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Objective:To explore the effect of the pharyngeal pressure feedback training on pharyngeal constriction in persons with swallowing disorders caused by brainstem lesions.Methods:Twenty patients with disordered swallowing caused by a brainstem lesion were randomly divided into a control group and an intervention group, each of 10. Both groups received routine swallowing training including oral sensorimotor training, neuromuscular stimulation and balloon catheter dilation, while the intervention group was additionally provided with two weeks of pharyngeal pressure feedback training. Before and after the treatment, both groups were evaluated in terms of the peak pressure of superior and inferior pharyngeal constriction, endoscopically and also using the functional oral intake scale.Results:There was no significant difference between the two groups in any measure before the intervention. Afterward, both groups had improved significantly by all of the measurements, but the average peak upper pharyngeal pressure, the average intake scale score and the endoscopy results of the intervention group were all significantly better than the control group′s averages.Conclusions:Pharyngeal pressure feedback training can significantly relieve swallowing disorders caused by brainstem lesions.
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Objective:To explore the application of digital acoustic analysis in assessing the risk of aspiration among persons with dysphagia using the Praat speech analysis software.Methods:The swallowing of 46 stroke survivors with dysphagia was studied using video fluoroscopy. Each patient was required to pronounce " yi/i/" 3 times before and after taking each mouthful of food, and their voice samples were collected. The subjects were divided into a non-aspiration group of 16 and an aspiration group of 30 based on their penetration-aspiration scale scores. Fundamental frequency, relative average perturbation (RAP), jitter, shimmer, amplitude perturbation quotient and harmonic-to-noise ratio were compared between the two groups before and after taking food.Results:For the non-aspiration group, there was no significant difference in the acoustic data before and after eating. For the aspiration group there were significant differences in fundamental frequency, relative average perturbation and jitter before and after taking food. The average RAP and jitter of the non-aspiration group were significantly better than the aspiration group′s averages before eating. After eating, however, significant differences were observed only in average jitter.Conclusions:Analyzing perturbation and jitter can help to identify persons at risk of aspiration.
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Objective@#To identify the pathophysiological characteristics of cortical stroke survivors′ swallowing.@*Methods@#Sixty cortical stroke survivors with dysphagia and cognitive impairment were enrolled into the observation group, while another 16 with dysphagia but without cognitive impairment formed the unimpaired control group and 16 healthy counterparts were selected for a normal control group. Each subject was recorded videofluoroscopically while swallowing 5ml of a liquid of medium consistency. The occurrence of refusing to eat, mouth opening difficulty, incomplete oral closure, residue in the oral cavity, residue in the pharyngeal cavity, leakage and aspiration were observed. Each subject′s swallowing time and kinematic parameters were analyzed from the fluoroscopic videos.@*Results@#The incidence of refusing to eat (37.5%) and/or incomplete mouth closure (68.75%) were significantly higher in the observation group than in the other two groups. The incidence of difficulty in opening the mouth (37.5%), residue in the oral cavity (81.25%), residue in the pharyngeal cavity (56.25%), leakage (56.25%) and aspiration (50%) of the observation group were significantly higher in the observation group than among the normal controls, but were not significantly different from those incidences among the group without cognitive impairment. The average oral transit time and soft palate elevation time of the observation group were significantly longer than those of the other two groups. The observation group′s average hyoid movement time was significantly longer than that of the normal control group, but not significantly different from that of the group without cognitive impairment. There were no significant differences among the groups in average upper esophageal sphincter opening time, larynx closure time or the kinematic parameters.@*Conclusions@#Stroke survivors with dysphagia and cognitive impairment present dysphagia characteristic of oral phase swallowing difficulties.
