Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study
Conclusion. The increased medicine administration error rate in patients with dysphagia requires healthcare professionals to take extra care when prescribing, dispensing and administering medicines to this group.
from the Journal of Advanced Nursing
Neuromuscular electrical stimulation is no more effective than usual care for the treatment of primary dysphagia in children
NMES treatment of anterior neck muscles in a heterogeneous group of pediatric patients with dysphagia did not improve the swallow function more than that seen in patients who did not receive NMES treatment. However, there may be subgroups of children that will improve with NMES treatment.
Self-Reported Dysphagia and Its Correlates Within a Prevalent Population of People with Parkinson’s Disease
Many people with Parkinson’s disease (PD) experience dysphagia; however, the prevalence of dysphagia in people with PD is unknown. We studied a prevalent population of PD cases. All of those who consented to participate were assessed for anxiety, depression, cognitive function, and quality of life using standard rating scales. Anyone who answered “yes” to either one of the two questions: Do you have difficulty swallowing food/liquid or tablets? and Do you cough after eating/drinking? was considered to have dysphagia. Question 7 of the Unified Parkinson’s Disease Rating Scale (UPDRS) was also used to identify dysphagia. Of 106 prevalent PD cases, 75 (38 males) patients consented to examination and assessment. The prevalence of dysphagia was 32.0% (n = 24; 11 males). Using the response to UPDRS Question 7 as an indicator of the impact of swallowing problems on the patient, there were significant correlations with cognitive function, anxiety, depression, quality of life, and UPDRS-reported gait disturbance, postural instability and problems with falling. There was no correlation with disease duration, age, or gender. Almost one third of the participants reported dysphagia. There was a strong correlation between dysphagia and gross motor skills; patients reporting such problems should be screened for swallowing problems.
A challenge facing the field of speech-language pathology is how to equip students at the university level with the transnasal endoscopy skills needed to perform fiberoptic endoscopic evaluation of swallowing (FEES). The use of simulation has the potential to allow students to gain transnasal endoscopy experience with repetitive practice without compromising patients. The present study examined the effects of two different forms of simulation training on multiple transnasal endoscopic passes on healthy volunteers by graduate student clinicians as measured by procedure duration and confidence ratings. Eighteen speech-language pathology graduate student clinicians were randomly assigned to groups that utilized either a human patient simulator (HPS) or a non-lifelike simulator for transnasal endoscopy training. Using a flexible nasal endoscope, each clinician performed seven training passes on a simulator and one pass on two different volunteers. Each volunteer was endoscoped two times, once by a clinician trained using a HPS and once by a clinician trained using a non-lifelike simulator. There was no difference in pass times on volunteers between clinicians trained using the HPS and clinicians trained on the non-lifelike simulator. Both training groups were faster and more confident on the second endoscopy on a volunteer than on the first.
Conclusion: Silent aspiration and laryngeal penetration of saliva are common features in PD patients with daily drooling. The presence of hypoesthesia of the laryngeal structures and the lack of protective reflexes in such patients may play a major role in the mechanisms of SLP/SA
from Movement Disorders
Evidence-Based Systematic Review: Effects of Oral Motor Interventions on Feeding and Swallowing in Preterm Infants
To conduct an evidence-based systematic review and provide an estimate of the effects of oral motor interventions (OMIs) on feeding/swallowing outcomes (both physiological and functional) and pulmonary health in preterm infants.
Conclusions: Young and old adults demonstrated reduced tongue strength and endurance after dining, but younger subjects showed greater declines in anterior tongue endurance, whereas older adults exhibited signs of swallowing difficulty.
Clinical and Fiberoptic Endoscopic Evaluation of Swallowing in Robin Sequence Treated with Nasopharyngeal Intubation. The Importance of Feeding Facilitating Techniques.
