Materiały źródłowe

• #1 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  Prognosis and outcome prediction for dysphagia can vary significantly based on the underlying cause and the patient’s overall health. Stroke patients recover swallowing function gradually, and therapeutic interventions for dysphagia generally are successful. In a prospective investigation of 128 patients admitted because of acute stroke, a swallowing abnormality was detected in 51% on clinical examination and in 64% on videofluoroscopy at initial presentation. At 6 months after stroke, 87% of patients had returned to their prestroke diet. […] In conditions in which recovery is possible (eg, TBI, stroke), the normalization of swallowing may take from 3 weeks to approximately 6 months or longer. Many patients tolerate normal oral caloric intake 9 months after a stroke, while some may require partial or nonoral caloric supplementation. In patients who have sustained a stroke, continued swallowing dysfunction after 6 months is associated with increased morbidity and mortality.

• #2 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOopdzQx_HQWsAVu5OT7L4_Sfb1pggZtIV1rn5hDFZaWe4Lc1qPmc

  Dysphagia is a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. […] Dysphagia may increase caregiver costs and burden and may require significant lifestyle alterations for the patient and the patients family. […] Dysphagia intervention may concentrate on swallowing exercises, compensatory swallowing strategies (including posture considerations), bolus consistency modification, and caregiver/patient education. […] The prevalence of dysphagia in community-dwelling adults over the age of 50 years is estimated to be somewhere between 15% and 22%. […] A report by the Agency for Health Care Policy and Research estimates that approximately one third of patients with dysphagia develop pneumonia and that 60,000 individuals die each year from such complications.

• #3 Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9873776/

  Oropharyngeal dysphagia is common post-stroke and can have serious consequences for patients. Understanding dysphagia recovery is critically important to inform prognostication and support patients and professionals with care planning. Dysphagia recovery was defined as improvement measured on a clinical swallowing scale or upgrade in oral and/or enteral feeding status by the end of the follow-up period. Age, airway compromise identified on instrumental assessment, dysphagia severity, bilateral lesions, and stroke severity were identified as predictors of persistent dysphagia and negative recovery in multiple logistic regression analysis. […] Studies investigating predictors of swallowing recovery provide important information to assist clinicians with prognostication, care planning, and supportive counselling for patients and families. The early identification of patients with good potential for swallowing recovery may influence decisions around the need for alternative feeding methods, such as nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) tubes.

• #4 Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9873776/

  Accurate prediction of dysphagia recovery can support decisions regarding timing and destination of discharge. […] The most common finding on logistic regression was that physiological features of dysphagia identified on instrumental assessment independently predicted dysphagia recovery. Airway compromise as evidenced by penetration or aspiration on instrumental swallow exam was the only symptom identified as a negative predictor of dysphagia recovery by more than one study. […] Stroke severity as conferred by NIHSS score was the strongest stroke variable related to dysphagia recovery. Higher initial NIHSS score was associated with longer time to removal of NG in non-brainstem stroke. […] This systematic review has identified physiological, demographic, stroke, and treatment variables that can influence dysphagia recovery after stroke. Studies reporting recovery as change in severity on a valid dysphagia scale or change in oral and/or enteral feeding status were included. We found consensus from two or more studies for predictors of persistent dysphagia and negative recovery including penetration or aspiration identified on instrumental assessment, age, bilateral lesions, initial FOIS score, and stroke severity measured by the NIHSS.

• #5 Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4056041/

  The development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. […] The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI). […] In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. […] In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes. […] Studies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder.

• #6 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  Prognosis and outcome prediction for dysphagia can vary significantly based on the underlying cause and the patient’s overall health. Stroke patients recover swallowing function gradually, and therapeutic interventions for dysphagia generally are successful. In a prospective investigation of 128 patients admitted because of acute stroke, a swallowing abnormality was detected in 51% on clinical examination and in 64% on videofluoroscopy at initial presentation. At 6 months after stroke, 87% of patients had returned to their prestroke diet. […] In conditions in which recovery is possible (eg, TBI, stroke), the normalization of swallowing may take from 3 weeks to approximately 6 months or longer. Many patients tolerate normal oral caloric intake 9 months after a stroke, while some may require partial or nonoral caloric supplementation. In patients who have sustained a stroke, continued swallowing dysfunction after 6 months is associated with increased morbidity and mortality.