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Objective:To explore the value of flexible endoscopic evaluation of swallowing (FEES) in guiding the decannulation of neurological disease patients with dysphagia after a tracheotomy.Methods:The FEES results of 188 neurological disease patients with dysphagia who had undergone a tracheotomy were analyzed retrospectively. The utility of FEES evaluation indexes (including glottis activity, the classification of pharyngeal secretions and residues as well as penetration-aspiration grade) for predicting the success of decannulation was explored.Results:One hundred and nine of the patients (the success group) were decannulated successfully and 79 (the failure group) were not, a success rate of 57%. The abnormal glottis activity rate among the failure group was 55%, significantly higher than among the success group (21%). The pharyngeal secretion classifications and penetration-aspiration grades among the success group were also significantly lower than among the failure group, on average. The average course of recovery from the tracheotomy was 184 days in the success group, significantly shorter than that of the failure group (292 days). No significant differences in residues were observed.Conclusion:The glottis activity, secretions and intake aspiration evaluated using FEES are of great value for guiding the decannulation of neurological disease patients with dysphagia after a tracheotomy.
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Objective:To observe the immediate effect of neuromuscular electrical stimulation (NMES) on the initiation of swallowing among stroke survivors with dysphagia.Methods:Forty-two patients with delayed swallowing initiation were asked to eat 3 boluses of a thin liquid before and during NMES stimulation. The process was recorded and analyzed using a digital data acquisition and analysis system, including the initiation of the pharyngeal swallow (IPS), oral transit time (OTT), larynx closure duration (LCD), and pharynx transit time (PTT). They were also evaluated using the Rosenbek penetration-aspiration scale (PAS).Results:During NMES, significant improvement was observed in the average IPS, PAS and OTT results compared to before the intervention. There was, however, no significant difference in the average LCD or PTT. No obvious adverse reactions were observed during the stimulation.Conclusion:NMES has an immediate effect on improving IPS, PAS and OTT, and can be used as a new compensatory early treatment for stroke survivors with dysphagia.
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Objective:To identify the pathophysiological characteristics of cortical stroke survivors′ swallowing.Methods:Sixty cortical stroke survivors with dysphagia and cognitive impairment were enrolled into the observation group, while another 16 with dysphagia but without cognitive impairment formed the unimpaired control group and 16 healthy counterparts were selected for a normal control group. Each subject was recorded videofluoroscopically while swallowing 5ml of a liquid of medium consistency. The occurrence of refusing to eat, mouth opening difficulty, incomplete oral closure, residue in the oral cavity, residue in the pharyngeal cavity, leakage and aspiration were observed. Each subject′s swallowing time and kinematic parameters were analyzed from the fluoroscopic videos.Results:The incidence of refusing to eat (37.5%) and/or incomplete mouth closure (68.75%) were significantly higher in the observation group than in the other two groups. The incidence of difficulty in opening the mouth (37.5%), residue in the oral cavity (81.25%), residue in the pharyngeal cavity (56.25%), leakage (56.25%) and aspiration (50%) of the observation group were significantly higher in the observation group than among the normal controls, but were not significantly different from those incidences among the group without cognitive impairment. The average oral transit time and soft palate elevation time of the observation group were significantly longer than those of the other two groups. The observation group′s average hyoid movement time was significantly longer than that of the normal control group, but not significantly different from that of the group without cognitive impairment. There were no significant differences among the groups in average upper esophageal sphincter opening time, larynx closure time or the kinematic parameters.Conclusions:Stroke survivors with dysphagia and cognitive impairment present dysphagia characteristic of oral phase swallowing difficulties.
