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This study prospectively investigated the incidence of vocal fold immobility, unilateral and bilateral, and its influence on aspiration status in a referred population of 1452 patients for a dysphagia evaluation from a large, urban, tertiary-care, teaching hospital. Main outcome measures included overall incidence of vocal fold immobility and aspiration status, with specific emphasis on age, etiology, and side of vocal fold immobility, i.e., right, left, or bilateral. Overall incidence of vocal fold immobility was 5.6% (81 of 1452 patients), including 47 males (mean age 55.7 yr) and 34 females (mean age 59.7 yr). In the subgroup of patients with vocal fold immobility, 31% (25 of 81) exhibited unilateral right, 60% (49 of 81) unilateral left, and 9% (7 of 81) bilateral impairment. Overall incidence of aspiration was found to be 29% (426 of 1452) of all patients referred for a swallow evaluation. Aspiration was observed in 44% (36 of 81) of patients presenting with vocal fold immobility, i.e., 44% (11 of 25) unilateral right, 43% (21 of 49) unilateral left, and 57% (4 of 7) bilateral vocal fold immobility. Left vocal fold immobility occurred most frequently due to surgical trauma. A liquid bolus was aspirated more often than a puree bolus. Side of vocal fold immobility and age were not factors that increased incidence of aspiration. In conclusion, vocal fold immobility, with an incidence of 5.6%, is not an uncommon finding in patients referred for a dysphagia evaluation in the acute-care setting, and vocal fold immobility, when present, was associated with a 15% increased incidence of aspiration when compared with a population already being evaluated for dysphagia.This research was supported in part by the McFadden, Harmon, and Mirikitani Endowments. 相似文献
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The purpose of this prospective study was to determine if fiberoptic endoscopic evaluation of swallowing (FEES) maintains high intra- and interrater reliability in detecting pharyngeal dysphagia and aspiration without the addition of FD&C Blue No. 1 to food. Twenty consecutive adults referred for a swallow evaluation participated. Nine subjects received blue-dyed food and 11 subjects received regular nondyed food, i.e., yellow pudding and white skim milk. Four variables were rated: (1) the stage transition characterized by depth of bolus flow to at least the vallecula prior to the pharyngeal swallow; (2) evidence of bolus retention in the vallecula or pyriform sinuses after the pharyngeal swallow; (3) laryngeal penetration defined as material in the laryngeal vestibule but not passing below the level of the true vocal folds either before or after the pharyngeal swallow; and (4) tracheal aspiration defined as material below the level of the true vocal folds either before or after the pharyngeal swallow. Three speech–language pathologists experienced in interpreting FEES results independently and blindly reviewed the digitized videotape three times. Intrarater agreements for the four variables with blue-dyed and non-blue-dyed food trials were 100% and monochrome trials ranged from 95% to 100%. Average kappa values for interrater reliability ranged from moderate to excellent agreement (0.61–1.00) for all viewing conditions. Kappa values for blue-dyed trials versus monochrome trials were 0.83 and for non-blue-dyed trials versus monochrome trials were 0.88, indicative of excellent reliability under both viewing conditions. FEES maintains both high intra- and interrater reliability in detecting the critical features of pharyngeal dysphagia and aspiration using either blue-dyed or non-blue-dyed foods. The endoscopist, therefore, can be assured of reliable FEES results using regular, non-dyed food trials.This research was supported in part by the McFadden, Harmon, and Mirikitani Endowments. 相似文献
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Lingual propulsion during swallowing is characterized by the sequential elevation of the anterior, middle, and dorsal regions
of the tongue. Although lingual discoordination underlies many swallowing disorders, the coordinative organization of lingual
propulsion during the typical and disordered swallow is poorly understood. The purpose of this investigation was to quantitatively
describe the coordinative organization of lingual propulsion during the normal adult swallow. Tongue movement data were obtained
from the X-Ray Microbeam Database at the University of Wisconsin. Movement of four pellets placed on specific tongue regions
were tracked in 36 healthy adult participants while they swallowed 10 cc of water across five discrete trials. The propulsive
action of the tongue during bolus transport was quantified using a cross-correlation analysis. Lingual transit time (LTT),
which was defined as the interval (lag time) between the movements of the anterior- and posterior-most tongue regions, was