• #7 Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9873776/

  Accurate prediction of dysphagia recovery can support decisions regarding timing and destination of discharge. […] The most common finding on logistic regression was that physiological features of dysphagia identified on instrumental assessment independently predicted dysphagia recovery. Airway compromise as evidenced by penetration or aspiration on instrumental swallow exam was the only symptom identified as a negative predictor of dysphagia recovery by more than one study. […] Stroke severity as conferred by NIHSS score was the strongest stroke variable related to dysphagia recovery. Higher initial NIHSS score was associated with longer time to removal of NG in non-brainstem stroke. […] This systematic review has identified physiological, demographic, stroke, and treatment variables that can influence dysphagia recovery after stroke. Studies reporting recovery as change in severity on a valid dysphagia scale or change in oral and/or enteral feeding status were included. We found consensus from two or more studies for predictors of persistent dysphagia and negative recovery including penetration or aspiration identified on instrumental assessment, age, bilateral lesions, initial FOIS score, and stroke severity measured by the NIHSS.

• #8

  https://link.springer.com/article/10.1007/s00455-022-10443-3

  Age was the most investigated demographic variable. […] Medical treatments including intubation and tracheostomy insertion post-stroke were negative predictors of dysphagia recovery. […] This systematic review has identified physiological, demographic, stroke, and treatment variables that can influence dysphagia recovery after stroke. Studies reporting recovery as change in severity on a valid dysphagia scale or change in oral and/or enteral feeding status were included. We found consensus from two or more studies for predictors of persistent dysphagia and negative recovery including penetration or aspiration identified on instrumental assessment, age, bilateral lesions, initial FOIS score, and stroke severity measured by the NIHSS.

• #9

  https://link.springer.com/article/10.1007/s00455-022-10443-3

  Analysis of the clinical predictors of dysphagia recovery is underrepresented in the literature. […] Therefore, we sought to systematically review and evaluate the evidence for clinical predictors of dysphagia recovery post-stroke. […] Dysphagia recovery was broadly defined as change in feeding status or change in severity on a validated dysphagia scale across all studies. […] A variety of clinical predictor variables for dysphagia recovery were investigated across the included studies. […] The most common finding on logistic regression was that physiological features of dysphagia identified on instrumental assessment independently predicted dysphagia recovery. […] Stroke-related variables such as severity, location, and co-occurring impairments were also commonly identified predictors of recovery in regression analysis.

• #10

  https://link.springer.com/article/10.1007/s00455-022-10443-3

  Age was the most investigated demographic variable. […] Medical treatments including intubation and tracheostomy insertion post-stroke were negative predictors of dysphagia recovery. […] This systematic review has identified physiological, demographic, stroke, and treatment variables that can influence dysphagia recovery after stroke. Studies reporting recovery as change in severity on a valid dysphagia scale or change in oral and/or enteral feeding status were included. We found consensus from two or more studies for predictors of persistent dysphagia and negative recovery including penetration or aspiration identified on instrumental assessment, age, bilateral lesions, initial FOIS score, and stroke severity measured by the NIHSS.

• #11 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  Prognosis and outcome prediction for dysphagia can vary significantly based on the underlying cause and the patient’s overall health. Stroke patients recover swallowing function gradually, and therapeutic interventions for dysphagia generally are successful. In a prospective investigation of 128 patients admitted because of acute stroke, a swallowing abnormality was detected in 51% on clinical examination and in 64% on videofluoroscopy at initial presentation. At 6 months after stroke, 87% of patients had returned to their prestroke diet. […] In conditions in which recovery is possible (eg, TBI, stroke), the normalization of swallowing may take from 3 weeks to approximately 6 months or longer. Many patients tolerate normal oral caloric intake 9 months after a stroke, while some may require partial or nonoral caloric supplementation. In patients who have sustained a stroke, continued swallowing dysfunction after 6 months is associated with increased morbidity and mortality.

• #12 Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4056041/

  The development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. […] The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI). […] In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. […] In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes. […] Studies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder.

