Swallowing ability and its impact on dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment.

PURPOSE: The purpose of this study was to identify the characteristics of swallowing ability, depression, and dysphagia-specific health-related quality of life (QOL), and the predictors of dysphagia-specific health-related QOL in oral cavity cancer patients post-treatment. METHODS: A cross-sectional study of 151 oral cavity cancer patients was performed at a medical center. Patients were assessed for swallowing ability, depression, and dysphagia-specific health-related QOL. Multiple stepwise regression was used to identify factors related to dysphagia-specific health-related QOL. RESULTS: Of the 151 patients surveyed, the top swallowing impairments were difficulty swallowing dry foods, difficulty swallowing hard food, and swallowing problems interfering with enjoyment or QOL. Patients with tumors of the tongue had worse functional dysphagia QOL than those with cancers in other locations. Patients with buccal cancer had worse overall dysphagia QOL, functional dysphagia QOL, and physical dysphagia QOL than patients with cancers in other locations. Patients with poor swallowing ability were more likely to have worse global dysphagia QOL. Emotional dysphagia QOL was associated with poor swallowing ability and depression. Poor swallowing ability, higher level of depression, and tumors of the tongue were associated with the worst functional dysphagia QOL. Patients with poor swallowing ability, higher level of depression, and less functional oral intake were more likely to have worse physical dysphagia QOL. CONCLUSION: Swallowing ability and depression were the most important factors associated with dysphagia-specific health-related QOL. Patient-centered swallowing rehabilitation programs are recommended to help cope with swallowing impairment.

Effects of a swallowing exercise education program on dysphagia-specific health-related quality of life in oral cavity cancer patients post-treatment: a randomized controlled trial.

PURPOSE: The purpose of this study was to evaluate the effects of a swallowing exercise education program (SEEP) on swallowing ability, depression, and dysphagia-specific health-related quality of life (QOL) in oral cavity cancer (OCC) patients. METHODS: This was a prospective, randomized controlled study with two groups using a pre- and post-repeated measures design. A total of 76 participants were randomly assigned to an experimental group (n = 38) and a control group (n = 38). The experimental group participated in a SEEP and the control group received normal care. Patients were assessed at five time points: baseline assessment (T0) and then 1, 2, 3, and 6-months (T1, T2, T3, and T4) after participating in the SEEP or receiving normal care. RESULTS: Patients in the experimental group had significantly greater emotional dysphagia QOL compared to those in the control group. In the experimental group, post-education (T4) depression was better than baseline (T0). For both groups, functional dysphagia QOL and physical dysphagia QOL were greatest at T0, decreased from T1 to T2, and slightly decreased at T3 and T4. There were no differences between the groups and within the groups with respect to dysphagia-specific health-related QOL, global dysphagia QOL, functional dysphagia QOL, and physical dysphagia QOL. CONCLUSIONS: The SEEP was effective in improving emotional dysphagia QOL during the initial 6 months after treatment of patients with OCC.

Foot contact pattern analysis in hemiplegic stroke patients: an implication for neurologic status determination.

OBJECTIVE: To investigate the feasibility of using a foot contact pattern to predict neurologic recovery and the effect of ambulation training in hemiplegic stroke patients. DESIGN: Case-comparison study. SETTING: Gait laboratory in a tertiary care center. PARTICIPANTS: Sixty-five functionally ambulant hemiplegic stroke patients, and 30 healthy subjects serving as the control group. INTERVENTIONS: Gait analyses were performed by using the conventional gait analysis system (6 cameras) and the portable Computer DynoGraphy (CDG) system. Main outcome measures Walking velocity, step length, and cadence were measured from the conventional gait analysis system. Cyclogram, gaitline, and ground reaction force (GRF) patterns were recorded with the CDG system. RESULTS: Velocity, cadence, and step length increased in higher Brunnstrom stages (P<.01). Negative correlation was noted between the Brunnstrom stages and the foot contact patterns (P<.01). Lower cyclogram, GRF, and gaitline patterns were expected in subjects with higher Brunnstrom stages. There were high prediction probabilities between cyclogram, gaitline, and GRF patterns. CONCLUSIONS: Foot contact pattern can be a simple and reliable indicator of hemiplegic gait in stroke patients. It is closely related to patient's neurologic status and is correlated with parameters obtained from conventional gait analysis systems. Pathologic presentations are noted in both the affected and unaffected limbs, suggesting that rehabilitation programs should be implemented on both sides.