Fast Facts: Neurogenic Dysphagia

M. Moerman, K. Kyriakou, A. Sabry

Description

Dysphagia refers to any difficulty or problem with deglutition or bolus movement from the time the bolus is placed in the mouth until the time it enters the stomach. It affects around 16 million individuals in the USA and over 40 million individuals in Europe. Evaluation of dysphagia by a phoniatrician/speech-language pathologist (SLP) may consist of a clinical swallow evaluation and an instrumental assessment, such as a videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic valuation of swallow (FEES). This resource is designed to benefit a broad audience, including phoniatricians, SLPs, trainee SLPs, physicians, nurses, dietitians, and occupational and physical therapists who work with populations who have dysphagia, as well as researchers in the field of swallowing disorders. Table of Contents: • Definition, etiology, epidemiology, symptoms and consequences • Normal swallowing and pathophysiology of dysphagia • Screening and clinical swallowing examination • Instrumental assessment • Management • Recent advances and future directions

Sujets

• Medical
• Médecine
• Neurology

Informations

• Publié par: S. Karger AG
• Date de parution: 06 décembre 2022
• Nombre de lectures: 0
• EAN13: 9783318072167
• Langue: English
• Poids de l'ouvrage: 3 Mo

Extrait

Fast Facts: Neurogenic Dysphagia
First published 2023
Text 2023 Aliaa Sabry, Kyriaki Kyriakou, Mieke Moerman
2023 in this edition S. Karger Publishers Ltd
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ISBN 978-3-318-06934-1
Sabry A (Aliaa)
Fast Facts: Neurogenic Dysphagia/
Aliaa Sabry, Kyriaki Kyriakou, Mieke Moerman
Medical illustrations by Graeme Chambers, Belfast, UK.
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.
List of abbreviations
Introduction
Definition, etiology, epidemiology, symptoms and consequences
Normal swallowing and pathophysiology of dysphagia
Screening and clinical swallowing examination
Instrumental assessment
Management
Recent advances and future directions
Appendices
Useful resources
Index
List of abbreviations
AI: artificial intelligence
ALS: amyotrophic lateral sclerosis
CN: cranial nerve
CNS: central nervous system
CPG: central pattern generator
CSE: clinical swallowing examination
EAT-10: Eating Assessment Tool (ten questions)
FEES: fiberoptic endoscopic evaluation of swallow
HLE: hyolaryngeal excursion
HRCA: high-resolution cervical auscultation
HRM: high-resolution manometry
LES: lower esophageal sphincter
LOC: level of consciousness
LV: laryngeal vestibule
MBSImp: modified barium swallow impairment profile
MS: multiple sclerosis
NA: nucleus ambiguus
NGT: nasogastric feeding tube
NMES: neuromuscular electrical stimulation
NPO: nil per os (nothing by mouth)
NTS: nucleus tractus solitarius
PAS: Penetration-Aspiration Scale
PCR: pharyngeal constriction ratio
PES: pharyngeal electrical stimulation
rTMS: repetitive transcranial magnetic stimulation
SLP: speech-language pathologist
SWAL-QOL: Swallowing Quality of Life (questionnaire)
tDCS: transcranial direct current stimulation
TMS: transcranial magnetic stimulation
UES: upper esophageal sphincter
VFSS: videofluoroscopic swallow study
VP: velopharyngeal port
Introduction
Dysphagia refers to any difficulty or problem with deglutition or bolus movement from the time the bolus is placed in the mouth until the time it enters the stomach. It affects around 16 million individuals in the USA and over 40 million individuals in Europe. Symptoms of dysphagia, which include difficulty feeding and swallowing, coughing and vomiting, may lead to medical complications, including aspiration, dehydration, undernutrition, weight loss, choking and death. Other important consequences are psychological problems, such as social isolation and depression, and economic issues, such as lost days of work and high healthcare costs.
Evaluation of dysphagia by a phoniatrician/speech-language pathologist (SLP) may consist of a clinical swallow evaluation and an instrumental assessment, such as a videofluoroscopic swallow study (VFSS) and fiberoptic endoscopic evaluation of swallow (FEES). Treatment includes food and liquid modifications (for example, texture-modified diets), as well as direct and indirect swallow therapy, which involves the use of various swallowing maneuvers with or without food or liquid, respectively.
This resource is designed to benefit a broad audience, including phoniatricians, SLPs, trainee SLPs, physicians, nurses, dietitians, and occupational and physical therapists who work with populations who have dysphagia, as well as researchers in the field of swallowing disorders. We hope it will increase readers knowledge about dysphagia, resulting in more accurate identification of the condition and prompt referral for specialist care. Ultimately, it is hoped that this will improve the quality of life of individuals with dysphagia and reduce the medical, economic and psychological consequences of the condition.
1 Definition, etiology, epidemiology, symptoms and consequences
Definition of dysphagia
The term swallowing signifies the entire act of deglutition from the placement of food in the mouth until the food arrives in the stomach. 1 Any difficulty or problem with deglutition or bolus movement from the time the bolus is placed in the mouth until the time it enters the stomach is defined as dysphagia. Problems with deglutition may include slow movement, incomplete passage or misdirection of a bolus. 2 Here, we focus on oropharyngeal swallowing problems caused by neurological problems, so the esophageal phase (from the moment the bolus has passed the upper esophageal sphincter [UES]) falls out of the scope of this resource.
Etiology
Neurogenic dysphagia is caused by a neuromuscular disorder. There are numerous possible etiologies of neurogenic dysphagia secondary to damage to the CNS and/or cranial nerves (CNs), and unilateral cortical and subcortical lesions ( Table 1.1 ).