• #13 Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4056041/

  The development of postextubation swallowing dysfunction is well documented in the literature with high prevalence in most studies. […] The purpose of our study was to determine prognostic indicators of dysphagia in ICU patients submitted to prolonged orotracheal intubation (OTI). […] In the univariate analyses, we found that statistically significant prognostic indicators of dysphagia included dysphagia severity rate at the initial swallowing assessment, time to initiate oral feeding and amount of individual treatment. […] In the multivariate analysis, we found that dysphagia severity rate at the initial swallowing assessment remained associated with good treatment outcomes. […] Studies of prognostic indicators in different populations with dysphagia can contribute to the design of more effective procedures when evaluating, treating, and monitoring individuals with this type of disorder.

• #14 Clinical prognostic indicators of dysphagia following prolonged orotracheal intubation in ICU patients

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4056041/

  The clinical relevance of dysphagia after extubation is profound; it occurs frequently and affects patients across all medical and surgical diagnostic categories. […] Prolonged intubation, typically defined as longer than 48 hours, is thought to contribute to swallowing dysfunction. […] Longer intubation duration has been correlated to dysphagic patients and has also been reported to be an independent predictor of dysphagia severity. […] The association between intubation duration and severity of dysphagia is supported by the Barker et al. review and other studies. […] We believe that the earlier oral feeding is introduced the higher the probability of reaching good dysphagia outcomes. […] The main contribution of the current research is related to the swallowing functional level at admission as a significant prognostic indicator of good swallowing outcome. […] The level of swallowing impairment, the time to initiate oral feeding and the amount of individual treatment can be used as clinical indicators to predict swallowing rehabilitation outcomes.

• #15 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  In all Parkinson syndromes, neurogenic dysphagia is also a major risk factor for pneumonia, which is the leading cause of death in these patients. Furthermore, swallowing disorders in these patients are associated with a reduced quality of life, insufficient drug effects, and malnutrition. […] Dysphagia is also a prominent clinical feature in various neuromuscular diseases. Up to 30% of patients with amyotrophic lateral sclerosis present with impaired swallowing at diagnosis and practically all of them develop dysphagia as the disease progresses. […] Regardless of the primary illness, 70-80% of patients requiring prolonged mechanical ventilation present, at least temporarily, with significant swallowing impairment and aspiration after successful weaning, probably due to a critical illness polyneuropathy and structural changes caused by the artificial airway like edema of the arytenoids. This impairment not only necessitates prolonged artificial nutrition, but is also linked to serious complications, such as pneumonia and the necessity for reintubation and is in addition an independent predictor of increased mortality.

• #16 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  In all Parkinson syndromes, neurogenic dysphagia is also a major risk factor for pneumonia, which is the leading cause of death in these patients. Furthermore, swallowing disorders in these patients are associated with a reduced quality of life, insufficient drug effects, and malnutrition. […] Dysphagia is also a prominent clinical feature in various neuromuscular diseases. Up to 30% of patients with amyotrophic lateral sclerosis present with impaired swallowing at diagnosis and practically all of them develop dysphagia as the disease progresses. […] Regardless of the primary illness, 70-80% of patients requiring prolonged mechanical ventilation present, at least temporarily, with significant swallowing impairment and aspiration after successful weaning, probably due to a critical illness polyneuropathy and structural changes caused by the artificial airway like edema of the arytenoids. This impairment not only necessitates prolonged artificial nutrition, but is also linked to serious complications, such as pneumonia and the necessity for reintubation and is in addition an independent predictor of increased mortality.

• #17 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  In all Parkinson syndromes, neurogenic dysphagia is also a major risk factor for pneumonia, which is the leading cause of death in these patients. Furthermore, swallowing disorders in these patients are associated with a reduced quality of life, insufficient drug effects, and malnutrition. […] Dysphagia is also a prominent clinical feature in various neuromuscular diseases. Up to 30% of patients with amyotrophic lateral sclerosis present with impaired swallowing at diagnosis and practically all of them develop dysphagia as the disease progresses. […] Regardless of the primary illness, 70-80% of patients requiring prolonged mechanical ventilation present, at least temporarily, with significant swallowing impairment and aspiration after successful weaning, probably due to a critical illness polyneuropathy and structural changes caused by the artificial airway like edema of the arytenoids. This impairment not only necessitates prolonged artificial nutrition, but is also linked to serious complications, such as pneumonia and the necessity for reintubation and is in addition an independent predictor of increased mortality.

