Dysphagia affects the vast majority of acute stroke patients. Although it improves within 2 weeks for most, some face longstanding swallowing problems that place them at risk for pneumonia, malnutrition, dehydration, and significantly affect quality of life. This paper discusses the scope, the disease burden, and the tools available for screening and formal evaluation of dysphagia. The most common and recently developed treatment interventions that might be useful in the treatment of this population are discussed.

/pdf/dysphagia-after-stroke-an-overview-13jv42gryf.pdf

Dysphagia after Stroke: an Overview

Background: Hyperkinetic dysarthria is characterized by abnormal involuntary movements affecting respiratory, phonatory, and articulatory structures impacting speech and deglutition Speech–language pathologists (SLPs) play an important role in the evaluation and management of dysarthria and dysphagia This review describes the standard clinical evaluation and treatment approaches by SLPs for addressing impaired speech and deglutition in specific hyperkinetic dysarthria populations Methods: A literature review was conducted using the data sources of PubMed, Cochrane Library, and Google Scholar Search terms included 1) hyperkinetic dysarthria, essential voice tremor, voice tremor, vocal tremor, spasmodic dysphonia, spastic dysphonia, oromandibular dystonia, Meige syndrome, orofacial, cervical dystonia, dystonia, dyskinesia, chorea, Huntington’s Disease, myoclonus; and evaluation/treatment terms: 2) Speech–Language Pathology, Speech Pathology, Evaluation, Assessment, Dysphagia, Swallowing, Treatment, Management, and diagnosis Results: The standard SLP clinical speech and swallowing evaluation of chorea/Huntington’s disease, myoclonus, focal and segmental dystonia, and essential vocal tremor typically includes 1) case history; 2) examination of the tone, symmetry, and sensorimotor function of the speech structures during non-speech, speech and swallowing relevant activities (ie, cranial nerve assessment); 3) evaluation of speech characteristics; and 4) patient self-report of the impact of their disorder on activities of daily living SLP management of individuals with hyperkinetic dysarthria includes behavioral and compensatory strategies for addressing compromised speech and intelligibility Swallowing disorders are managed based on individual symptoms and the underlying pathophysiology determined during evaluation Discussion: SLPs play an important role in contributing to the differential diagnosis and management of impaired speech and deglutition associated with hyperkinetic disorders

/pdf/speech-language-pathology-evaluation-and-management-of-2qbhmgn0ka.pdf

Speech-Language Pathology Evaluation and Management of Hyperkinetic Disorders Affecting Speech and Swallowing Function.

Cerebral palsy (CP) is a “group of disorders of the development of movement and posture, causing activity limitation, that is attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder.”1 This group of syndromes ranges in severity and is the result of a variety of etiologies occurring in the prenatal, perinatal, or postnatal period. Though the disorder is nonprogressive, the clinical manifestations may change over time as the brain develops, with other neurologic impairments frequently co-occurring.1,2

Interventions for Feeding and Nutrition in Cerebral Palsy

Purpose To associate the degree of biomechanical impairment in the swallowing process with the severity (National Institute of Health Stroke Scale – NIHSS) and type of neurological injury in patients post stroke. Methods A cross-sectional, descriptive study conducted with 42 patients (22 females), aged 65.7 years on average diagnosed with stroke. All patients underwent clinical neurological evaluation and application of the NIHSS in the first 48 hours after stroke. The swallowing function was evaluated using the Functional Oral Intake Scale (FOIS) and the Protocol for the Investigation of Oropharyngeal Dysphagia in Adults. The Fisher’s Exact Probability Test was used to assess the correlation between the degree of swallowing impairment and the severity (NIHSS score) and type of stroke. The study results were statistically analyzed at 5% significance level (p≤0.05). Results 92.9% of the patients presented ischemic stroke; 59.5% presented impairment of the anterior cerebral circulation. Statistically significant correlation was found between the neurological scale (NIHSS) scores and the swallowing impairment scale (p=0.016). Conclusion An association between stroke severity and oropharyngeal dysphagia severity was observed. A high proportion of patients with ischemic stroke with circulation affected in the anterior cerebral region presented severe oropharyngeal dysphagia. No statistically significant correlation was observed between the FOIS scale and stroke severity.

https://www.scielo.br/pdf/codas/v28n6/2317-1782-codas-2317-178220162015139.pdf

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke.