TABLE 1.1
Causes of neurogenic dysphagia
CNS damage Cerebral vascular accident Traumatic brain injury Parkinson s disease Multiple sclerosis Cerebral palsy
Motor neuron disease Amyotrophic lateral sclerosis Postpolio syndrome
Neuromuscular disease Muscular dystrophy Myasthenia gravis
Epidemiology
Prevalence . Dysphagia, particularly oropharyngeal dysphagia, affects around 16 million individuals in the USA and over 40 million individuals in Europe. 3 In 2014, a US national health interview survey reported that 9.44 million (1 in 25; 4%) adults had a swallowing problem. 4 In a 2020 population-based survey of more than 31 000 adults in the USA, 1 in 6 participants (16.1%) reported experiencing dysphagia. 5
Incidence of neurogenic dysphagia varies widely depending on its etiology and method of diagnosis. For example, a systematic review of 33 studies reported the incidence of dysphagia in patients with stroke, Parkinson s disease and traumatic brain injury to be 8.1-80%, 11-81% and 27-30%, respectively. 6 In patients with strokes, the incidence of dysphagia was found to be 51-55% with clinical testing and 64-78% with instrumental testing. 7 In patients with multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and cervical dystonia, the incidence of dysphagia was reported to be 24-34%, 86% and 2-36%, respectively. 8
Symptoms
Symptoms of dysphagia are shown in Table 1.2 .
Consequences
Dysphagia may lead to medical, psychological and economic consequences.
Medical consequences
Aspiration occurs when materials (for example, food, liquids, pills or secretions) descend below the vocal cords and enter the trachea; 10 it is one of the main complications of dysphagia. Intense or chronic aspiration of swallowed material or material that regurgitates from the stomach into the airway can result in aspiration pneumonia: 55.2% of patients diagnosed with oropharyngeal dysphagia and aspiration have been shown to also have pneumonia. 11
Dehydration is a situation in which there is not enough water in the body to maintain a normal level of liquids in the body tissues. 10 Patients with dysphagia who need to be on thickened liquids but do not like to drink them may become dehydrated. In one study, 53% of patients with dysphagia secondary to a stroke demonstrated evidence of dehydration. 12

TABLE 1.2
Symptoms of dysphagia Difficulty feeding and swallowing Failure to maintain fluids and food inside the mouth Food residue in the mouth after meals Coughing Difficulty breathing Vomiting Changes in voice quality (e.g. wetness, hoarseness, wheezing) A feeling of food backing up or getting stuck in the throat Heartburn Odynophagia (pain when swallowing) Dehydration Malnutrition Unexplained fever Frequent respiratory infections
Adapted from ledzik and Szlendak 2020. 9
Undernutrition and weight loss. Undernutrition occurs when the body does not receive adequate quantities of nutrients. 10 It may occur in patients who are unable to swallow safely or who are unwilling or afraid to eat or drink because of previous swallowing problems. This can affect the patient s energy levels and compromise their immune system. 13 In one study, 17% of nursing home residents with oropharyngeal dysphagia were malnourished compared with residents without oropharyngeal dysphagia. 14
Weight loss may occur when the individual does not eat or eats less because of swallowing difficulties. Extensive weight loss may result in a loss of muscle mass, which can lead to significant weakness that may affect daily activities. 10
Choking occurs when a solid bolus physically blocks the airway. 13 It may stop the individual from breathing properly and can be life threatening.
Death may occur as a result of choking, dehydration, undernutrition and/or aspiration pneumonia. Mortality has been shown to increase in patients with oropharyngeal dysphagia compared with individuals without the condition 30 days (22.9% vs 8.3%) and 1 year (55.4% vs 26.7%) after they are diagnosed with