• #18 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOopdzQx_HQWsAVu5OT7L4_Sfb1pggZtIV1rn5hDFZaWe4Lc1qPmc

  Patients with suspected dysphagia may warrant further instrumental assessment to examine the impact of swallowing anatomy and physiology on clinical presentation. […] The primary goals of dysphagia intervention are to support adequate nutrition and hydration and return to oral intake. […] Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. […] The SLP should consider and integrate the patients wishes and advocate on behalf of the patient to the health care team, the family, and other relevant individuals. […] The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition. […] Understanding emotional and psychological issues related to death is essential to treating patients with swallowing problems at the end of life.

• #19

  https://link.springer.com/article/10.1007/s00405-019-05687-z

  Oropharyngeal dysphagia (OD) has a major influence on health in general and health-related quality of life (HR-QoL) in particular. […] Aspiration or silent aspiration in severe OD can cause aspiration pneumonia and, when accompanied by malnutrition and dehydration, can lead to hospitalization, intensive care admission or even death. […] The presence of aspiration is the most critical clinical sign in patients with OD. […] The predicted outcome of most studies was dysphagia, though not differentiating between dysphagia with or without aspiration. […] The purpose of this study was to build a predictive model that could forecast aspiration in patients with OD using oral intake status and commonly used self-evaluation questionnaires on FHS and HR-QoL. […] This study shows that it may be possible to accurately predict aspiration in oropharyngeal dysphagia by a non-invasive and non-instrumental assessment protocol including oral intake status and self-report questionnaires on functional health status and HR-QoL.

• #20 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  In the aforementioned study by Boyapati et al of patients aged 65 years or older with hip fracture, the mortality rate in persons with dysphagia was 8.9%, compared with 2.6% in patients without dysphagia. More specifically, individuals with acute dysphagia had a 12.4% mortality rate, versus a 5% mortality rate in those with chronic dysphagia. The timing of the dysphagic event also seemed to affect mortality, with perioperative dysphagia linked to a 13.9% mortality rate, and non-perioperative dysphagia, to a 4% rate. […] Pneumonia accounts for about 34% of all stroke-related deaths and represents the third highest cause of death during the first month after a stroke. Although not all of these cases of pneumonia are attributable to the aspiration of food, the early detection and treatment of dysphagia in patients who have sustained a stroke is nonetheless very critical.

• #21 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  Early swallow screening and dysphagia management in patients with acute stroke reduces their risk of aspiration pneumonia, is cost effective, and helps to ensure good-quality care with optimal outcomes. […] Patients who have had a stroke are likely to decrease their dietary intake, which increases their risk of malnutrition or exacerbates existing malnourishment. In an investigation of the nutritional status of patients with stroke who were admitted to a rehabilitation service, 49% had malnutrition, and 65% of those with dysphagia were malnourished. […] Malnutrition is a risk factor for pneumonia because it renders the person susceptible to altered colonization in the oropharynx and reduced resistance to infection by depressing the immune system.

• #22 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  Early swallow screening and dysphagia management in patients with acute stroke reduces their risk of aspiration pneumonia, is cost effective, and helps to ensure good-quality care with optimal outcomes. […] Patients who have had a stroke are likely to decrease their dietary intake, which increases their risk of malnutrition or exacerbates existing malnourishment. In an investigation of the nutritional status of patients with stroke who were admitted to a rehabilitation service, 49% had malnutrition, and 65% of those with dysphagia were malnourished. […] Malnutrition is a risk factor for pneumonia because it renders the person susceptible to altered colonization in the oropharynx and reduced resistance to infection by depressing the immune system.

• #23 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  Early swallow screening and dysphagia management in patients with acute stroke reduces their risk of aspiration pneumonia, is cost effective, and helps to ensure good-quality care with optimal outcomes. […] Patients who have had a stroke are likely to decrease their dietary intake, which increases their risk of malnutrition or exacerbates existing malnourishment. In an investigation of the nutritional status of patients with stroke who were admitted to a rehabilitation service, 49% had malnutrition, and 65% of those with dysphagia were malnourished. […] Malnutrition is a risk factor for pneumonia because it renders the person susceptible to altered colonization in the oropharynx and reduced resistance to infection by depressing the immune system.

