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
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Article Info
Publication History
Published online: December 19, 2015
Footnotes
Current affiliation for Ivey, Department of Otolaryngology, Icahn School of Medicine, Mount Sinai, New York, NY.
Partially supported by Teachers College, Columbia University and a seed grant from Purdue University.
Disclosures: G.A.M. developed the Intensive Dysphagia Rehabilitation approach. The other authors have nothing to disclose.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
