Dysphagia
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Dysphagia may predispose stroke patients toward undernutrition and hydration. These comorbidities increase patient risks for reduced functional outcome and short-term mortality. Despite this impact, available information on relationships among dysphagia, nutrition, and hydration status in acute stroke is limited and conflicted. ⋯ Results of this study support prior results indicating that dysphagia is not associated with poor nutrition status during the first week post stroke. Dehydration status is associated with dysphagia during this period. The results have implications for future confirmatory research and for clinical management of dysphagia in the acute stroke period.
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The aim of this study was to validate the Swedish version of the dysphagia-specific quality-of-life questionnaire, the M. D. Anderson Dysphagia Inventory (MDADI). ⋯ The Swedish version of the MDADI showed good psychometric properties and is a valid instrument to assess dysphagia-related quality of life. It was also shown to be a reliable instrument after correction for systematic errors in the subjects' responses to two reversed questions. Its known-group validity enables the differentiation between dysphagic and nondysphagic patients for group-level research.
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Comparative Study
Readability of patient-reported outcome questionnaires for use with persons with swallowing disorders.
The purposes of this study were to examine the readability of published patient-related outcome (PRO) questionnaires for persons with swallowing problems, and to compare the readability results to existing data about average reading levels of English-speaking adults living in the United States. A search was conducted to identify published PRO questionnaires related to swallowing problems that traditionally are completed by patients in a self-administered format. Reading grade levels were analyzed separately for four different swallowing-related PRO questionnaires using the Flesch Reading Ease, FOG, and FORCAST formulas as computed by a readability calculations software package. ⋯ In the demand for standardization of swallowing-related quality-of-life assessment tools, developers should consider readability as another testable construct, since poor readability may affect validity, reliability, and sensitivity. The swallowing clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or his or her proxy. Developers of PRO questionnaires should consider the reading level of respondents and include information about this when reporting psychometric data.
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In this study we explored the validity of clinician judgments of voice abnormalities as indicators of penetration-aspiration or other swallowing abnormalities. Voice samples were collected using a high-quality microphone from 40 adults during videofluoroscopy (VFSS), at baseline and following each of four thin liquid swallows. Blinded speech-language pathologists (SLPs) rated the audio recordings for voice quality using the GRBAS scale and the VFSS recordings for abnormal swallow onset, penetration-aspiration, airway closure, and pharyngeal residues. ⋯ Overall, perceptual judgments of postswallow wet voice showed the strongest potential for detecting penetration-aspiration (relative risk = 3.24). We conclude that a clear postswallow voice quality provides reasonable evidence that penetration-aspiration and dysphagia are absent. However, observations of abnormal postswallow voice quality can be misleading and are not a valid indication that penetration-aspiration or dysphagia exists.
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The case of a 68-year-old woman with postoperative speech and swallowing problems following a circumferential pharyngolaryngectomy and neopharyngeal reconstruction with a jejunal free flap is presented. The primary tumor was an extended papillary thyroid carcinoma (pT4N0M0). ⋯ Pre- and/ or post-treatment data on speech and swallowing function were gathered using the following assessment methods: esophageal insufflation test, Voice Handicap Index (VHI), videofluoroscopy of phonation (VFSph), digital high-speed endoscopy of jejunal vibration during voice production, fiber-optic endoscopic evaluation of swallowing (FEES), and videofluoroscopy of swallowing (VFSs). This case clearly demonstrates that even after extensive laryngopharyngectomy with jejunal free flap reconstruction, a tailored rehabilitation program can improve both voice and swallowing function, and that these results clearly can be objectified/visualized, underlining the validity of this approach.