• #24 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  Regardless of the underlying diseases, the risk of developing a swallowing disorder increases significantly with age. Thus, dysphagia is found in 30-40% of independently living older people, while more than 50% of nursing home residents and approximately 70% of all geriatric in-patients are affected by this disorder. […] In patients with severe neurogenic dysphagia, nasogastric tube feeding is often recommended, at least temporarily, to ensure safe and sufficient enteral feeding. Despite contrary recommendations in other guidelines, from a practical point of view it is important to consider that a nasogastric tube should not be removed for instrumental or clinical dysphagia diagnosis or for dysphagia therapy. […] The fundamental impact of a simple aspiration screening in patients with neurogenic dysphagia has been studied in recent years, especially in the context of acute stroke. In several prospective observational studies, the implementation of an aspiration screening was associated with a reduction of infectious complications.

• #25 Dysphagia: Practice Essentials, Background, Anatomy

  https://emedicine.medscape.com/article/2212409-overview

  In the aforementioned study by Boyapati et al of patients aged 65 years or older with hip fracture, the mortality rate in persons with dysphagia was 8.9%, compared with 2.6% in patients without dysphagia. More specifically, individuals with acute dysphagia had a 12.4% mortality rate, versus a 5% mortality rate in those with chronic dysphagia. The timing of the dysphagic event also seemed to affect mortality, with perioperative dysphagia linked to a 13.9% mortality rate, and non-perioperative dysphagia, to a 4% rate. […] Pneumonia accounts for about 34% of all stroke-related deaths and represents the third highest cause of death during the first month after a stroke. Although not all of these cases of pneumonia are attributable to the aspiration of food, the early detection and treatment of dysphagia in patients who have sustained a stroke is nonetheless very critical.

• #26 Dysphagia is associated with worse clinical outcomes in geriatric trauma patients | Trauma Surgery & Acute Care Open

  https://tsaco.bmj.com/content/7/1/e001043

  Dysphagia is associated with increased morbidity, mortality, and resource utilization in hospitalized patients, but studies on outcomes in geriatric trauma patients with dysphagia are limited. […] We hypothesized that geriatric trauma patients with dysphagia would have worse clinical outcomes compared with those without dysphagia. […] Dysphagia was associated with increased odds of unplanned ICU admission (OR 4.6, 95% CI 2.0 to 9.6, p0.001) and non-home discharge (OR 5.2, 95% CI 2.4 to 13.9, p0.001), as well as increased ICU LOS (OR 4.9, 95% CI 3.1 to 8.1, p0.001), and hospital LOS (OR 2.1, 95% CI 1.7 to 2.6, p0.001). […] Clinically apparent dysphagia is associated with poor outcomes, but it remains unclear if dysphagia represents a modifiable risk factor or a marker of underlying frailty, leading to poor outcomes. […] Our study demonstrates the clinical significance of dysphagia in this patient population and highlights the potential benefit of more rigorous screening protocols as no consensus screening guidelines currently exist for dysphagia in geriatric trauma patients.

• #27 Prediction of dysphagia aspiration through machine learning-based analysis of patients’ postprandial voices | Journal of NeuroEngineering and Rehabilitation | Full Text

  https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-024-01329-6

  Dysphagia is a difficulty in swallowing food normally due to impaired movement in swallowing-related organs, which increases the risk of food passing into the airway. The most common diagnostic method, the Videofluoroscopic Swallowing Study (VFSS), requires specialized equipment typically found only in hospitals, resulting in long wait times and radiation risks. Thus, the current dysphagia diagnostic methods in clinical settings are limited in their ability to continuously monitor changes in a patient’s condition over time. […] In this study, we developed a machine learning algorithm that can distinguish between normal and dysphagia-aspiration using postprandial voice data. This research is significant as it is the first to apply the Efficient Pre-trained CNNs for Audio Pattern Recognition, developed for existing audio classification problems, to the differentiation of dysphagia-aspiration.

