Dysphagia最新文献

{"title":"Assessment of Dysphagia Management Competence among Healthcare Providers: A Scoping Review.","authors":"R Jordan Hazelwood, Garnet F Robinson, George W Wolford, Rebecca F Smith","doi":"10.1007/s00455-025-10835-1","DOIUrl":"https://doi.org/10.1007/s00455-025-10835-1","url":null,"abstract":"<p><p>Functional swallowing is imperative to sustain life and maintain health, necessitating healthcare providers' competence in managing swallowing disorders. This scoping review aims to identify and compare how competence in dysphagia management is assessed among healthcare providers. Our search identified 11 final records, demonstrating the limited existing literature. Overall, no specific standardized protocol currently exists for the assessment of dysphagia competence across healthcare disciplines. Therefore, developing a standardized metric to assess competence in dysphagia management among healthcare providers would not only improve training in dysphagia management by creating a consistent standard for healthcare providers' competence, but also promote equitable and effective care delivery across diverse healthcare settings, improving outcomes for individuals with swallowing disorders on a global scale.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White Matter Microstructural Correlates of Swallowing Biomechanics: An Exploratory Pilot Study in Healthy Young Adults.","authors":"Rahul Krishnamurthy, Caitlin Cloud, Ross Westemeyer, Yingying Wang, Douglas H Schultz, Angela M Dietsch","doi":"10.1007/s00455-025-10841-3","DOIUrl":"https://doi.org/10.1007/s00455-025-10841-3","url":null,"abstract":"<p><p>White matter (WM) enables complex brain connectivity by linking several cortical and subcortical regions. Most studies investigating the association between WM tracts and swallowing function have predominantly used a disease (lesion) based approach, and there is currently a paucity of research investigating the associations between swallowing physiology and WM microstructure in healthy individuals. Moreover, studies in healthy individuals are essential to understanding typical WM architecture and identifying any deviations caused by diseases or adaptations resulting from specific interventions or training regimes. The current study addresses this critical gap by investigating the association between quantitative metrics of WM microstructure and kinematic and temporal measures of swallowing biomechanics in healthy young adults. Diffusion-weighted magnetic resonance imaging (DW-MRI) was obtained from 17 right-handed healthy adults (males = 9; females = 8) aged 20 to 35 (mean age = 27.11 years). DW-MRI was pre-processed and analyzed using a custom-developed analysis pipeline to generate diffusion tensor image (DTI) derived scalar measures. Furthermore, videofluoroscopic data were collected from these participants and quantified using computational analysis of swallowing mechanics (CASM) and traditional pixel-based temporal and kinematic measures. We performed partial correlations to explore the association between swallowing biomechanics and WM diffusion metrics, with participants' age and sex as covariates. Our study revealed that the corpus callosum, cerebellar peduncle, thalamic radiation, corticospinal tract, cingulum, stratum, corona radiata, fornix, internal capsule, external capsule, and the superior frontal-occipital fasciculus showed significant bidirectional associations with the kinematic and temporal measures of swallowing biomechanics investigated in the current study. These findings are interpreted in relation to lesion studies and well-established functions of WM tracts. Future directions and limitations of our study are also discussed.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head Lifting Strength is Associated with Pharyngeal Residuals in Older Inpatients with Suspected Dysphagia.","authors":"Kazuki Eimoto, Koutatsu Nagai, Yuta Nakao, Yuki Oshima, Takahiro Matsufuji, Takuya Hamana, Megumi Takato, Tomoyuki Ogino, Naoki Sasanuma, Yuki Uchiyama, Kazuhisa Domen","doi":"10.1007/s00455-025-10843-1","DOIUrl":"https://doi.org/10.1007/s00455-025-10843-1","url":null,"abstract":"<p><p>Head lifting strength can be easily measured without special equipment. The relationship between head lifting strength and dysphagia is well-established. However, its association with Pharyngeal residuals-a risk factor for aspiration-has not yet been explored. This study aimed to determine the association between head lifting strength and Pharyngeal residuals, as assessed through a Videofluoroscopic swallowing study (VFSS), in older inpatients with suspected dysphagia. A