Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies. This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with. 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. The present article is an abridged and translated version of the guideline recently published online (
 https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf
 ).

/pdf/diagnosis-and-treatment-of-neurogenic-dysphagia-s1-guideline-1w9qzpq3qb.pdf

Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology.

Dysphagia affects a multitude of people worldwide with tremendous impact on the affected individual, families, and caregivers. Understanding dysphagia, as well as the status of screening, evaluation, and treatment, aids in the knowledge required by a interprofessional team to holistically care for patients with dysphagia and their caregivers. The impact of dysphagia includes potential associated risk and a cascade of effects. Conversations regarding meeting nutrition and fluid needs with consideration for quality of life need to be integrated into the plan of care for individuals with dysphagia.

Dysphagia: Interprofessional Management, Impact, and Patient-Centered Care.

Oropharyngeal dysphagia has features of geriatric syndromes and is strongly associated with sarcopenia. In this cross-sectional study, we aimed to evaluate the association between dysphagia and sarcopenia, in a practical way, accompanied by comprehensive geriatric assessment. Dysphagia and sarcopenia were defined by the EAT-10 and SARC-F questionnaires, respectively. Cognition and mood, was evaluated by the Mini-mental State Examination (MMSE) and Geriatric Depression Scale (GDS), respectively. Physical performance was assessed by the Timed up and Go Test (TUG) and muscle strength was determined by Hand Grip Strength (HGS). Functionality was stated by Katz and Lawton Indexes. Serum levels of hemoglobin, triglyceride, albumin, and total cholesterol were recorded. A total of 512 (151 male/361 female) patients age 60 and older were included in the study. Prevalences of dysphagia and sarcopenia were 23% and 40.6%, respectively. In multivariate analysis sarcopenia (OR:2.596, p = 0.008), depressive symptoms (OR:1.115, p < 0.001), and lower KATZ scores (OR:0.810, p = 0.036) were independently related with dysphagia. Dysphagic patients with sarcopenia had lower scores on the Katz and Lawton scales (p < 0.001, rpb = 0.380 and p < 0.001, rpb = 0.447 respectively) and TUG performances were worse (p = 0.009, rpb = − 0.254). Serum hemoglobin and albumin levels were significantly low in dysphagic patients with sarcopenia (p < 0.001, rpb = 0.345, p = 0.008, rpb = 0.243). Dysphagia is independently associated with sarcopenia, depressive symptoms, and functionality. Dysphagia coexist with sarcopenia is associated with worse clinical consequences than without sarcopenia.

Relationship Between Dysphagia and Sarcopenia with Comprehensive Geriatric Evaluation

Videofluoroscopic swallowing study (VFSS) is currently considered the gold standard to precisely diagnose and quantitatively investigate dysphagia. However, VFSS interpretation is complex and requires consideration of several factors. Therefore, considering the expected impact on dysphagia management, this study aimed to apply deep learning to detect the presence of penetration or aspiration in VFSS of patients with dysphagia automatically.The VFSS data of 190 participants with dysphagia were collected. A total of 10 frame images from one swallowing process were selected (five high-peak images and five low-peak images) for the application of deep learning in a VFSS video of a patient with dysphagia. We applied a convolutional neural network (CNN) for deep learning using the Python programming language. For the classification of VFSS findings (normal swallowing, penetration, and aspiration), the classification was determined in both high-peak and low-peak images. Thereafter, the two classifications determined through high-peak and low-peak images were integrated into a final classification.The area under the curve (AUC) for the validation dataset of the VFSS image for the CNN model was 0.942 for normal findings, 0.878 for penetration, and 1.000 for aspiration. The macro average AUC was 0.940 and micro average AUC was 0.961.This study demonstrated that deep learning algorithms, particularly the CNN, could be applied for detecting the presence of penetration and aspiration in VFSS of patients with dysphagia. 

Deep Learning Analysis to Automatically Detect the Presence of Penetration or Aspiration in Videofluoroscopic Swallowing Study

Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults

Objective
To compare the swallowing characteristics of dysphagic patients with traumatic brain injury (TBI) with those of dysphagic stroke patients.

/pdf/characteristics-of-dysphagia-in-severe-traumatic-brain-14yzqkjg3r.pdf

Characteristics of Dysphagia in Severe Traumatic Brain Injury Patients: A Comparison With Stroke Patients.

OBJECTIVE To investigate the final diagnosis of patients with unexplained dysphagia and the clinical and laboratory findings supporting the diagnosis. METHODS We retrospectively analyzed 143 patients with dysphagia of unclear etiology who underwent a videofluoroscopic swallowing study (VFSS). The medical records were reviewed, and patients with a previous history of diseases that could affect swallowing were categorized into a missed group. The remaining patients were divided into an abnormal or normal VFSS group based on the VFSS findings. The clinical course and final diagnosis of each patient were examined. RESULTS Among the 143 patients, 62 (43%) had a previous history of diseases that could affect swallowing. Of the remaining 81 patients, 58 (72.5%) had normal VFSS findings and 23 (27.5%) had abnormal VFSS findings. A clear cause of dysphagia was not identified in 9 of the 23 patients. In patients in whom a cause was determined, myopathy was the most common cause (n=6), followed by laryngeal neuropathy (n=4) and drug-induced dysphagia (n=3). The mean ages of the patients in the normal and abnormal VFSS groups differed significantly (62.52±15.00 vs. 76.83±10.24 years, respectively; p<0.001 by Student t-test). CONCLUSION Careful history taking and physical examination are the most important approaches for evaluating patients with unexplained swallowing difficulty. Even if VFSS findings are normal in the pharyngeal phase, some patients may need additional examinations. Electrodiagnostic studies and laboratory tests should be considered for patients with abnormal VFSS findings.

/pdf/diagnosis-and-clinical-course-of-unexplained-dysphagia-1npi9yiylp.pdf

Diagnosis and Clinical Course of Unexplained Dysphagia

Objective
To compare optical motion capture system (MoCap), attitude and heading reference system (AHRS) sensor, and Microsoft Kinect for the continuous measurement of cervical range of motion (ROM).

/pdf/validation-of-attitude-and-heading-reference-system-and-43v8nzogtm.pdf

Validation of Attitude and Heading Reference System and Microsoft Kinect for Continuous Measurement of Cervical Range of Motion Compared to the Optical Motion Capture System

Provided is a virtual image display device including: an image generator outputting a virtual image; a filter transmitting light in a first polarization state in the output virtual image; a multipath optical element guiding the transmitted light in the first polarization state; a first optical element arranged on a first side of the multipath optical element and allowing the guided light in the first polarization state and real-world light to pass therethrough; a second optical element arranged on a second side opposite to the first side of the multipath optical element and allowing the real-world light to pass therethrough; and a processor controlling the image generator, the first optical element, and the second optical element.

Method and device for displaying virtual image

The Effect of Balloon Dilatation and/or Botulinum Toxin Injection on the Severe Dysphagic Patients with Cricopharyngeal Dysfunction: Case Series

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