• #28

  https://link.springer.com/article/10.1007/s00405-019-05687-z

  Oropharyngeal dysphagia (OD) has a major influence on health in general and health-related quality of life (HR-QoL) in particular. […] Aspiration or silent aspiration in severe OD can cause aspiration pneumonia and, when accompanied by malnutrition and dehydration, can lead to hospitalization, intensive care admission or even death. […] The presence of aspiration is the most critical clinical sign in patients with OD. […] The predicted outcome of most studies was dysphagia, though not differentiating between dysphagia with or without aspiration. […] The purpose of this study was to build a predictive model that could forecast aspiration in patients with OD using oral intake status and commonly used self-evaluation questionnaires on FHS and HR-QoL. […] This study shows that it may be possible to accurately predict aspiration in oropharyngeal dysphagia by a non-invasive and non-instrumental assessment protocol including oral intake status and self-report questionnaires on functional health status and HR-QoL.

• #29

  https://link.springer.com/article/10.1007/s00405-019-05687-z

  This study shows that aspiration in patients with OD may be predicted by a cost-effective, simple and non-invasive assessment protocol including oral intake status and patient self-evaluation questionnaires on FHS and HR-QoL. […] This predictive model determines the chance of aspiration, not just a pass or fail outcome, with excellent performance (AUC 0.92).

• #30 Prediction of dysphagia aspiration through machine learning-based analysis of patients’ postprandial voices | Journal of NeuroEngineering and Rehabilitation | Full Text

  https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-024-01329-6

  Dysphagia is a difficulty in swallowing food normally due to impaired movement in swallowing-related organs, which increases the risk of food passing into the airway. The most common diagnostic method, the Videofluoroscopic Swallowing Study (VFSS), requires specialized equipment typically found only in hospitals, resulting in long wait times and radiation risks. Thus, the current dysphagia diagnostic methods in clinical settings are limited in their ability to continuously monitor changes in a patient’s condition over time. […] In this study, we developed a machine learning algorithm that can distinguish between normal and dysphagia-aspiration using postprandial voice data. This research is significant as it is the first to apply the Efficient Pre-trained CNNs for Audio Pattern Recognition, developed for existing audio classification problems, to the differentiation of dysphagia-aspiration.

• #31 Prediction of dysphagia aspiration through machine learning-based analysis of patients’ postprandial voices | Journal of NeuroEngineering and Rehabilitation | Full Text

  https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-024-01329-6

  The primary outcome of this study is the Area Under the ROC Curve (AUC), considering the imbalanced distribution of data among groups in the medical field. The ROC curve visually shows how well the model distinguishes between actual aspiration and normal cases by plotting the true aspiration rate against the false normal rate, while the AUC, which varies between 0 and 1, measures this distinction’s accuracy, with values closer to 1 signifying more accurate predictions. […] This study developed a model to predict dysphagia aspiration based on the postprandial voice. The expected benefits of this study are as follows. First, by determining the occurrence of aspiration and providing clinicians with more parameters through voice, it enhances the clinical utility compared to previous studies. Second, it is anticipated that the diagnosis time for both outpatient and inpatient cases will be significantly reduced, providing additional diagnostic parameters for a more accurate assessment of dysphagia.

• #32 Prediction of dysphagia aspiration through machine learning-based analysis of patients’ postprandial voices | Journal of NeuroEngineering and Rehabilitation | Full Text

  https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-024-01329-6

  In this study, we utilized mel-spectrogram analysis of postprandial voice recordings and trained a MobileNetV3 model for mobile and medical device applications. This model showed high performance in predicting dysphagia aspiration, suggesting advancements in machine learning-based monitoring. Our study highlights the potential of voice analysis as a valuable tool for screening, diagnosing, and monitoring dysphagia.

• #33 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia.

• #34 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOopdzQx_HQWsAVu5OT7L4_Sfb1pggZtIV1rn5hDFZaWe4Lc1qPmc

  Patients with suspected dysphagia may warrant further instrumental assessment to examine the impact of swallowing anatomy and physiology on clinical presentation. […] The primary goals of dysphagia intervention are to support adequate nutrition and hydration and return to oral intake. […] Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. […] The SLP should consider and integrate the patients wishes and advocate on behalf of the patient to the health care team, the family, and other relevant individuals. […] The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition. […] Understanding emotional and psychological issues related to death is essential to treating patients with swallowing problems at the end of life.