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Objective@#To explore the sensitivity and specificity of the Chinese version of the volume and viscosity swallowing test with modified safety and effectiveness indicators (VVST-CV) in assessing deglutition disorders.@*Methods@#The solvent, volume, viscosity, and test index of the volume and viscosity swallowing test were modified before it was used to evaluate 89 patients with swallowing disorders. The positive rates of the safety indexes (coughing, voice changes and blood oxygen saturation decline at least 3%) and the efficiency indexes (poor lip closure, oral residue, pharynx residue and swallowing) were recorded and compared and compared with the positive rates of penetration, aspiration and food residue determined by means of according to the videofluoroscopic swallowing study, then the sensitivity, specificity, positive predictive value and negative predictive value of the modified VVST-CV with regard to the safety and efficiency of swallowing were calculated.@*Results@#The VVST-CV′s sensitivity in detecting dysphagia was 0.97. For impaired safety it was 0.85 and for impaired swallowing efficiency it was 0.95. The sensitivity of the coughing index was 0.65, that of sound change was 0.60 and that of oxygen saturation decrease was 0.42. The positive predictive values for coughing, sound change and oxygen saturation decrease were 0.98, 0.94 and 0.94, respectively.@*Conclusion@#The VVST-CV is simple, feasible and sensitive. It can be widely useful in the evaluation of dysphagia in clinical practice.
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Objective To explore the sensitivity and specificity of the Chinese version of the volume and viscosity swallowing test with modified safety and effectiveness indicators ( VVST-CV) in assessing deglutition disor-ders. Methods The solvent, volume, viscosity, and test index of the volume and viscosity swallowing test were modified before it was used to evaluate 89 patients with swallowing disorders. The positive rates of the safety indexes ( coughing, voice changes and blood oxygen saturation decline at least 3％) and the efficiency indexes ( poor lip clo-sure, oral residue, pharynx residue and swallowing) were recorded and compared and compared with the positive rates of penetration, aspiration and food residue determined by means of according to the videofluoroscopic swallowing study, then the sensitivity, specificity, positive predictive value and negative predictive value of the modified VVST-CV with regard to the safety and efficiency of swallowing were calculated. Results The VVST-CV's sensitivity in detecting dysphagia was 0.97. For impaired safety it was 0.85 and for impaired swallowing efficiency it was 0.95. The sensitivity of the coughing index was 0.65, that of sound change was 0.60 and that of oxygen saturation decrease was 0.42. The positive predictive values for coughing, sound change and oxygen saturation decrease were 0.98, 0.94 and 0.94, respectively. Conclusion The VVST-CV is simple, feasible and sensitive. It can be widely useful in the e-valuation of dysphagia in clinical practice.
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Objective To evaluate the effect of radiotherapy on the swallowing ability of persons with nasopharyngeal carcinoma (NPC) when swallowing food with different consistencies.Methods Twenty NPC patients were monitored fluoroscopically while swallowing materials with three different consistencies after radiotherapy.The oral transit time,oral residue,pharyngeal residue,penetration-aspiration and cricopharyngeal muscle function were observed.Results There were significant differences in all of the measurements when swallowing the three different foods.There were significant differences in all of the measurements between swallowing paste and liquids,but only in the oral transit time,oral residue and pharyngeal residue between swallowing thin and thick liquids.Conclusions The severity of swallowing dysfunction varies in NPC patients after radiotherapy.Foods with different consistencies have different effects on swallowing ability.Videofluoroscopy can evaluate swallowing objectively and provide an objective basis for food preparation.
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Ohjective To explore the impact of constraint-induced aphasia therapy (CIAT) on language function and neural activity in patients with chronic Broca's aphasia.Methods Two chronic aphasics whose use of language was recovering after standard language therapy were selected to receive 1.5 h of CIAT twice daily for two weeks (30 hours in total).Before and after the CIAT they were tested using a block-designed picture-naming task,fMRIs were taken and their use of language was examined.Results The language function assessments showed relatively large improvements in the subjects' use of language after 4 weeks of conventional language training,but not much further change after 8 and 12 weeks.After the two weeks of CIAT,their language function improved further to a certain extent.fMRI showed increased activation in the left inferior frontal gyrus with or without enhanced activation in the left hemisphere,and reduced activation in the right inferior frontal gyrus.Conclusions Functional reorganization induced in the brain by CIAT was associated with up-regulation of the left inferior frontal gyrus or down-regulation of the right inferior frontal gyrus.Even the whole language network may have been modified.
