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Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence.

J Speech Lang Hear Res. 2008 Feb;51(1):S276-300. doi: 10.1044/1092-4388(2008/021).
Robbins J1, Butler SG, Daniels SK, Diez Gross R, Langmore S, Lazarus CL, Martin-Harris B, McCabe D, Musson N, Rosenbek J.

Abstract

PURPOSE:

This review presents the state of swallowing rehabilitation science as it relates to evidence for neural plastic changes in the brain. The case is made for essential collaboration between clinical and basic scientists to expand the positive influences of dysphagia rehabilitation in synergy with growth in technology and knowledge. The intent is to stimulate thought and propose potential research directions.

METHOD:

A working group of experts in swallowing and dysphagia reviews 10 principles of neural plasticity and integrates these advancing neural plastic concepts with swallowing and clinical dysphagia literature for translation into treatment paradigms. In this context, dysphagia refers to disordered swallowing associated with central and peripheral sensorimotor deficits associated with stroke, neurodegenerative disease, tumors of the head and neck, infection, or trauma.

RESULTS AND CONCLUSIONS:

The optimal treatment parameters emerging from increased understanding of neural plastic principles and concepts will contribute to evidence-based practice. Integrating these principles will improve dysphagia rehabilitation directions, strategies, and outcomes. A strategic plan is discussed, including several experimental paradigms for the translation of these principles and concepts of neural plasticity into the clinical science of rehabilitation for oropharyngeal swallowing disorders, ultimately providing the evidence to substantiate their translation into clinical practice.

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Effects on facial dysfunction and swallowing capacity of intraoral stimulation early and late after stroke

NeuroRehabilitation. 2015 Jan 1;36(1):101-6. doi: 10.3233/NRE-141197.
Hägg MK, Tibbling LI.
BACKGROUND: Most patients with post-stroke dysphagia are also affected by facial dysfunction in all four facial quadrants. Intraoral stimulation can successfully treat post-stroke dysphagia, but its effect on post-stroke facial dysfunction remains unknown. OBJECTIVE: This study aimed to investigate whether intraoral stimulation after stroke has simultaneous effects on facial dysfunction in the contralateral lower facial quadrant and in the other three facial quadrants, on lip force, and on dysphagia. METHODS: Thirty-one stroke patients were treated with intraoral stimulation and assessed with a facial activity test, lip force test, and swallowing capacity test at three time-points: before treatment, at the end of treatment, and at late follow-up (over one year after the end of treatment). RESULTS: Facial activity, lip force, and swallowing capacity scores were all improved between baseline and the end of treatment (P < 0.001 for each), with these improvements remaining at late follow-up. Baseline and treatment data did not significantly differ between patients treated short and late after stroke. CONCLUSIONS: Treatment with intraoral stimulation significantly improved post-stroke dysfunction in all four facial quadrants, swallowing capacity, and lip force even in cases of long-standing post-stroke dysfunction. Furthermore, such improvement remained for over one year after the end of treatment.

Jeri Logemann – O estudo sobre a disfagia no mundo

Quem é fonoaudiólogo e trabalha com disfagia com certeza já leu algum texto da Dra Jeri Logemann. O site http://www.swallowstudy.com/?p=653 traz uma análise do percurso desta pesquisadora na fonoaudiologia e, ao longo do texto, encontramos uma série de links para artigos clássicos na nossa área. Ótima leitura e grande homenagem!

Jeri A. Logemann, PhD, CCC-SLP, BCS-S (from http://www.swallowstudy.com/?p=653)

Dysphagia after Occipitothoracic Fusion is Caused by Direct Compression of Oropharyngeal Space Due to Anterior Protrusion of Mid-cervical Spine.

J Spinal Disord Tech. 2014 Oct 28. [Epub ahead of print]
Abstract

STUDY DESIGN::

A retrospective study.

OBJECTIVE::

To investigate the relationship among the craniocervical alignment, the oropharyngeal space and the incidence of dysphagia after occipitothoracic fusion (OTF).

SUMMARY OF BACKGROUND DATA::

Craniocervical malalignment after occipitothoracic fusion is one of a trigger of dysphagia. However, there has been no logical explanation for the etiology yet.

METHODS::

A total of 32 patients who underwent OTF (5 male, 27 female) were reviewed. Following four parameters on the lateral cervical radiogram, pharyngeal tilt angle (PTA); the angle between the McGregor’s line and the line that links the center of C2 pedicle and the center of vertebral body at the apex of cervical sagittal curvature, diameter of oropharyngeal airway space (dPS), O-C2 angle and C2-C7 angle were measured at follow-up and then the relationship of these parameters and their influence to the incidence of dysphagia were analyzed.

RESULTS::

Six of 32 cases (18.8%) exhibited postoperative dysphagia. ROC curves showed that PTA and dPS had moderate accuracy for the predictor of the dysphagia after OTF with the area under the curve (AUC) of 0.76 and 0.86 respectively, whereas O-C2 angle had low accuracy with AUC of 0.69 and C2-C7 angle was almost useless for prediction of postoperative dysphagia with AUC of 0.51. A multiple linear regression analysis showed that only PTA was significantly correlated with dPS (β=0.822, P=0.014), whereas the O-C2 angle (β=0.101, P=0.779) and C2-C7 angle (β=0.352, P=0.157) had negligibly small influence on dPS.

CONCLUSIONS::

Our results demonstrated strong relationships between PTA and the value of dPS, and the incidence of dysphagia. Since PTA reflects anterior protrusion of mid-cervical spine, these results indicated that dysphagia after OTF is caused by narrowing of oropharyngeal space due to direct compression from anteirorly protruded mid-cervical spine.

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