Computational Deglutition: Using Signal- and Image-Processing Methods to Understand Swallowing and Associated Disorders [Life Sciences] (original) (raw)
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Dysphagia, 2016
The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. The central coordination of this complex sensorimotor task uses a widespread network of cortical, subcortical, and brainstem structures. Many diseases and disorders affecting the central swallowing network or downstream peripheral nerves, muscles, and structures may result in an impaired oropharyngeal swallow. In addition, aging is also associated with multifactorial changes of swallowing physiology for which the term presbyphagia has been coined. Oropharyngeal dysphagia broadly affects respiratory safety due to the increased risk of aspiration, and swallowing efficacy leading to the impeding danger of insufficient nutrition and hydration.
Dysphagia: A Short Review of the Current State
Dysphagia is the clinical expression of disruption of the synchronized activity surrounding the normal swallowing mechanism. It results from a large number of causes including neurologic, myopathic, metabolic, inflammatory/autoimmune, infectious, structural, iatrogenic, and psychiatric diseases. It can have a signifi cant impact on social and psychologic levels, as well as overall health, and is crucial to a patient’s sense of well-being. Dysphagia is very common and is presently considered an alarm symptom that requires immediate attention. This article reviews current literature on the subject and summarizes the state of knowledge regarding the prevalence, classification, identification, management, and treatment of this condition. It also considers the diverse effects of cultural variables on dysphagia service delivery and capacity. Implications for practice are targeted to the members of a dysphagia multidisciplinary team, including several professional domains: speech and language pathologists, occupational therapists, physiotherapists, dieticians, and nursing and medical staff. Possible directions for future research are indicated.
Investigation and management of chronic dysphagia
BMJ, 2003
Timely intervention by a multidisciplinary team can prevent or ameliorate the complications of chronic dysphagia, reducing the burden of this common and diverse condition Dysphagia is an impairment of swallowing that may involve any structures from the lips to the gastric cardia. Causes include a wide variety of acute cerebral conditions, progressive disorders, and trauma, disease, or surgery to the oro-pharyngo-oesophageal tract (box 1). Department of Health figures for 2001-2 record more than 23 000 primary diagnoses of dysphagia in England and Wales, associated with almost 76 000 bed days in hospital. 1 Even these figures do not adequately reflect the substantial healthcare costs of dysphagia. The aim of this review is to summarise the incidence, causes, and risks of dysphagia and to provide a detailed update on investigation and management, including the need for a multidisciplinary approach.
Dysphagia: a growing concern? a personal view
Gastroenterology & Hepatology: Open Access, 2018
The population across the world is ageing. The fastest growing group is that of the >85 years. Many will be frail, have multiple long term conditions and dysphagia. Inevitably this will result in malnutrition, hospital admissions and death. Action needs to be taken to prevent this happening by concerted action from Public Health. Failure to do this will result in a strain on health resources. "Death is caused by swallowing small amounts of saliva over a long period of time".
Dysphagia. Part 1: General issues
Anaesthesiology Intensive Therapy, 2020
Swallowing disorders-such as aphagia, odynophagia and dysphagia are increasingly observed among patients in intensive care units (ICU). Aphagia means inability to swallow, and odynophagia means painful swallowing. Their most common causes are inflammatory or neoplastic lesions in the oropharynx, or the consequences of oncological treatment, e.g. radiotherapy [1-3]. Dysphagia is an abnormality in the swallowing process, i.e. ingestion of food, grinding it, and transporting it from the oral cavity through the oesophagus to the stomach. The severity of the pathology may vary depending on the aetiology. It can be caused by structural anomalies in the upper gastrointestinal (GI) tract or functional disturbances of the nervous and/or muscular systems [3]. Both the diagnosis and treatment of dysphagia require the cooperation of specialists in many fields of medicine. It seems that anaesthesiologists should be included in this group [3]. Dysphagia significantly worsens the patients' quality of life. It results in increased morbidity and mortality, mainly due to a higher risk of aspiration and subsequent aspiration pneumonia, as well as to difficulties in the intake of food and/or fluids by mouth, which leads to malnutrition [1]. Diagnosis and determination of the cause of dysphagia is crucial, and in many cases it offers the opportunity to treat and/or compensate for swallowing problems and thus reduce the risk of complications. The final effect of the therapy, however, is
Dysphagia Research Society Annual Meeting March 2–4, 2017
Dysphagia, 2017
Purpose: Risk of developing aspiration pneumonia increases when dysphagia co-occurs with poor oral hygiene. Oral health screening by SLPs may identify patients who require intervention for oral care. This study examines the accuracy and reliability of SLPs in administering the OHAT following a shorter training duration from a 3-hour training program reported previously (Simpelaere et al., 2016). Method(s): Seventeen SLPs were randomized into training versus. no-training groups. The training group received 1.5 h of training by a qualified dental hygienist. All SLPs rated 25 video-recordings of patients' oral cavities twice using the OHAT, 2 weeks apart, for intrarater reliability. OHAT scores were compared between SLPs and the dental hygienist. Result(s): Seventy five percent of trained SLPs were as accurate as the dental hygienist in screening for specific oral health conditions compared to 56% of the untrained SLPs. Trained SLPs were better (Sensitivity = 92%) than untrained SLPs (Sensitivity = 84%) in identifying patients requiring further dental examination, compared to the dental hygienist. Intra-rater reliability was strong (ICC = 0.77) for trained SLPs but fair (ICC = 0.57) for untrained SLPs. Conclusions (Including Clinical Relevance): Oral health training increases SLPs' accuracy and reliability in screening for suboptimal oral health status and identifying patients for further dental intervention. Longer training duration may further improve accuracy and reliability. By incorporating a structured oral health screening tool in clinical evaluation, SLPs may contribute to improved clinical outcomes for dysphagic patients with co-occurring oral health conditions.
Dysphagia Diagnosis and Treatment: A Multidisciplinary Challenge
Dysphagia, 2014
Introduction: Among head and neck cancer survivors many experience diminished quality of life owing to dysphagia following treatment. The aim of this study was to investigate frequency, intensity and dose-volume dependency for late dysphagia in head and neck cancer patients treated with curative radiotherapy (IMRT). Materials and Methods: Candidates for the study were patients treated with primary IMRT from 2006-2010; a total of 259 patients (88 %) accepted the invitation to participate by answering the EORTC QLQ-C30 and H&N35 questionnaires. A total of 65 patients were further examined with i.a. Modified Barium Swallow (MBS) and saliva samples. Data on patient, tumor and treatment characteristics were obtained from the DAHANCA database including observed-rated dysphagia and DVHs of relevant organs at risk (OAR) were analyzed. Results: Median follow-up after treatment was 3.3 years (range 1.0-5.3), median age 63 years, 85 % men, larynx 37 %, pharynx 52 %, oral cavity 11 %; 57 % stage IV disease; weekly cisplatin 41 %, Zalutumumab 16 %. The QoL data showed low degree of dysphagia with mean scores below 15. The most frequent objective swallowing dysfunction was retention on MBS, occurring in 41 of the 65 patients (63 %). Penetration and aspiration was less common, 31 and 6 %, respectively. In general, complications observed on MBS and observer assessed late dysphagia correlated with the dose to superior and middle PCM, whereas quality of life endpoints correlated with dose-volume parameters in the larynx and supraglottic larynx. Conclusion: In this cohort a high rate of retention was found on MBS whereas aspiration was rare. Objective and subjective swallowing dysfunction cannot be expected to be described using DVH parameters of the same OAR.