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Objective To explorer the effectiveness of game-based surface electromyographic biofeedback training (GBsEMGBF) on dysphagic brainstem injury patients.Methods Thirty-six brainstem injury dysphagic patients were randomly and evenly divided into a treatment group and a control group,both of 18,by using a random number table.Both groups were given conventional swallowing rehabilitation including oral sensory and motor training,Mendelsohn swallowing training and balloon dilatation of the cricopharyngeal muscle.The treatment group was additionally provided with GBsEMGBF training.All the treatments were provided 5 times per week for 5 weeks.Both groups were assessed using the functional oral intake scale (FOIS),penetration-aspiration scale (PAS),hyoid anterior movement (HAM),hyoid superior movement (HSM) and upper esophageal sphincter opening (UO) before and after the intervention.Results Before the treatment there were no significant differences between the two groups in all the measurements.After the treatment,there was a significant improvement in the average FOIS,PAS,HAM and HSM scores in both groups,but with significantly greater improvement in the treatment group.Significant improvement was observed in the average UO score after the intervention,but without significant differences between the two groups.Conclusion GBsEMGBF can significantly improve the swallowing function and hyoid motor function in dysphagic patients caused by brainstem injury.
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Objective To explore the effect of the modified balloon dilatation on excitability of the submental swallowing muscle and its relationship with swallowing function of dysphagic patients with brainstem stroke.Methods Thirty unilateral brainstem stroke patients with upper esophageal sphincter (UES) dysfunction were recruited and randomly divided into a dilatation group and a control group,each of 15.The control group was given the routine swallowing therapy twice daily,while the dilatation group was provided one routine swallowing treatment plus a modified balloon dilatation daily.The treatment lasted 3 weeks,30min per day and 5 days per week.Both groups were evaluated using the bilateral submental motor evoked potentials (SMEPs),penetration-aspiration scale (PAS) and functional oral intake scale (FOIS) before and after treatment.Results Repeated analysis of variance showed that there was significant interaction effect of group,time on SMEPs.The MEPs of the affected submental muscle increased significantly in both groups after treatment (P＜0.01),but only the amplitude of SMEP of the affected submental muscles in the dilatation group was higher than that of the control group after treatment (P＜0.05).In the dilatation group,the average FOIS score increased significantly (P＜0.01),while the average PAS score decreased significantly after the treatment (P＜0.05).An increase of amplitude of the affected SMEP was strongly correlated with the improvement in the average PAS score (P＜0.01,r=0.815),but weakly correlated with the average FOIS score (P =0.02,r =0.43).Conclusion The modified balloon dilatation therapy can increase the excitability of the cortical-affected lateral brainstem-swallowing muscle pathway in patients with unilateral brainstem stroke,which might be more correlated with improvement in swallowing safety.
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Objective To explore effective precautions and interventions for choking in dysphagia patients.Methods Clinical data on f dysphagia patients hospitalized from September 1,1996 to Aug 8,2014 were retrospectively analyzed to correlate choking with gender,age,consciousness,type of aspiration,food-intake pathway and food texture.Results Only 0.17％ of the patients (n =8) were found to have choked,and 6 of them were men.Children,teenagers,the middle-aged and the aged constituted 25％,12.5％,37.5％ and 25％ of the patients respectively.75％ were conscious and 62.5％ displayed silent aspiration.6 cases used oral intake and 2 used nasogastric tube feeding.Among the 8 choking patients,half ate solid food,2 semisolid and 2 liquid food.Six survived and 2 died.Conclusion The risk factors for choking include silent aspiration and oral intake of solid or semisolid food.The successful rescue rate for choking is relatively low,so clinicians should be aware of and try to eliminate these risk factors.
