Dysphagia
-
Dysphagia is common after stroke. Neuromuscular electrical stimulation (NMES) and fiberoptic endoscopic evaluation of swallowing (FEES) for the treatment of dysphagia have gained in popularity, but the combined application of these promising modalities has rarely been studied. We aimed to evaluate whether combined NMES, FEES, and traditional swallowing rehabilitation can improve swallowing functions in stroke patients with moderate to severe dysphagia. ⋯ This preliminary case series demonstrated that combined NMES, FEES, and traditional swallowing rehabilitation showed promise for improving swallowing functions in stroke patients with moderate-to-severe dysphagia. The benefits were maintained for up to 2 years. The results are promising enough to justify further studies.
-
The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. ⋯ No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.
-
The scope of dysphagia rehabilitation has been expanding. Therapeutic approaches have begun to move away from the use of behavioral compensations and maneuvers only, toward a greater emphasis on research-supported exercise-based therapies. Given the change in focus and demand for evidence-based practice, this study surveyed licensed speech language pathologists who treat dysphagic adults to ascertain the utilization of exercise-based techniques and supportive research in treatment decision-making. ⋯ The concept of "usual care practice" for dysphagia is not supported. Utilization of research-supported assessment techniques and exercise-based approaches was also sparse. These data clearly highlight ongoing challenges to professional education and growth in the area of dysphagia management.