total of 50 patients who underwent VFSS for suspected dysphagia were included. Head lifting strength was measured as the number of repetitions of maximum head lifting and the time to maintain maximum head lifting. The Normalized Residue Ratio Scale (NRRS) was scored at the valleculae (NRRSv) and piriform sinus (NRRSp) while swallowing 3 ml of a moderately thick liquid during the VFSS. Univariate and multiple regression analyses examined the relationship between head lifting strength and NRRSv and NRRSp. The time to maintain maximum head lifting and the number of repetitions of maximum head lifting were significantly negatively correlated with the NRRSv and NRRSp. However, in the adjusted multiple regression analysis model, only the number of repetitions of maximum head lifting was related to NRRSv and NRRSp. This study implies that a simple head lifting strength test can be implemented in the clinic to determine the risk of pharyngeal residuals after swallowing and, consequently, the possibility of aspiration.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transsurgical Palatal Obturator for Maxillectomy Patients: A Preliminary Study of Swallowing and Oropharyngeal Geometry.","authors":"Eliane Cristina Viana Revoredo, Coeli Regina Carneiro Ximenes, Thiago Freire Pinto Bezerra, Kelly Greyce Sukar Cavalcanti de Oliveira, Hilton Justino da Silva, Adriana de Oliveira Camargo Gomes, Jair Carneiro Leão","doi":"10.1007/s00455-025-10831-5","DOIUrl":"https://doi.org/10.1007/s00455-025-10831-5","url":null,"abstract":"<p><strong>Introduction: </strong>Resection of malignancy through maxillectomy and subsequent maxillofacial prosthetics provides adequate swallowing function and rehabilitation. The aim of this study was to verify whether there is association between changes in swallowing and the oropharyngeal geometry in maxillectomy patients with and without using transsurgical palatal obturators (TPO).</p><p><strong>Methods: </strong>The study includes 7 maxillectomy patients, TPO users who underwent complementary radiotherapy. Outcome variables were investigated by acoustic pharyngometry (APh) and fiberoptic endoscopic evaluation of swallowing (FEES) to assess the oropharyngeal geometry and swallowing, respectively with and without TPO. Sociodemographic and clinical characteristics (postoperative radiotherapy, type of surgery, type of obturator, time elapsed between adaptation and the swallowing test) were evaluated. To compare with and without TPO conditions, Mann-Whitney test and Spearman's correlation coefficient were used.</p><p><strong>Results: </strong>Swallowing variables: early escape and nasopharyngeal reflux showed better results with TPO (p = 0.021 and p = 0.029, respectively) compared to swallowing without TPO. The oropharyngeal geometry was not statistically associated with swallowing changes.</p><p><strong>Conclusion: </strong>Oropharyngeal measures by APh compared to the swallowing evaluation by FEES showed a correlation between early escape and longer length of the vocal tract in individuals with TPO. Swallowing in maxillectomy patients showed significant improvement with the use of transsurgical palatal obturator, related to the lack of early escape and absence of nasopharyngeal reflux.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Oral Neuromuscular Training on Tracheostomy Decannulation and Swallowing Function in Patients with Severe Acquired Brain Injury: A Pilot Randomized Controlled Trial.","authors":"Melanie Blichfeldt, Mohit Kothari, Jesper Fabricius","doi":"10.1007/s00455-025-10837-z","DOIUrl":"https://doi.org/10.1007/s00455-025-10837-z","url":null,"abstract":"<p><p>There is a lack of evidence on training modalities for improving swallowing function in tracheostomized patients. The objective was to investigate the effect of oral neuromuscular training on decannulation and swallowing function in tracheostomized patients with acquired brain injury. A pilot randomized controlled trial with 22 patients, 11 in the intervention group and 11 in the usual care group. Inclusion criteria were: ≥ 18 years, cuffed tracheostomy tube at admission for rehabilitation, and Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) ≥ 4 at admission. Primary outcome was days from baseline until decannulation. Secondary outcomes were swallowing function assessed with FEDSS, Penetration Aspiration Scale (PAS), and the Yale pharyngeal residue scale (Yale scale) at baseline and following 4 weeks intervention. Participants in the two groups were comparable at baseline with regards to demographics and functional level. Difference in time until decannulation in the two groups was expressed with a hazard ratio of 1.40 (95%CI: 0.57; 3.43) in favour of the IQoro group. Swallowing function improved statistically significant in the usual care group on both PAS and Yale scale, whereas improvements in the IQoro group was only observed in FEDSS. Investigating between group differences, there was a statistically significant difference in pharyngeal residue assessed with the Yale Scale-pyriform sinus in favour of usual care (p = 0.018). Training with IQoro did not facilitate improvements in early decannulation or swallowing function compared to usual care. On the contrary, results showed less improvements in pharyngeal residue in the IQoro group compared with the usual care group.