Swallowing disorders, especially dysphagia, might lead to malnutrition and dehydration and could potentially lead to fatal aspiration. Benchmark swallowing assessments, such as videofluoroscopy or endoscopy, are expensive and invasive. Wearable technologies using acoustics and accelerometric sensors could offer opportunities for accessible and home-based long-term assessment. Identifying valid swallow events is the first step before enabling the technology for clinical applications. The objective of this review is to summarize the evidence of using acoustics-based and accelerometric-based wearable technology for swallow detection, in addition to their configurations, modeling, and assessment protocols. Two authors independently searched electronic databases, including PubMed, Web of Science, and CINAHL. Eleven (n = 11) articles were eligible for review. In addition to swallowing events, non-swallowing events were also recognized by dry (saliva) swallowing, reading, yawning, etc., while some attempted to classify the types of swallowed foods. Only about half of the studies reported that the device attained an accuracy level of >90%, while a few studies reported poor performance with an accuracy of <60%. The reviewed articles were at high risk of bias because of the small sample size and imbalanced class size problem. There was high heterogeneity in assessment protocol that calls for standardization for swallowing, dry-swallowing and non-swallowing tasks. There is a need to improve the current wearable technology and the credibility of relevant research for accurate swallowing detection before translating into clinical screening for dysphagia and other swallowing disorders.

/pdf/swallow-detection-with-acoustics-and-accelerometric-based-3rqzyz06.pdf

Swallow Detection with Acoustics and Accelerometric-Based Wearable Technology: A Scoping Review

Clinical non-instrumental evaluation plays an important role in the assessment of the dysphagic patient. This evaluation, called "bedside examination", aims to establish whether dysphagia is present, evaluating severity, determining the alterations which cause it, planning rehabilitation, testing outcome of treatment. The assessment takes into consideration anamnesis regarding the swallowing problem, evaluation of the anatomy and functionality, of sensitivity and the reflexes, of the swallowing apparatus. Finally, the oral feeding test is performed, which evaluates the oral and pharyngeal phases of swallowing. The examination performed in the neurologic patient is different from that performed in the patient submitted to ENT or maxillo-facial surgery.

/pdf/clinical-non-instrumental-evaluation-of-dysphagia-4vfccrrqw7.pdf

Clinical non-instrumental evaluation of dysphagia.

Background
Hearing loss, occurring in 1-3/1,000 newborns in the well-babies population, is one of the most common congenital diseases, and hearing screening at birth still represents the only means for its early detection. Since 2011 the Emilia Romagna Regional Health Agency has recommended Newborn Hearing Screening for all babies at its birth points and for newborns moving to the region. The aims of this study are to analyze the results of this regional-based Newborn Hearing Screening program and to discuss the impact of the legislative endorsement on the organization.


Material and methods
This is an observational retrospective chart study. The recordings of well-babies and babies at Neonatal Intensive Care Units were collected during the period from January 1st 2015 to December 31st 2020. The following data were included: Newborn Hearing Screening coverage, percentage of refer at otoacoustic emissions, prevalence and entity of hearing loss, unilateral/bilateral rate, presence of audiological risk factors.


Results
More than 99% of a total of 198,396 newborns underwent the Newborn Hearing Screening test during the period January 1st 2015 to December 31st 2020, with a coverage ranging between 99.6% and 99.9%. Overall, the percentage of confirmed hearing loss cases was about 17-30 % of refer cases, 745 children received a diagnosis of hearing loss (prevalence 3.7/1,000). Considering profound hearing loss cases, these represent 13% of bilateral hearing loss.


Conclusions
A regional-based Newborn Hearing Screening program is valuable and cost-effective. In our experience, the centralization of the data system and of the data control is crucial in order to implement its efficiency and effectiveness. Healthcare policies, tracking systems and public awareness are decisive for a successful programme implementation.

A regional-based newborn hearing screening program: the Emilia-Romagna model after ten years of legislation.

SUMMARY Clinical non-instrumental evaluation plays an important role in the assessment of the dysphagic patient. This evaluation, called “bedside examination”, aims to establish whether dysphagia is present, evaluating severity, determining the alterations which cause it, planning rehabilitation, testing outcome of treatment. The assessment takes into consideration anamnesis regarding the swallowing problem, evaluation of the anatomy and functionality, of sensitivity and the refl exes, of the swallowing apparatus. Finally, the oral feeding test is performed, which evaluates the oral and pharyngeal phases of swallowing. The examination performed in the neurologic patient is different from that performed in the patient submitted to ENT or maxillo-facial surgery.

Clinical non-instrumental evaluation of dysphagia La valutazione clinica non strumentale della disfagia

AUSL della Romagna, Medical Genetics Unit, Cesena, Azienda OspedalieroUniversitaria di Ferrara, Medical Genetics Unit, Ferrara, AUSL della Romagna ENT Unit, Cesena, Neurosciences Department, Università di Padova, Otorhinolaryngology Unit, Padova, Italy Correspondence to Giulia Parmeggiani, MD, AUSL della Romagna Medical Genetics Unit, 47522 Cesena, Italy Tel: +39 0547 394841; fax: +39 0547 352008; e-mail: giulia.parmeggiani@auslromagna.it

A familial case of NOG-related symphalangism spectrum disorder due to a novel NOG variant

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Clinical non-instrumental evaluation of dysphagia.

A regional-based newborn hearing screening program: the Emilia-Romagna model after ten years of legislation.

Clinical non-instrumental evaluation of dysphagia La valutazione clinica non strumentale della disfagia

A familial case of NOG-related symphalangism spectrum disorder due to a novel NOG variant