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@#Objective To explore the rehabilitation for dysphagia in young patient after tracheotomy and cricopharyngeal achalasia with-out cough reflex. Methods A child was reviewed, who accepted tracheotomy after resection of cerebellar pilocytic astrocytoma for dyspha-gia. The features characterized as severe silent aspiration and failure of cricopharyngeus muscle relaxation. Therapies included Passy-Muir valve placement, breathing exercises, balloon dilatation, surface electromyography biofeedback, and electrical stimulation. Results The aspi-ration was observed when she drank thin liquid with weak cough reflex, and disappeared as eating thick liquid and paste food, with complete cricopharyngeus muscle opening, 7 weeks after treatment. She was removed the tracheotomy tube and nasal feeding tube 11 weeks after treatment, and got sufficient nutrition by fully oral intake. Conclusion The application of Passy-Muir valve and comprehensive swallowing training is helpful for patient post tracheotomy with silent aspiration in decreasing the risk of aspiration, improving cough reflex and prompt-ing swallowing function.
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Objective To analyze temporal and kinematic parameters of video fluoroscopic images of swallowing using a digital acquisition and analysis system and to verify the reliability of this method.Methods Eighteen patients with dysphagia were requested to completed six swallows (3 ml and 5 ml of thin liquid, thick liquid, and paste mixed with 600 kg/m3 barium sulfate suspension) in the natural sitting position.Video fluoroscopy was used to measure the oral transit times, soft palate elevation times, hyoid movement times, laryngeal closure times, cricopharyngeal muscle opening times, hyoid anterior movement (HAM) , hyoid superior movement (HSM) , cricopharyngeal muscle opening diameter and pharyngeal constriction rate.Each was extracted from the videos four times by two raters working separately with an interval of 4 weeks between the sets of evaluations.Results Reliability varied among the different observations.HAM and HSM showed inter-rater reliability between 0.41 and 0.60 and intra-rater reliability between 0.61 and 0.80.The other observations all demonstrated acceptable reliability.Conclusion The self-designed digital acquisition and analysis system tested showed acceptable reliability and could be applied to analyze swallowing function clinically.
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Objective To evaluate the activation patterns in the cortexes of expressive aphasics after stroke so as to explore the pathogenic mechanism of expressive aphasia.Methods Blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI) was the method of choice.It was administered to 9 subjects with expressive aphasia at 1 to 3 months post-stroke onset and to 10 healthy controls.Active areas in the patients' brains were observed using a block-designed picture-naming task,and language function was tested with the China Rehabilitation Research Center's aphasia examination (CRRCAE).The control group received BOLD-fMRI only.SPM8 software was used to process the fMRI data.Results Differences were observed in the mapping of activated areas between the two groups,but many activated areas showed no difference.Significant differences in activation were observed in areas associated with vision,language and cognition,including the bilateral inferior frontal gyrus,the bilateral superior temporal gyrus,the bilateral insula,the bilateral basal ganglia,the left superior frontal gyrus,the left middle frontal gyrus,the left precentral gyrus,the left thalamus,and the left middle temporal gyrus.All the patients had activated cortex regions associated with visual processing in the left and/or right hemisphere,such as the middle frontal gyrus,the middle temporal gyrus,the lingual gyrus and the fusiform gyrus.The activation volumes in the left hemisphere were significantly smaller than those in normal adults.Regions related to language such as the left inferior frontal gyrus (Broca's area),the left middle frontal gyrus,and the right inferior frontal gyrus (the mirror region of Broca's area) were activated in some of them.While the activation frequency,activated volume and activation intensity generally were all less in the patients than in the controls,the activation intensity in the right superior temporal gyrus,the bilateral superior parietal lobule and the left inferior temporal gyrus were stronger.Conclusions Language production may be associated with multiple,interconnected regions.The right hemisphere participates in natural language processing.Aphasia damages both linguistic and cognitive areas,reducing activation in Broca's aphasia.Activation areas in the left hemisphere and the right inferior frontal gyrus decrease significantly,while some regions in the right hemisphere are relatively more activated.The right inferior frontal gyrus may play a different role in language recovery at different periods of aphasia after stroke.