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Pharyngoesophageal Motility Characteristics During Concurrent Oral Feeding in Infants: Novel Pilot Observations.","authors":"Sudarshan R Jadcherla, Roseanna Helmick, Enas S Alshaikh, Erika K Osborn, Reza Shaker","doi":"10.1007/s00455-025-10832-4","DOIUrl":"https://doi.org/10.1007/s00455-025-10832-4","url":null,"abstract":"<p><p>Effect of interventions or diseases on the mechanisms of swallowing difficulties, and indications to change nipples, flows, or formula thickness in high-risk infants remains unclear. We evaluated and compared the effects of nipple flows and/or formula thickness on pharyngoesophageal timing and amplitude characteristics during oral milk challenge (OMC). A total of 48 OMC trials were undertaken in 12 infants [born at 36.4 ± 3.8 weeks gestation, studied at 48.0 ± 5.6 weeks postmenstrual age (PMA)] concurrent with high resolution pharyngoesophageal manometry (HRPM). We evaluated timing and amplitude of swallowing characteristics (pharyngeal and esophageal contractile strength, duration, activity, pharyngeal peak interval variability, bursts, and rhythm) and volume intakes. We compared within and between the entities: un-thickened formula vs. thickened formula and slower- vs. faster flow nipple. OMC durations averaged 71 ± 31 s and did not differ between interventions (p > 0.05). Pharyngeal swallow rhythms (timing) and contractile characteristics were dependent on the interaction between nipple flow rates and formula thickness (p < 0.05). Thickness decreased overall contractility and modified distal pharyngeal contractile activity (p < 0.05), which is critical to opening the upper esophageal sphincter. A structural equation model was developed that revealed the influence of PMA, respiratory status, volume extracted, nipple flow rate, and thickener presence on pharyngeal swallowing frequency with a comparative fit index of 0.83. Oropharyngeal stimulus-types trigger, integrate, and modify brainstem mediated oral and pharyngeal rhythms and modulate contractility and airway protection mechanisms. Effects of therapies, maturation and diagnoses are measurable using these novel approaches at crib-side.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Reducing Videofluoroscopy Frame Rate Affect DIGEST Grades in Modified Barium Swallow Studies?","authors":"Shitong Mao, Carla L Warneke, Sheila N Buoy, Ariana J Sahli, Brinda Rao Korivi, Carly E A Barbon, Kristy K Brock, Katherine A Hutcheson","doi":"10.1007/s00455-025-10840-4","DOIUrl":"https://doi.org/10.1007/s00455-025-10840-4","url":null,"abstract":"<p><p>Understanding the effects of reduced frame rates on the reliability of Modified Barium Swallow (MBS) ratings for swallowing safety and efficiency is essential for clinical practice. While previous research has examined frame rate (simulated pulse rates) implications concerning penetration, aspiration, and residue ratings, the impact on summary grading systems like the Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) remains unclear. This study analyzed a total of 315 full MBS videos collected from 278 patients, and 76.25% of patients were diagnosed with head and neck cancer (mean age 62.51 years, SD 8.53; 12.23% female). We performed pairwise comparisons of DIGEST grades and DIGEST grade components (Safety and Efficiency) derived independently across studies with 30, 15, and 7.5 frames per second (FPS). Weighted Cohen's kappa values consistently exceeded 0.84 across all assessments, indicating \"almost perfect\" agreement among the different simulated pulse rates. Exact agreement for all comparisons surpassed 85%. These findings suggest that the DIGEST grading system is robust to variations in frame rate, allowing for reliable assessments even under reduced pulse rate conditions.