Advertisement

The Intensive Dysphagia Rehabilitation Approach Applied to Patients With Neurogenic Dysphagia: A Case Series Design Study

Published:December 19, 2015DOI:https://doi.org/10.1016/j.apmr.2015.11.019

      Abstract

      Objective

      To examine the effects of the Intensive Dysphagia Rehabilitation approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia.

      Design

      Intervention study; before-after trial with 4-week follow-up through an online survey.

      Setting

      Outpatient university clinics.

      Participants

      A consecutive sample of subjects (N=10) recruited from outpatient university clinics. All subjects were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subjects withdrew from the study.

      Interventions

      Participants completed the 4-week Intensive Dysphagia Rehabilitation protocol, including 2 oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice per week and home practice for approximately 45min/d.

      Main Outcome Measures

      Outcome measures assessed pre- and posttreatment included airway safety using an 8-point Penetration Aspiration Scale, lingual isometric pressures, self-reported swallowing-related quality of life (QOL), and level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey).

      Results

      The Intensive Dysphagia Rehabilitation approach was effective in improving maximum and mean Penetration Aspiration Scale scores (P<.05, η2=.8146 and P<.05, η2=.799708, respectively) and level of oral intake (P<.005, Cohen d=−1.387). Of the 5 patients who were feeding tube dependent initially, 2 progressed to total oral nutrition, and 2 progressed to partial oral nutrition. One patient remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% confidence interval, 6.38–14.5; P<.00), but not at the posttreatment. No adverse effects were observed/reported.

      Conclusions

      The Intensive Dysphagia Rehabilitation approach was safe and improved physiological and some functional swallowing outcomes in our sample; however, further investigation is needed before it can be widely applied.

      Keywords

      List of abbreviations:

      ASHA (American Speech-Language-Hearing Association), EAT-10 (10-item Eating Assessment Tool), FEES (fiberoptic endoscopic evaluation of swallowing), NOMS (National Outcomes Measurement System), NPO (nothing by mouth), PAS (Penetration Aspiration Scale), QOL (quality of life)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Colodny N.
        Dysphagic independent feeders’ justifications for noncompliance with recommendations by a speech-language pathologist.
        Am J Speech Lang Pathol. 2005; 14: 61-70
        • Macqueen C.E.
        • Taubert S.
        • Cotter D.
        • Stevens S.
        • Frost G.S.
        Which commercial thickening agent do patients prefer?.
        Dysphagia. 2003; 18: 46-52
        • Carnaby-Mann G.D.
        • Crary M.A.
        McNeill Dysphagia Therapy Program: a case-control study.
        Arch Phys Med Rehabil. 2010; 91: 743-749
        • Clark H.
        • Shelton N.
        Training effects of the effortful swallow under three exercise conditions.
        Dysphagia. 2014; 29: 553-563
        • Crary M.A.
        • Carnaby G.D.
        • Lagorio L.A.
        • Carvajal P.J.
        Functional and physiological outcomes from an exercise-based dysphagia therapy: a pilot investigation of the mcneill dysphagia therapy program.
        Arch Phys Med Rehabil. 2012; 93: 1173-1178
        • Lazarus C.L.
        • Logemann J.A.
        • Huang C.F.
        • Rademaker A.W.
        Effects of two types of tongue strengthening exercises in young normals.
        Folia Phoniatr Logop. 2003; 55: 199-205
        • Logemann J.A.
        • Rademaker A.
        • Pauloski B.R.
        • et al.
        A randomized study comparing the Shaker exercise with traditional therapy: a preliminary study.
        Dysphagia. 2009; 24: 403-411
        • Malandraki G.A.
        • Kaufman A.
        • Hind J.
        • et al.
        The effects of lingual intervention in a patient with inclusion body myositis and Sjogren’s syndrome: a longitudinal case study.
        Arch Phys Med Rehabil. 2012; 93: 1469-1475
        • McCullough G.H.
        • Kamarunas E.
        • Mann G.C.
        • Schmidley J.W.
        • Robbins J.A.
        • Crary M.A.
        Effects of Mendelsohn maneuver on measures of swallowing duration post stroke.
        Top Stroke Rehabil. 2012; 19: 234-243
        • Robbins J.
        • Gangnon R.E.
        • Theis S.M.
        • Kays S.A.
        • Hewitt A.L.
        • Hind J.A.
        The effects of lingual exercise on swallowing in older adults.
        J Am Geriatr Soc. 2005; 53: 1483-1489
        • Robbins J.
        • Kays S.A.
        • Gangnon R.E.
        • et al.
        The effects of lingual exercise in stroke patients with dysphagia.
        Arch Phys Med Rehabil. 2007; 88: 150-158
        • Kleim J.A.
        • Jones T.A.
        Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage.
        J Speech Lang Hear Res. 2008; 51: S225-S239
        • Robbins J.
        • Butler S.G.
        • Daniels S.K.
        • et al.
        Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence.
        J Speech Lang Hear Res. 2008; 51: S276-S300
        • Rogus-Pulia N.
        • Robbins J.
        Approaches to the rehabilitation of dysphagia in acute poststroke patients.
        Semin Speech Lang. 2013; 34: 154-169
        • Carnaby G.D.
        • Harenberg L.
        What is “usual care” in dysphagia rehabilitation: a survey of usa dysphagia practice patterns.
        Dysphagia. 2013; 28: 567-574
        • Rosenbek J.C.
        • Robbins J.A.
        • Roecker E.B.
        • Coyle J.L.
        • Wood J.L.
        A penetration-aspiration scale.
        Dysphagia. 1996; 11: 93-98
        • American Speech-Language-Hearing Association
        National Outcomes Measurement System (NOMS): adult speech-language pathology user’s guide.
        American Speech-Language-Hearing Association, Rockville2003
        • Belafsky P.C.
        • Mouadeb D.A.
        • Rees C.J.
        • et al.
        Validity and reliability of the Eating Assessment Tool (EAT-10).
        Ann Otol Rhinol Laryngol. 2008; 117: 919-924
        • Butler S.
        • Markley L.
        • Sanders B.
        • Stuart A.
        Reliability of the penetration aspiration scale with flexible endoscopic evaluation of swallowing.
        Ann Otol Rhinol Laryngol. 2015; 124: 480-483
        • Garber C.E.
        • Blissmer B.
        • Deschenes M.R.
        • et al.
        Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
        Med Sci Sports Exerc. 2011; 43: 1334-1359
        • Burkhead L.M.
        • Sapienza C.M.
        • Rosenbek J.C.
        Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research.
        Dysphagia. 2007; 22: 251-265
        • Kisner C.
        • Colby L.
        Therapeutic exercise, foundations and techniques.
        Jaypee Brothers, New Delhi1996
        • Schmidt R.A.
        • Lee T.D.
        Motor control and learning: a behavioral emphasis.
        Human Kinetics, Champaign2005
        • Langmore S.E.
        • Terpenning M.S.
        • Schork A.
        • et al.
        Predictors of aspiration pneumonia: how important is dysphagia?.
        Dysphagia. 1998; 13: 69-81
        • Collins L.M.
        • Murphy S.A.
        • Strecher V.
        The Multiphase Optimization Strategy (MOST) and the Sequential Multiple Assignment Randomized Trial (SMART). New methods for more potent eHealth interventions.
        Am J Prev Med. 2007; 32: S112-S118