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A digital correlation of the hyoid bone (black arrow), larynx (black arrowhead), epiglottis (black dotted line with white arrow), with the control frame for the x- and y-axes. The zero point was defined as the anterior–inferior margin of the fourth cervical vertebral body, the y-axis as the straight line connecting the zero point with the anterior–inferior margin of the second cervical vertebral body, and the x-axis as the line perpendicular to the y-axis. Coins were used as the scale for length
Source publication
The purpose of this study was to compare the swallowing function and kinematics in stroke patients with and without tracheostomies. In this retrospective matched case–control study, we compared stroke patients with (TRACH group, n = 24) and without (NO-TRACH group, n = 24) tracheostomies. Patients were matched for age, sex, and stroke-type. Swallow...
Citations
... Tracheostomy tube insertion can be done surgically or using percutaneous technique such as described by Ciagila [3,4]. Due to the large and quite recent adoption of the percutaneous technique allowing tracheostomy placement in the ICU [5][6][7], the amount of tracheostomized ABI patients is expected to increase. However, despite its numerous advantages in the ICU, tracheostomy itself may exacerbate dysphagia due to mechanical effects (e.g. ...
Concurrently to the recent development of percutaneous tracheostomy techniques in the intensive care unit (ICU), the amount of tracheostomized brain-injured patients has increased. Despites its advantages, tracheostomy may represent an obstacle to their orientation towards conventional hospitalization or rehabilitation services. To date, there is no recommendation for tracheostomy weaning outside of the ICU. We created a pluridisciplinary tracheostomy weaning protocol relying on standardized criteria but adapted to each patient’s characteristics and that does not require instrumental assessment. It was tested in a prospective, single-centre, non-randomized cohort study. Inclusion criteria were age > 18 years, hospitalized for an acquired brain injury (ABI), tracheostomized during an ICU stay, and weaned from mechanical ventilation. The exclusion criterion was severe malnutrition. Decannulation failure was defined as recannulation within 96 h after decannulation. Thirty tracheostomized ABI patients from our neurosurgery department were successively and exhaustively included after ICU discharge. Twenty-six patients were decannulated (decannulation rate, 90%). None of them were recannulated (success rate, 100%). Two patients never reached the decannulation stage. Two patients died during the procedure. Mean tracheostomy weaning duration (inclusion to decannulation) was 7.6 (standard deviation [SD]: 4.6) days and mean total tracheostomy time (insertion to decannulation) was 42.5 (SD: 24.8) days. Our results demonstrate that our protocol might be able to determine without instrumental assessment which patient can be successfully decannulated. Therefore, it may be used safely outside ICU or a specialized unit. Moreover, our tracheostomy weaning duration is very short as compared to the current literature.
... Regardless of what precipitated the need for tracheostomy tube placement, its presence can impact swallowing biomechanics, adversely affecting bolus transit and increasing the risk of airway compromise. Tracheostomy may reduce hyolaryngeal movement particularly when the cuff is inflated (Amathieu et al., 2012), restrict upper esophageal sphincter opening, and complicate sensory integration for swallow execution, thus increasing residue and aspiration risk (Ceriana et al., 2015;Seo et al., 2017;Skoretz, Riopelle, et al., 2020). In addition, the presence of a tracheostomy tube often changes subglottic pressures during swallowing, altering the swallowing sequence and increasing pharyngeal residue (Gross, Mahlmann, et al., 2003). ...
... Hasegawa et al., 2012;Hazard et al., 2020;Hur et al., 2020;Kaushal et al., 2021;Koppurapu et al., 2021;Kwak et al., 2021;Ledl & Ullrich, 2017;Logemann et al., 1998;Matsuo & Palmer, 2013;McGrath et al., 2020;Ohmae et al., 2006;Oliver et al., 2020;T. Park et al., 2010;Postma et al., 2007;Scheel et al., 2016;Schultz et al., 2020;Seo et al., 2017;Shinn et al., 2019;Skoretz et al., 2014;Skoretz, Anger, et al., 2020;Skoretz, Riopelle, et al., 2020;Stam et al., 2020;Su et al., 2015;Turcotte et al., 2018;Vergara, Lirani-Silva, et al., 2021;Vergara, Starmer, et al., 2021;Wang et al., 2020;Youmans & Stierwalt, 2006;Youmans et al., 2009. ...
Purpose
Swallowing impairments (dysphagia) following severe COVID-19 are complex, as is recovery from the disease itself. Like other critical illnesses, dysphagia management requires multidisciplinary involvement owing to the interaction between numerous physiological systems. Our objectives are to (a) propose a literature-based network medicine framework highlighting multisystem considerations for dysphagia management following critical illness including COVID-19 and (b) discuss clinician innovation and the evolution of dysphagia practice during a global pandemic.