determined to be approximately 168 ms. The average time interval (lag) between the movements of the posterior tongue regions
was significantly shorter than the intervals between more anterior tongue regions. The results also suggest that during bolus
transport movement patterns of the anterior tongue regions are distinct from those of the posterior tongue regions. Future
work is needed to determine if the absence of the observed coordinative organization of lingual propulsion is indicative of
oral stage dysphagia. 相似文献
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Nan D. Musson M.A. CCC-SLP Jean Kincaid M.S. R.D. Pat Ryan ARNP Betty Glussman ARNP Litha Varone M.S. R.N. Nydia Gamarra M.S. R.D. Reba Wilson B.A. William Reefe M.D. Michael Silverman M.D. 《Dysphagia》1990,5(2):96-101
Malnutrition and dehydration are common problems in nursing home patients. One explanation for this may be the large number
of patients requiring feeding assistance. The Dysphagia Team at the Department of Veterans Affairs Medical Center in Miami,
Florida served as the primary source in the expansion of a nutritionally supportive environment to assist in the prevention
of malnutrition and dehydration in patients with feeding/swallowing disorders. “Silver Spoons,” a program in which volunteers
provide supervised feeding, “Happy Hour,” a time each day during which an atmosphere is provided that encourages socialization
and hydration, and “Second Seating,” during which lunch is provided for patients who require modification of eating style,
food texture, or timing are described. Analysis of the program's outcomes show it to be timely, pleasing to patients, and
cost-effective. 相似文献
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Edward Chaw DO Kazuko Shem MD Kathleen Castillo MA CCC-SLP BRS-S Sandra Lynn Wong BA RCP James Chang BA CBIS 《Topics in spinal cord injury rehabilitation》2012,18(4):291-299
Background:
Dysphagia is a relatively common secondary complication that occurs after acute cervical spinal cord injury (SCI). The detrimental consequences of dysphagia in SCI include transient hypoxemia, chemical pneumonitis, atelectasis, bronchospasm, and pneumonia. The expedient diagnosis of dysphagia is imperative to reduce the risk of the development of life-threatening complications.Objective:
The objective of this study was to identify risk factors for dysphagia after SCI and associated respiratory considerations in acute cervical SCI.Methods:
Bedside swallow evaluation (BSE) was conducted in 68 individuals with acute cervical SCI who were admitted to an SCI specialty unit. Videofluroscopy swallow study was conducted within 72 hours of BSE when possible.Results:
This prospective study found dysphagia in 30.9% (21 out of 68) of individuals with acute cervical SCI. Tracheostomy (P = .028), ventilator use (P = .012), and nasogastric tube (P = .049) were found to be significant associated factors for dysphagia. Furthermore, individuals with dysphagia had statistically higher occurrences of pneumonia when compared with persons without dysphagia (P < .001). There was also a trend for individuals with dysphagia to have longer length of stay (P = .087).Conclusion:
The role of respiratory care practitioners in the care of individuals with SCI who have dysphagia needs to be recognized. Aggressive respiratory care enables individuals with potential dysphagia to be evaluated by a speech pathologist in a timely manner. Early evaluation and intervention for dysphagia could decrease morbidity and improve overall clinical outcomes. 相似文献7.
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Kazuko Shem MD Kathleen Castillo MA CCC-SLP BRS-S Sandra Lynn Wong BA RCP James Chang BA CBIS Stephanie Kolakowsky-Hayner PhD CBIST 《Topics in spinal cord injury rehabilitation》2012,18(1):15-22
Dysphagia occurs in a significant number of individuals with spinal cord injury (SCI) presenting to acute care and inpatient rehabilitation. This prospective study has found dysphagia in nearly 40% of individuals with tetraplegia. Tracheostomy, mechanical ventilation, nasogastric tube, and age are significant risk factors. The detrimental complications of dysphagia in SCI can cause significant morbidity and delays in rehabilitation. Thus, early and accurate diagnosis of dysphagia is imperative to reduce the risk of developing life-threatening complications. Incidence and risk factors of dysphagia and the use of the bedside swallow evaluation (BSE) and videofluoroscopy swallow study (VFSS) to diagnose dysphagia are presented. The often underappreciated role of respiratory therapists, including assist cough, high tidal volume ventilation, and the use of Passy-Muir valve, in the care of individuals with SCI who have dysphagia is discussed. Improved secretion management and respiratory stabilization enable the individuals with dysphagia to be evaluated sooner and safely by a speech pathologist. Early evaluation and intervention could improve upon morbidity and delayed rehabilitation, thus improving overall clinical outcomes. 相似文献