Home-Based Orolingual Exercise Improves the Coordination of Swallowing and Respiration in Early Parkinson Disease: A Quasi-Experimental Before-and-After Exercise Program Study

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Front Neurol. 2018 Jul 30;9:624. doi: 10.3389/fneur.2018.00624. eCollection 2018.
Wang CM1,2, Shieh WY3, Ho CS1, Hu YW1, Wu YR1,2.

Abstract

Introduction: The coordination of swallowing and respiration is important for safety swallowing without aspiration. This coordination was affected in Parkinson disease (PD). A noninvasive assessment tool was used to investigate the effect of an easy-to-perform and device-free home-based orolingual exercise (OLE) program on swallowing and respiration coordination in patients with early-stage PD. Materials and Methods: This study had a quasi-experimental before-and-after exercise program design. Twenty six patients with early-stage PD who were aged 62.12 ± 8.52 years completed a 12-week home-based OLE program. A noninvasive assessment tool was used to evaluate swallowing and respiration. For each patient, we recorded and analyzed 15 swallows (3 repeats of 5 water boluses: 1, 3, 5, 10, and 20 mL) before and after the home-based OLE program. Oropharyngeal swallowing and its coordination with respiration were the outcome measures. The frequency of piecemeal deglutition, pre- and post-swallowing respiratory phase patterns, and parameters of oropharyngeal swallowing and respiratory signals (swallowing respiratory pause [SRP], onset latency [OL], total excursion time [TET], excursion time [ET], second deflexion, amplitude, and duration of submental sEMG activity, and amplitude of laryngeal excursion) were examined. Results: The rate of piecemeal deglutition decreased significantly when swallowing 10- and 20-mL water boluses after the program. In the 1-mL water bolus swallowing trial, the rate of protective pre- and post-swallowing respiratory phase patterns was significantly higher after the program. For the parameters of oropharyngeal swallowing and respiratory signals, only the amplitude of laryngeal excursion was significantly lower after the program. Moreover, the volume of the water bolus significantly affected the SRP and duration of submental sEMG when patients swallowed three small water bolus volumes (1, 3, and 5 mL). Conclusion: The home-based OLE program improved swallowing and its coordination with respiration in patients with early-stage PD, as revealed using a noninvasive method. This OLE program can serve as a home-based program to improve swallowing and respiration coordination in patients with early-stage PD.

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Post-extubation Dysphagia: Does Timing of Evaluation Matter?

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Marvin S1, Thibeault S2, Ehlenbach WJ3.

Dysphagia. 2018 Jul 24. doi: 10.1007/s00455-018-9926-3. [Epub ahead of print]

Abstract

Swallowing evaluations are often delayed at least 24 h following extubation with the assumption that swallow function improves over time. The purpose of this prospective cohort study was to determine if dysphagia, as measured by aspiration and need for diet modification, declines over the first 24-h post-extubation, whereby providing evidence-based evaluation guidelines for this population. Forty-nine patients completed FEES at 2-4 h post-extubation and 24-26 h post-extubation. We compared Penetration-Aspiration Scale scores and diet recommendation between time points. Multivariable logistic regression models were created to investigate associations between age, reason for admission, reason for intubation, and a history of COPD and outcomes of aspiration or silent aspiration at either FEES exam. Sixty-nine percent of participants safely swallowed at least one texture without aspiration at 2-4 h post-extubation. Within participants, there was a significant decrease in penetration/aspiration at 24 h and 79% showed improvement in airway protection on at least one bolus type, suggesting an improvement in swallow function over the first day following extubation. These findings suggest that although patients may be safe to begin a modified diet soon after extubation, delaying evaluation until 24-h post-extubation may allow for a less restricted diet.

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The role of speech-language pathologists in adult palliative care.

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Chahda L1, Mathisen BA2, Carey LB1.

Int J Speech Lang Pathol. 2017 Feb;19(1):58-68. doi: 10.1080/17549507.2016.1241301.

Créditos Imagem: http://www.indusage.com.au/after-hours-helpline-for-palliative-care-patients-and-carers/

Abstract

PURPOSE: Given minimal studies describing the role and practice of speech-language pathologists (SLPs) in adult palliative care, the aim of this review was to compile a database of research literature, examine the potential research gaps and to consider material that specifically discussed the need for and/or use of procedures and protocols for SLPs working in palliative care that would support the development of SLP palliative care guidelines.

METHOD: A scoping review was conducted utilising Arksey and O’Malley’s framework with the goal of exploring any key concepts and approaches utilised by SLPs in adult palliative care, plus any literature and/or recommendations regarding SLP practice in adult palliative care settings.

RESULT: Over 1200 articles were initially identified. Of the 1200 articles, 13 academic papers were considered relevant as they recommended, or at least suggested, the need for speech-language pathology therapy guidelines to be implemented within adult palliative care settings.

CONCLUSION: The main focus of these articles was on ethical considerations and clinical recommendations for SLPs. Recommendations arising from this scoping review include providing goals to support current practising SLP clinicians and developing clinical guidelines to manage swallowing and/or communication needs of people receiving palliative care.

Getting comfortable with “comfort feeding”: An exploration of legal and ethical aspects of the Australian speech-language pathologist’s role in palliative dysphagia care.

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Kelly K1,2, Cumming S2, Kenny B2, Smith-Merry J2, Bogaardt H2.

Int J Speech Lang Pathol. 2018 Mar 28:1-9. doi: 10.1080/17549507.2018.1448895. [Epub ahead of print]

Abstract

PURPOSE: With an ageing population, speech-language pathologists (SLPs) can expect to encounter legal and ethical challenges associated with palliative and end-of-life care more frequently. An awareness of the medico-legal and ethical framework for palliative dysphagia management will better equip SLPs to work effectively in this area.