Method
A literature search identified current and relevant studies in areas pertinent to speech-language pathologists caring for patients with COVID-19. Our tutorial presents a network medicine framework of critical illness dysphagia and its “phenotypic” presentation with application to COVID-19. We also consider the individual and collective burden of the illness and global pandemic.
Results
Iatrogenic and complex pathophysiologies likely contribute to dysphagia during critical illness. Upper aerodigestive tract functions, specifically swallowing, rely upon multiple systems for safe execution. Critical illness comorbidities, particularly respiratory challenges and supportive ventilation, are features of COVID-19 often exacerbating dysphagia risk. Throughout the pandemic, increased demands on and reallocation of resources have led to clinical adaptations across settings and placed significant burden on those who deliver care.
Conclusions
Care provision for patients with COVID-19 relies on dynamic knowledge about disease mechanisms and effective interventions. Dysphagia management should employ a multidisciplinary and multisystem approach. Together, clinicians and health care systems should endeavor to proactively establish robust infrastructure and appropriate funding streams to optimize outcomes when considering the cumulative impacts of COVID-19.
... Samples sizes of patients with tracheostomy ranged from 10 [20,36,56] to 3320 [69], with a mean of 112 (SD = 399) and median of 28 (IQR = 45). Patient diagnoses included: burns [24,70,71], cardiothoracic surgery [12,17,20,33,72,73], multiple medical conditions [13, 14, 18, 21-23, 25, 27, 28, 30, 34, 37-42, 44-47, 49, 50, 52-55, 57, 59, 62, 63, 68, 69, 74-81], neurological diagnoses [15,29,32,35,36,43,48,51,56,58,60,61,[64][65][66][67][82][83][84], and respiratory conditions [16]. In some cases, the diagnoses were unknown [19,26,31,85]. ...
Critically ill patients who require a tracheostomy often have dysphagia. Widespread practice guidelines have yet to be developed regarding the acute assessment and management of dysphagia in patients with tracheostomy. In order for clinicians to base their practice on the best available evidence, they must first assess the applicable literature and determine its quality. To inform guideline development, our objective was to assess literature quality concerning swallowing following tracheostomy in acute stages of critical illness in adults. Our systematic literature search (published previously) included eight databases, nine gray literature repositories and citation chasing. Using inclusion criteria determined a priori, two reviewers, blinded to each other, conducted an eligibility review of identified citations. Patients with chronic tracheostomy and etiologies including head and/or neck cancer diagnoses were excluded. Four teams of two reviewers each, blinded to each other, assessed quality of included studies using a modified Cochrane Risk of Bias tool (RoB). Disagreements were resolved by consensus. Data were summarized descriptively according to study design and RoB domain. Of 6,396 identified citations, 74 studies met our inclusion criteria. Of those, 71 were observational and three were randomized controlled trials. Across all studies, the majority (> 75%) had low bias risk with: participant blinding, outcome reporting, and operationally defined outcomes. Areas requiring improvement included assessor and study personnel blinding. Prior to translating the literature into practice guidelines, we recommend attention to study quality limitations and its potential impact on study outcomes. For future work, we suggest an iterative approach to knowledge translation.
... The Functional Oral Intake Scale (FOIS) (1,7), is a commonly used assessment tool for categorizing and documenting clinical changes in oral intake of food and liquids in patients with ABI; with level 1 − 3 relating to varying degrees of tube feeding and level 4-7 relating to varying degrees of oral feeding without feeding tube supplements (7). Apart from its original purpose, the FOIS has also frequently been applied as a proxy to categorize dysphagia/swallowing function (2,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Some studies report that FOIS ratings are based on conclusion from clinical and instrumental assessments of swallowing (8)(9)(10)17), which may be the justification for applying the FOIS as a proxy for dysphagia. ...
... Apart from its original purpose, the FOIS has also frequently been applied as a proxy to categorize dysphagia/swallowing function (2,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Some studies report that FOIS ratings are based on conclusion from clinical and instrumental assessments of swallowing (8)(9)(10)17), which may be the justification for applying the FOIS as a proxy for dysphagia. In support of this application of the FOIS, other studies in patients with stroke have found associations between the FOIS and clinical and instrumental assessments of dysphagia (7,(18)(19)(20), while two other studies in patients with neurological illness and head and neck cancer have not found this association (21,22). ...
Objective
To investigate the construct validity of the Functional Oral Intake Scale (FOIS) as a proxy measure for dysphagia, through associations with swallowing prerequisites, orofacial functions, age, and diagnosis; and to investigate content validity through distributions of FOIS ratings.
