratio(PCR) was also measured to determine if weak pharyngeal constriction is associated with post radiation therapy.RESULTS: The rt HNC group was characterized by poor swallowing outcomes compared to the control group in regards to: Penetration-aspiration scale(P < 0.0001), normalized residue ratio scale(NRRS) for the valleculae(P = 0.002) and NRRS for the piriform sinuses(P = 0.003). Timing and distance measurements of the anterior muscular sling were not significantly different in the two groups, whereas for the PMS time of displacement was abbreviated(P = 0.002) and distance of excursion was reduced(P = 0.02) in the rt HNC group. A canonical variate analysis shows a significant reduction in pharyngeal mechanics in the rt HNC group(P < 0.0001). The PCR was significantly higher in the test group than the control group(P = 0.0001) indicating reduced efficiency in pharyngeal clearance. CONCLUSION: Using videofluoroscopy, this study shows rt HNC patients have worse swallowing outcomes associated with reduced hyolaryngeal mechanics and pharyngeal constriction compared with controls.
文摘To the Editor:In the last recent years,significant progress has been achieved in research on dysphagia.This is important because approximately 50% of patients with dysphagia after acute stroke still have a slow functional recovery,and the duration of disease may last for several months or the whole life.The ultimate aim of dysphagia treatment is for patients to be able to eat again and to examine if the influence of eating conditions is inevitable in dysphagia research.
基金Supported by Naturalof Science and Technology Department of Jilin Province To the role of SET 8 gene in the expression of P 53 and apoptosis in laryngeal carcinoma TU 212 cells(No.20200201432JC)
文摘OBJECTIVE:To evaluate the effect of acupuncture therapies administered in combination with swallowing training on the quality of life of laryngeal cancer patients with dysphagia after surgery.METHODS:Seventy-one postoperative patients with laryngeal cancer participated in this study.The patients diagnosed with swallowing dysfunction by video fluoroscopic swallowing examination(VFSE)were randomly divided into experimental group(n=36)and control group(n=35).Patients in both groups were provided swallowing training and rehabilitation consultation.Patients in the experimental group were additionally provided with acupuncture therapies.All patients were evaluated using VFSE and MD Anderson dysphagia inventory(MDADI)and Quality of Life Questionnaire-core 30(QLQ-c30)score immediately after surgery and three months later.RESULTS:The effective rate of 97.1%(n=35)and the complete remission rate of 36.1%(n=13)in the experimental group were higher than those in the control group of 60%(n=21)and 14.3%(n=5)(P<0.01).The scores of VFSE,MDADI and QLQ-c 30 in the experimental group and the control group at three months after therapies were significantly improved compared with those before therapies(P<0.05).The scores of VFSE,MDADI and QLQ-c30 in the experimental group at three months after therapies were significantly improved compared with the control group.The improvement in the intervention group was significantly better than that in the control group.There were no adverse reactions in two groups.CONCLUSIONS:Acupuncture therapies combined with swallowing training can improve the swallowing function and the quality of life of laryngeal cancer patients with dysphagia after surgery.
文摘This review article provides an overview of the physiology and biomechanics of food oral processing,with a wider view towards the development of wellness foods that facilitate proper chewing and safe swallowing.The complexity of food oral processing is well recognized,involving food-mouth-gut-brain interplay.This process requires precise coordination of chewing,oro-sensing,neural control,saliva secretion,bolus formation,swallowing and respiration,involving central and peripheral nervous systems,sensors and muscles of the oral cavity,pharynx,larynx and oesophagus.Oral processing of an ingested food leads to its fragmentation,hydration,breakdown,transformation and reconstruction,and provides simultaneous oro-sensory perception and preliminary food digestion via mechanical fracture and chemical/enzymatic reactions.There exists a complex food structure-property-processing relationship from the first bite of a food through to bolus formation for swallowing.Achieving maximal deformability of a bolus is a key criterion for successful swallow-aided food development.Food structure is the main variable affecting food breakdown,food sensory perception and bolus formation.More research is needed to better understand the food structure-oral processing relationship,which guides the tailoring of foods/diets for individuals with chewing and swallowing difficulties to achieve balanced nutrition and an enjoyable eating experience.
基金Supported by 2021 China Disabled Persons'Federation to Fund Projects,No.2021CDPFAT-45.
文摘Dysphagia has been classified as a“geriatric syndrome”and can lead to serious complications that result in a tremendous burden on population health and healthcare resources worldwide.A characteristic age-related change in swa-llowing is defined as“presbyphagia.”Medical imaging has shown some changes that seriously affect the safety and efficacy of swallowing.However,there is a general lack of awareness of the effects of aging on swallowing function and a belief that these changes are part of normal aging.Our review provides an overview of presbyphagia,which has been a neglected health problem for a long time.Attention and awareness of dysphagia in the elderly population should be strengthened,and targeted intervention measures should be actively imple-mented.
基金This work was supported by the Jiangsu Provincial Administration of Traditional Chinese Medicine(No.YB201840).