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Objective To observe the effect of surface electromyographic biofeedback (sEMG-BFB) combined with routine swallow training on dysphagic patients with cerebral infarction at recovery stage.Methods Fiftyone dysphagic patients with cerebral infarction were randomly divided into two groups:control group (26 cases) and biofeedback training group (25 cases).The control group was given routine training including orofacial function training,balloon dilatation and behavioral swallowing training,while the biofeedback training group was given behavioral swallowing training was conducted with the guidance of sEMG-BFB in addition to the routine training.Before and after the treatment,videofluoroscopy swallowing study (VFSS) was performed to observe the opening of upper esophageal sphincter (UES).Functional oral intake scale (FOIS) was used to evaluate swallow function.Results Before treatment,there were no significant difference between the two groups in terms of FOIS score and UES opening (P ＞0.05).The FOIS score increased in both groups after treatment (P ＜ 0.05),and the FOIS score was higher in the biofeedback training group than that of the control group (P ＜ 0.05).After treatment,the number of UES complete opening and incomplete opening was 18 and 8,respectively,in the control group,versus 20 and 5,respectively,in the biofeedback training group.UES opening improved in both groups after treatment (P ＜ 0.05).Conclusion Routine swallowing training combined with sEMG-BFB can benefit the dysphagic patients with cerebral infarction for their UES opening and swallowing ability at recovery stage.
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@#Objective To screen the factors that affect severity of language disorder in subcortex aphasia, and analyze its characteristics and therapeutic effect. Methods 10 moderate degree and 12 severe degree subcortex aphasics were evaluated with Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE) and the Boston Diagnostic Aphasia Examination (BDAE) before and 4 weeks after language training. The factors affecting severity of subcortex aphasia and characteristics were analyzed before training, and effect of language training was examined before and after training. Results Severity of subcortex aphasia was related to age and the complication of apraxia of speech. There was a relatively high level in listening comprehension, reading, repeating and reading aloud abilities. After training, all kinds of language abilities improved significantly in moderate degree subcortex aphasics. Whereas, comprehension and verbal communication capabilities increased obviously, but written communication abilities advanced rarely in severe degree subcortex aphasics. Conclusion Age and the complication of aphasia of speech may be important factors influencing severity of language disorder in subcortex aphasia. There are specific clinical features in subcortex aphasia. Almost all language abilities can be improved by language training, but therapeutic effect is differrent between moderate degree and severe degree subcortex aphasics.
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Objective To observe the application of dysphagia ventilation swallowing and speaking valve inchildren with swallowing disorder after tracheostomy.Methods Four children with tracheostomy done and swallowing disorders(3 with brainstem encephalitis caused by hand,foot and mouth disease and 1 post-surgery case of cerebellar astrocytoma)were observed.Videofluoroscopic swallowing studies(VFSS)showed cricopharyngeal achalasia and silent aspiration.After VFSS assessments,ventilation swallowing and speaking valves(Passy-Muir,USA,PMVs)were applied to the 4 children.After that they received comprehensive swallowing trainings including balloon dilatation,breathing exercises,sensory stimulation and electrical stimulation.Results Four children could pronounce with PMVs immediately.After(36.50 ± 35.63)d of comprehensive intervention,all of them could live without tracheostomy tube or nasal feeding tube,their swallowing function improved obviously and could take food per os.Conclusions The application of PMVs combining with swallowing training is effective for children with swallowing disorder and dysphonia after tracheostomy.It is helpful to decrease the risk of aspiration,to open the cricopharyngeus muscle and to restore pronunciation.
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@#ObjectiveTo study the effects and feasibility of Smart Equitest Balance Master training for severe balance disorder caused by cerebellar hemorrhage in children. MethodsA 10-year-old boy with severe ataxia caused by cerebellar hemorrhage were trained with Smart Equitest Balance Master. He was assessed with Smart Equitest Balance Master, Modified Barthel Index and Berg Balance Scale. ResultsAfter 22 weeks of balance training, he improved in equilibrium, gait, posture control, activity of daily living, dysarthria, and return to school to continue his study. ConclusionSmart Equitest Balance Master training can significantly improve balance function，motor function and activities of daily living after cerebellar hemorrhage.