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consciousness Disorders and Swallowing Difficulties.","authors":"Xiru Zhang, Ru Zhang, Feng Xiong, Yaolun Zhang, Yali Li","doi":"10.1007/s00455-025-10834-2","DOIUrl":"https://doi.org/10.1007/s00455-025-10834-2","url":null,"abstract":"<p><p>With the advancement of medicine, the survival rate of patients with brain injuries has significantly increased. Among these patients, some remain in a chronic state of altered consciousness and experience difficulties in swallowing. Swallowing difficulties can lead to clinical issues such as aspiration and malnutrition. Since swallowing function is closely related to the level of consciousness, effective oral swallowing is an early sign of consciousness recovery. The relationship between swallowing difficulties and the prognosis and quality of life of patients with consciousness disorders is increasingly recognized by scholars. However, patients with consciousness disorders often find it difficult to cooperate with treatments for swallowing difficulties, resulting in a lack of effective treatment options for swallowing difficulties associated with altered consciousness. This article discusses the correlation between consciousness disorders and swallowing difficulties, the physiology of swallowing, the main issues faced by patients with consciousness disorders regarding swallowing difficulties. Specifically the lack of an effective oral swallowing phase, as well as the available assessment tools and treatment methods for swallowing difficulties in these patients.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Response To Editorial Letter \"A Letter To the Editor on Presbyphagia: A Conceptual Analysis of Contemporary Proposals and their Influences on Clinical Diagnosis\".","authors":"Manuel Matías Ambiado-Lillo","doi":"10.1007/s00455-025-10838-y","DOIUrl":"https://doi.org/10.1007/s00455-025-10838-y","url":null,"abstract":"","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysphagia and Muscle Weakness Caused by Botulinum Toxin Poisoning after Cosmetic Injection: Three Case Reports and Clinical Warnings.","authors":"Lei Wu, Yangshan Fu, Fenshuang Zheng, Jialong Chen, Xingcheng Li","doi":"10.1007/s00455-025-10839-x","DOIUrl":"https://doi.org/10.1007/s00455-025-10839-x","url":null,"abstract":"<p><p>Botulinum toxin (BoNT), a neurotoxic protein produced by Clostridium botulinum, is widely used for cosmetic and therapeutic purposes, including managing muscle hyperactivity, movement disorders, and chronic migraines by blocking acetylcholine release at neuromuscular junctions. While generally safe, it can cause localized adverse effects (erythema, ptosis, pain) and rare systemic complications (dysphagia, dysarthria, respiratory distress), particularly with improper dosing. From August 2024, This case report presents three female patients, aged 25, 50, and 49, in the Affiliated Hospital of Yunnan University, who experienced severe complications following the injection of botulinum toxin. The first patient, developed dysarthria and dysphagia 18 days post-injection, with a history of administration in northern Myanmar. The second patient, reported similar symptoms 3 days after a lesser dosage was injected into her masseter muscles. The third patient, exhibited fatigue and difficulty in eye opening and swallowing 7 days after receiving botulinum toxin. The symptoms of all patients were significantly improved after receiving symptomatic treatment in our hospital. The three cases presented are significant as they highlight the potential complications arising from botulinum toxin injections, particularly when used for cosmetic purposes. Botulinum toxin, though effective for cosmetic and therapeutic applications, carries risks of localized (muscle weakness, ptosis, bone loss) and systemic complications (generalized weakness, botulism), particularly near critical anatomical structures. Dysphagia and dysarthria, observed in cases post-injection, likely arise from toxin diffusion causing unintended muscle impairment. Treatment outcomes vary, with supportive care or invasive interventions often yielding limited improvement, highlighting management challenges. Clinicians must prioritize patient education, informed consent, and vigilant post-treatment monitoring for neurological symptoms. Future guidelines should standardize safe administration practices-optimizing dosage, injection sites, and follow-up-while enhanced practitioner training and multidisciplinary approaches are critical to mitigating risks and improving outcomes. This underscores the imperative for heightened clinical awareness and robust safety protocols to safeguard patient welfare.</p>","PeriodicalId":11508,"journal":{"name":"Dysphagia","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}