Abstract Objective: To evaluate oral feeding capacity, the swallowing process and risk for aspiration, both clinically and during fiberoptic endoscopic evaluation of swallowing (FEES), in infants with Isolated Robin Sequence (IRS) treated exclusively with nasopharyngeal intubation (NPI) and feeding facilitating techniques (FFT). Design: Longitudinal and prospective study. Setting: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, Brazil. Patients: Eleven infants with IRS, under 2 months of age, treated with NPI. Interventions: Feeding facilitating techniques (FFT) were applied in all infants throughout the study period. The infants were evaluated clinically and through FEES at 1st, 2nd and, if necessary, at 3rd week of hospitalization (T1, T2, T3). The mean volume of ingested milk was registered during clinical evaluation, and events were registered during feeding. Results: The respiratory status of all infants was improved after NPI; 72% of them presented risk for aspiration during FEES at T1. This risk was less frequent when thickened milk was given to the infants and at subsequent evaluations (T2 and T3). Conclusions: NPI aids in stabilizing the airway in IRS but it does not relate directly to feeding. The risk for aspiration was present in most of the infants, mainly during the 1st week of hospitalization, and improved within few weeks, after the use of FFT.
from the Cleft Palate-Craniofacial Journal
Conclusion. It is vital to ensure that each patient has an individualized medication regimen, and for patients with dysphagia the formulation of the medicine is as important as the active ingredients.
from the Journal of Advanced Nursing
The present study examined tongue strength in 150 children and adolescents, 3–16 years of age, with no history of speech or swallowing disorders using the Iowa Oral Pressure Instrument (IOPI). Children as young as 3 years of age were able to tolerate the IOPI standard tongue bulb and were reliable performers on measures of tongue strength with an unconstrained mandible. Tongue strength measurements were elicited in blocks of three trials with a 30-s rest between the trials and a 20-min rest between blocks. Tongue strength increased with age with no consistent best trial across ages and participants. Males showed a slight increase in tongue strength over females at ages 14 and 16. This study suggests maximum pediatric tongue strength may be reliably evaluated using commercially available equipment and provides a limited sample comparative database.
Improved foods for elderly patients with swallowing difficulties are a potential outcome from a new industry linkage grant awarded to a team of University of Queensland researchers.
Abstract:Purpose: This epilogue summarizes the contribution of the articles in the clinical forum, “Managing Dysphagia in the Schools” and discusses future trends in pediatric dysphagia and the need for clinical practice and research. Method: The contribution of each of the 10 articles that make up the forum is summarized briefly. Conclusion: This clinical forum provides a discussion of numerous issues that need to be considered by clinicians working with children who exhibit swallowing and feeding problems and their families in school settings. Current and future challenges exist for clinicians, children, and families dealing with dysphagia. Discussion of current issues and strategies for successful treatment outcomes are provided. [ABSTRACT FROM AUTHOR]
Training and Self-Reported Confidence for Dysphagia Management Among Speech-Language Pathologists in the Schools
ABSTRACT: Purpose: The number of children requiring dysphagia management in the schools is increasing. This article reports survey findings relative to speech-language pathologists’ (SLPs’) training and self-rated confidence to treat children with swallowing and feeding disorders in the schools. Method: Surveys were completed by 222 SLPs representing Virginia and its contiguous states. Queries on dysphagia training targeted formal education, on-the-job experiences, and current caseload information. In addition, participants self-rated their confidence to treat dysphagia. Results: Statistically significant relationships between training and self-confidence levels were demonstrated. Specifically, participation in continuing education and currency of educational activities revealed significant and moderately strong correlations to self-reported confidence to treat children with dysphagia in the school setting. Conclusion: Findings support continuing education as a correlate to self-reported confidence to treat dysphagia in the school setting among SLPs in Virginia and its contiguous states. Further research is merited to ascertain if these findings reflect national trends. Quantifiable, costeffective, and evidenced-based dysphagia training, consultancy, and management models are needed if school-based SLPs are to meet the increasing challenges of their diverse caseloads. [ABSTRACT FROM AUTHOR]
Abstract:Purpose: This article discusses children’s development of mature swallowing and feeding as a process of skill acquisition and considers the applicability of motor learning concepts for advancing these capabilities in school-aged children. Method: The motor learning literature was reviewed, with concentration on (a) concepts that are relevant for the acquisition of skill and (b) structuring practice experiences to optimize learning. Results: The discussion includes (a) swallowing physiology with a focus on motor task components, (b) normal development of eating skills, (c) factors that may slow or disrupt normal development, (d) motor learning concepts found to influence learning efficiency and performance adequacy, (e) applications to the assessment and treatment of pediatric swallowing and feeding disorders, and (f ) an illustrative case history. Conclusion: Deficiencies in swallowing and feeding may encompass eating, saliva control, swallowing during oral hygiene, and swallowing medications. Motor learning literature provides a rich foundation of evidence-based theory and educational strategies for the development and remediation of motor-based skills such as swallowing and feeding. [ABSTRACT FROM AUTHOR]