文摘Background:Post-stroke dysphagia is one of the common clinical symptoms in the rehabilitation department of primary hospitals,which seriously affects the quality of life of patients and their families.Majority of medical workers have comprehensively studied post-stroke dysphagia as it easily induces inhalation pneumonia,asphyxia,and many other complications.At present,many methods for post-stroke dysphagia have been proved to be effective.With regard to comprehensive treatment effect,patient compliance,technology promotion difficulty,grassroots hospital operability,and other factors,we found that acupoint injection combined with nerve electrical stimulation is a good method worthy of promotion.Methods:A total of 130 patients with dysphagia after stroke were randomly divided into nerve electrical stimulation group(n=41),acupoint injection group(n=40),and comprehensive treatment group(nerve electrical stimulation plus acupoint injection,n=49).The therapeutic effect in each group was evaluated before treatment and 20 days after treatment using the improved water swallow test,video fluoroscopic swallowing study,and standardized swallowing assessment.Results:After 20 days of treatment,significant differences were noted in each group.The scores of improved water swallow test decreased from 4.10±0.74 to 2.12±0.95 in the nerve electrical stimulation group,4.00±0.78 to 2.28±1.04 in the acupoint injection group,and 4.16±0.77 to 1.73±0.79 in the comprehensive treatment group;video fluoroscopic swallowing study scores increased from 3.71±2.16 to 5.05±2.111 in the nerve electrical stimulation group,3.80±1.94 to 5.20±1.942 in the acupoint injection group,and 3.73±2.22 to 6.24±2.21 in the comprehensive treatment group;and standardized swallowing assessment scores of the three groups also decreased from 35.13±3.38 to 28.17±3.42,34.66±3.46,and 34.48±3.26 to 26.39±3.86,respectively.The overall scores of each group after treatment were significantly different from those before treatment(P<0.05),indicating that both nerve electrical stimulation and acupoint injection were effective for post-stroke dysphagia;the scores of nerve electrical stimulation group and acupoint injection group were similar,but those of the comprehensive treatment group were significantly better than the single treatments(P<0.05).It shows that the two treatment methods have synergistic effect,and combined treatments have more benefits.Conclusion:Nerve electrical stimulation and acupoint injection have a synergistic therapeutic effect on post-stroke dysphagia.The combined treatment is more beneficial to patients with post-stroke dysphagia than the single treatments.
基金supported by the Beijing Municipal Science and Technology Commission Capital Clinical Feature Applied Research Project of China,No.Z181100001718205(to WJG and PLH)。
文摘Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.
文摘AIM: To determine the accuracy of 2-channel surface electromyography(sE MG) for diagnosing oropharyngeal dysphagia(OPD) in patients with cerebral palsy.METHODS: Participants with cerebral palsy and OPD between 5 and 30 years of age and age- and sexmatched healthy individuals received s EMG testing during swallowing. Electrodes were placed over the submental and infrahyoid muscles, and s EMG recordings were made during stepwise(starting at 3 mL) determination of maximum swallowing volume. Outcome measures included submental muscle group maximum amplitude, infrahyoid muscle group maximum amplitude(IMGMA), time lag between the peak amplitudes of 2 muscle groups, and amplitude difference between the 2 muscle groups.RESULTS: A total of 20 participants with cerebral palsy and OPD(OPD group) and 60 age- and sex-matched healthy volunteers(control group) were recruited. Among 20 patients with OPD, 19 had Dysphagia Outcome and Severity Scale records. Of them, 8 were classified as severe dysphagia(level 1), 1 was moderate dysphagia(level 3), 4 were mild to moderate dysphagia(level 4), 3 were mild dysphagia(level 5), and 3 were within functional limits(level 6). Although the groups were matched for age and sex, participants in the OPD group were significantly shorter, weighed less and had lower body mass index than their counterparts in the control group(both, P < 0.001). All s EMG parameter values were significantly higher in the OPD group compared with the control group(P < 0.05). Differences were most pronounced at the 3 mL swallowing volume. IMGMA at the 3 mL volume was the best predictor of OPD with a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 85.0%, 90.0%, 73.9%, 94.7% and 88.8%, respectively.
文摘More than a century has elapsed since the identification of Clostridia neurotoxins as the cause of paralytic diseases. Clostridium botulinum is a heterogeneous group of Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacteria that produce a potent neurotoxin. Eight different Clostridium botulinum neurotoxins have been described(A-H) and 5 of those cause disease in humans. These toxins cause paralysis by blocking the presynaptic release of acetylcholine at the neuromuscular junction. Advantage can be taken of this blockade to alleviate muscle spams due to excessive neural activity of central origin or to weaken a muscle for treatment purposes. In therapeutic applications, minute quantities of botulinum neurotoxin type A are injected directly into selected muscles. The Food and Drug Administration first approved botulinum toxin(BT) type A in 1989 for the treatment of strabismus and blepharospasm associated with dystonia in patients 12 years of age or older. Ever since, therapeutic applications of BT have expanded to other systems, including the gastrointestinal tract. Although only a single fatality has been reported to our knowledge with use of BT for gastroenterological conditions, there are significant complications ranging from minor pain, rash and allergic reactions to pneumothorax, bowel perforation and significant paralysis of tissues surrounding the injection(including vocal cord paralysis and dysphagia). This editorial describes the clinical experience and evidence for the use BT in gastrointestinal motility disorders in children.