• #35 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  Regardless of the underlying diseases, the risk of developing a swallowing disorder increases significantly with age. Thus, dysphagia is found in 30-40% of independently living older people, while more than 50% of nursing home residents and approximately 70% of all geriatric in-patients are affected by this disorder. […] In patients with severe neurogenic dysphagia, nasogastric tube feeding is often recommended, at least temporarily, to ensure safe and sufficient enteral feeding. Despite contrary recommendations in other guidelines, from a practical point of view it is important to consider that a nasogastric tube should not be removed for instrumental or clinical dysphagia diagnosis or for dysphagia therapy. […] The fundamental impact of a simple aspiration screening in patients with neurogenic dysphagia has been studied in recent years, especially in the context of acute stroke. In several prospective observational studies, the implementation of an aspiration screening was associated with a reduction of infectious complications.

• #36 Clinical Predictors of Dysphagia Recovery After Stroke: A Systematic Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9873776/

  Oropharyngeal dysphagia is common post-stroke and can have serious consequences for patients. Understanding dysphagia recovery is critically important to inform prognostication and support patients and professionals with care planning. Dysphagia recovery was defined as improvement measured on a clinical swallowing scale or upgrade in oral and/or enteral feeding status by the end of the follow-up period. Age, airway compromise identified on instrumental assessment, dysphagia severity, bilateral lesions, and stroke severity were identified as predictors of persistent dysphagia and negative recovery in multiple logistic regression analysis. […] Studies investigating predictors of swallowing recovery provide important information to assist clinicians with prognostication, care planning, and supportive counselling for patients and families. The early identification of patients with good potential for swallowing recovery may influence decisions around the need for alternative feeding methods, such as nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) tubes.

• #37 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOopdzQx_HQWsAVu5OT7L4_Sfb1pggZtIV1rn5hDFZaWe4Lc1qPmc

  Patients with suspected dysphagia may warrant further instrumental assessment to examine the impact of swallowing anatomy and physiology on clinical presentation. […] The primary goals of dysphagia intervention are to support adequate nutrition and hydration and return to oral intake. […] Management of individuals with dysphagia should be based on results of comprehensive assessment, including both instrumental and non-instrumental assessments as applicable. […] The SLP should consider and integrate the patients wishes and advocate on behalf of the patient to the health care team, the family, and other relevant individuals. […] The role of the SLP in treating individuals with progressive neurological disorders is designed to maximize current function, compensate for irreversible loss of function, assess and reassess changes in status, and educate and counsel patients regarding the progression of the disorder and potential options, including non-oral means of nutrition. […] Understanding emotional and psychological issues related to death is essential to treating patients with swallowing problems at the end of life.

• #38 Adult Dysphagia

  https://www.asha.org/practice-portal/clinical-topics/adult-dysphagia/?srsltid=AfmBOopdzQx_HQWsAVu5OT7L4_Sfb1pggZtIV1rn5hDFZaWe4Lc1qPmc

  Dysphagia is a swallowing disorder involving the oral cavity, pharynx, esophagus, or gastroesophageal junction. […] Dysphagia may increase caregiver costs and burden and may require significant lifestyle alterations for the patient and the patients family. […] Dysphagia intervention may concentrate on swallowing exercises, compensatory swallowing strategies (including posture considerations), bolus consistency modification, and caregiver/patient education. […] The prevalence of dysphagia in community-dwelling adults over the age of 50 years is estimated to be somewhere between 15% and 22%. […] A report by the Agency for Health Care Policy and Research estimates that approximately one third of patients with dysphagia develop pneumonia and that 60,000 individuals die each year from such complications.

• #39 Diagnosis and treatment of neurogenic dysphagia – S1 guideline of the German Society of Neurology | Neurological Research and Practice | Full Text

  https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-021-00122-3

  Regardless of the underlying diseases, the risk of developing a swallowing disorder increases significantly with age. Thus, dysphagia is found in 30-40% of independently living older people, while more than 50% of nursing home residents and approximately 70% of all geriatric in-patients are affected by this disorder. […] In patients with severe neurogenic dysphagia, nasogastric tube feeding is often recommended, at least temporarily, to ensure safe and sufficient enteral feeding. Despite contrary recommendations in other guidelines, from a practical point of view it is important to consider that a nasogastric tube should not be removed for instrumental or clinical dysphagia diagnosis or for dysphagia therapy. […] The fundamental impact of a simple aspiration screening in patients with neurogenic dysphagia has been studied in recent years, especially in the context of acute stroke. In several prospective observational studies, the implementation of an aspiration screening was associated with a reduction of infectious complications.

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