METHOD: This narrative review examines a range of legislation, legal, ethical and SLP literature that is currently available to orient SLPs to legal and ethical palliative dysphagia management in the Australian context.

RESULT: Relevant legal and ethical considerations in palliative and end-of-life care are described.

CONCLUSION: SLPs have a role in palliative dysphagia management, however, this can involve unique legal and ethical challenges. The legal position on provision and cessation of nutrition and hydration differs between Australian States and Territories. Decisions by the courts have established a body of relevant case law. This article introduces SLPs to some of the important considerations for legal and ethical palliative care, but is not intended to be directive. SLPs are encouraged to explore their local options for ethical and medico-legal guidance. It is hoped that increasing SLPs awareness of many of the concepts discussed in this article enhances the provision of high-quality patient-centred care.

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Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines

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P Clarke,1 K Radford,2 M Coffey,3 and M Stewart4
Author information ► Copyright and License information ►

Abstract

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The disease itself and the treatment can have far reaching effects on speech and swallow function, which are consistently prioritised by survivors as an area of concern. This paper provides recommendations on the assessments and interventions for speech and swallow rehabilitation in this patient group.

Recommendations

• All multidisciplinary teams should have rehabilitation patient pathways covering all stages of the patient’s journey including multidisciplinary and pre-treatment clinics. (G)

• Clinicians treating head and neck cancer patients should consult the National Cancer Rehabilitation Pathway for head and neck cancers. (G)

• All head and neck cancer patients should have a pre-treatment assessment of speech and swallowing. (G)

• A programme of prophylactic exercises and the teaching of swallowing manoeuvres can reduce impairments, maintain function and enable a speedier recovery. (R)

• Continued speech and language therapist input is important in maintaining voice and safe and effective swallow function following head and neck cancer treatment. (R)

• Disease recurrence must be ruled out in the management of stricture and/or stenosis. (R)

• Continuous radial expansion balloons offer a safe, effective dilation method with advantages over gum elastic bougies. (R)

• Site, length and completeness of strictures as well as whether they are in the presence of the larynx or not, need to be assessed when establishing the likelihood of surgically improved outcome. (G)

• Primary surgical voice restoration should be offered to all patients undergoing laryngectomy. (R)

• Attention to surgical detail and long-term speech and language therapist input is required to optimise speech and swallowing after laryngectomy. (G)

• Patients should commence wearing heat and moisture exchange devices as soon as possible after laryngectomy. (R)

 

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Effect of Lee Silverman Voice Treatment (LSVT LOUD®) on swallowing and cough in Parkinson’s disease: A pilot study.

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Miles A1, Jardine M2, Johnston F2, de Lisle M2, Friary P2, Allen J3.

J Neurol Sci. 2017 Dec 15;383:180-187. doi: 10.1016/j.jns.2017.11.015. Epub 2017 Nov 15.

Abstract

PURPOSE: Lee Silverman Voice Treatment (LSVT LOUD®) is an effective therapy for phonation in Parkinson’s Disease (PD) but little is known about any additional spread of effects to swallowing and cough function. This pilot study examined the effect of LSVT LOUD on pharyngeal swallowing parameters and reflexive cough strength.

METHODS: Twenty participants (14 men, 6 women; mean 68years, SD3.5) with PD referred for LSVT LOUD with complaints of voice deterioration were recruited. Mean duration of PD was 6yrs., SD 3. Self-reported Eating Assessment Tool-10 scores ranging from 0 to 25 (normal<3). Prior to LSVT LOUD, 1-week post- and 6-months post-treatment, participants undertook a videofluoroscopic study of swallowing and aerodynamic measures of involuntary cough.

RESULTS: All participants completed the LSVT LOUD programme; 3 participants were lost to follow-up at 6-months. All participants made significant gains in average sound pressure level (dB SPL). Aspiration was not observed. Pharyngeal residue (p<0.05) and pharyngeal area at rest reduced (p<0.01) while maximal opening of pharyngoesophageal segment (PES) (p<0.05) and PES opening duration (p<0.05) significantly increased. There was a significant improvement in involuntary cough peak expiratory flow rate and peak expiratory flow rise time. All changes were maintained at 6-months.

CONCLUSION: LSVT LOUD demonstrates additional spread effects on pharyngoesophageal deglutitive function and involuntary cough effectiveness in people with mild PD referred with voice complaints. Consequently, LSVT LOUD has potential to provide additional benefits for swallowing safety and efficiency in this patient group.

Copyright © 2017 Elsevier B.V. All rights reserved.

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Effects of jaw opening exercise on aspiration in stroke patients with dysphagia: a pilot study.

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Oh DH1, Won JH2, Kim YA2, Kim WJ3.

J Phys Ther Sci. 2017 Oct;29(10):1817-1818. doi: 10.1589/jpts.29.1817. Epub 2017 Oct 21.

Imagem: Cefon

Abstract

[Purpose] The purpose of this study was to investigate the effect of jaw opening exercise (JOE) on aspiration in patients with dysphagia after stroke. [Subjects and Methods] Three subjects were recruited. Isometric and isotonic JOE were performed using a rubber ball, 5 days a week for 4 weeks. Aspiration was evaluated using the penetration-a spiration scale (PAS) based on a videofluoroscopic swallowing study. [Results] All subjects showed a score reduction of at least 1 point and a maximum reduction of 2 points in the PAS in the liquid type. [Conclusion] This study confirmed that JOE can be used to reduce aspiration in patients with dysphagia after stroke.

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