Methods
A cohort of 1,876 patients with severe acquired brain injury. Early Functional Abilities items were applied as measures of swallowing prerequisites and orofacial functions. Clustered logistic regression model with 6,052 cross-sectional observations.
Results
Disturbance in swallowing 10.55 OR (95%CI:7.90;14.09), oro-facial stimulation 3.04 OR (95%CI:2.41;3.83), and head control 2.86 OR (95%CI:2.25;3.62) were robustly associated with tube feeding (FOIS 1–3). Disturbance in trunk control, wakefulness, tongue movement/chewing, older age, and a non-stroke diagnosis were also associated with tube feeding. BMI did not attenuate associations in sensitivity analyses. FOIS ratings had greatest density in FOIS level 1 and level 7, with 25% and 40% of registrations, respectively. Level 4 was rated in only 1% of 6,052 registrations.
Conclusions
The FOIS was robustly associated with indicators of dysphagia. However, associations with postural control, wakefulness, age and diagnosis highlights that tube feeding may be attributed to other issues than dysphagia. It should be further investigated whether FOIS level 4 is meaningful in neurorehabilitation.
... In adults with stroke, it was reported that patients with tracheostomies had inferior swallowing function and kinematics compared to those without tracheostomies (14). In children with tracheostomies, it was reported that the time required to close the laryngeal vestibule once the arytenoids initiate anterior movement was longer than in those with no tracheostomy (15). ...
It has been suggested that oral feeding trial has therapeutic implications for improving oral-motor and swallowing function in infants and young children fed via an enteral tube or gastrostomy. This study aimed to investigate whether oral feeding challenges in children with tracheostomy could improve feeding outcomes, even with the finding of aspiration compared to those who did not receive oral feeding at all. Children (age <7 years) with tracheostomy who had thin fluid aspiration on videofluoroscopic swallowing study (VFSS) were included in this retrospective study. Enrolled children were then divided into two feeding method groups according to the physician's decision at the time of VFSS: oral feeding (OF) group and non-oral feeding (NOF) group. Data were obtained from 47 children (median age: 49.75 months, interquartile range [IQR]: 24.08–79.42). The incidence of pneumonia within 1 year after the VFSS was not different between NOF (n = 17) and OF (n = 30) groups. In OF group, 11 subjects achieved full oral feeding and 16 subjects were in partial oral feeding status 1 year after the VFSS. On the contrary, only one subject achieved full oral feeding and 5 subjects were in partial oral feeding status in NOF group (p < 0.001). Initial and follow-up penetration-aspiration scale on VFSS were different only in the OF group (p = 0.003). These results suggest that oral feeding challenges might be attempted even with the findings of aspiration in infants or young children with tracheostomy.
... encontraron. Aquellos sujetos que requieran una TQT, tienen un resultado funcional más deficiente al tragar y esta condición altera los movimientos laríngeos durante la deglución (39) . En el presente estudio solo 3 sujetos presentaron estas 2 variables al mismo tiempo. ...
Introducción: El accidente cerebrovascular (ACV) representa el 87% de todas las muertes en países de bajos y medianos ingresos como Argentina. Los estudios epidemiológicos en este país, en sujetos con ACV, son escasos.
Objetivo: Describir las características clínicas, demográficas y de la recuperación motora de los sujetos internados con secuela de ACV a su ingreso al Hospital de Rehabilitación Manuel Rocca (HRMR) durante el año 2018.
Método: El diseño fue descriptivo, retrospectivo. Las variables clínico demográficas fueron extraídas de las hojas de ingreso de las historias clínicas.
Resultados: La muestra final se compuso de 38 sujetos. Las mujeres representaron el 42,1% de la muestra, con una mediana de edad 56 años (rango intercuartílico-RIQ-48,5-78,5). El ACV isquémico representó el 78,9% de la muestra, de los cuales el 65,8% tenían un compromiso de la circulación anterior. Con una media al ingreso de 49,08 puntos (desvío estándar 19,47) en la escala Functional Independence Measure (FIM) y una mediana de 66,5 días (RIQ 34-129,25) a la fecha de ingreso de ocurrido el evento.
Conclusión: El presente estudio permite las características clínicas, demográficas y de la recuperación motora de los sujetos internados con secuela de ACV a su ingreso al HRMR durante el año 2018.
Palabras claves: accidente cerebrovascular, terapia física, Argentina, estudio epidemiológico, estudio retrospectivo
... Digital motion data were transformed into actual diameters using the distance from the reference metal ball. On the VFSS Maximum movement of the hyoid bone was defined as the distance between the highest and lowest points that the bone reached during swallowing [11]. We calculated the velocity of the hyoid bone movement using the distance between two adjacent time points (1/30 s) throughout the swallowing cycle. ...
Objective
This study aimed to evaluate swallowing function in advanced tongue cancer patients before and after bilateral neck dissection following superselective intra-arterial chemoradiotherapy (CRT).
Methods
A videofluoroscopic swallowing study (VFSS) was used to evaluate swallowing function in 10 patients with advanced tongue cancer before and after bilateral neck dissection.
Results
Laryngeal penetration increased in the postoperative VFSS. Temporal analysis comparing two time points revealed that, after surgery, oral transit time increased significantly, but there was no difference in pharyngeal delay time or pharyngeal transit time. Spatial analysis revealed significant decreases after surgery in the maximum distance of upper esophageal sphincter (UES) opening, the maximum distance of hyoid bone movement in both the anterior and superior direction, and the maximum velocity of hyoid bone movement.
Conclusions
Laryngeal penetration and aspiration increased as a result of limited hyoid movement and diminished UES opening after bilateral neck dissection following superselective intra-arterial CRT for advanced tongue cancer.
... A tracheostomy is a surgical procedure that forms an airway through an incision in the trachea (Myatt 2015). An estimated 1-3% of patients who have experienced a stroke will require a tracheostomy (Seo et al 2017). While a tracheostomy is reversible, a patient who has experienced a stroke may require one for an extended period of their rehabilitation, and it may ultimately be permanent (Myatt 2015, Seo et al 2017. ...
... An estimated 1-3% of patients who have experienced a stroke will require a tracheostomy (Seo et al 2017). While a tracheostomy is reversible, a patient who has experienced a stroke may require one for an extended period of their rehabilitation, and it may ultimately be permanent (Myatt 2015, Seo et al 2017. Tracheostomies are used either for maintaining airway and breathing during the acute phase of a stroke, or in severe ongoing dysphagia where repeated aspiration significantly affects the patient's rehabilitation (Bösel 2014, Seo et al 2017. ...
... While a tracheostomy is reversible, a patient who has experienced a stroke may require one for an extended period of their rehabilitation, and it may ultimately be permanent (Myatt 2015, Seo et al 2017. Tracheostomies are used either for maintaining airway and breathing during the acute phase of a stroke, or in severe ongoing dysphagia where repeated aspiration significantly affects the patient's rehabilitation (Bösel 2014, Seo et al 2017. ...
Stroke is a leading cause of death and adult disability in the UK. A stroke can have significant negative effects on the lives of patients and their families and carers. While improved stroke management has contributed to a reduction in mortality and improved outcomes following rehabilitation, the incidence of stroke continues to rise in the UK, partly because of the ageing population. Stroke rehabilitation involves a multidisciplinary approach, with nurses performing a central role. This article describes the risk factors and types of stroke, the main areas of stroke rehabilitation and the role of the nurse. It emphasises that providing support to families and carers is a particularly important element of caring for people who have experienced a stroke.
... 29,30 Furthermore, this exercise may also be beneficial to patients with stroke or those with tracheotomy, who have decreased elevation velocity of the hyoid bone during swallowing. 15,40 It is known that among the various motor elements, equilibrium, flexibility, and agility undergo marked decline with advanced age. 41 High-speed muscle training may effectively improve agility. ...
Purpose
This study was aimed to examine the effectiveness of a high-speed jaw-opening exercise, which targets the contraction of fast-twitch muscle fibers, in improving swallowing function.
Subjects and methods
Twenty-one subjects (mean age 74.0±5.7 years) with dysphagia-related symptoms, such as coughing or choking during eating, performed the exercise. None of the included subjects had neurological symptoms or history of surgery that could cause significant dysphagia. All subjects took regular meals, and maintained independent activities of daily life. The exercise schedule consisted of 3 sets of 20 repetitions each of rapid and maximum jaw-opening movement with a 10-second interval between sets. The exercise was performed twice daily for 4 weeks.
Results
Following the intervention, there was a significant increase in the vertical position of the hyoid bone at rest. Furthermore, during swallowing, the elevation of the hyoid bone and the velocity of its movement and esophageal sphincter opening increased significantly while the duration of the hyoid elevation and the pharyngeal transit time reduced significantly.
Conclusions
Our results demonstrated that high-speed jaw-opening exercise resulted in increased elevation velocity of the hyoid bone during swallowing, indicating its role in effectively strengthening the fast-twitch muscle fibers of suprahyoid muscles. Furthermore, since the rest position of the hyoid bone appeared to have improved, this exercise may be especially useful in elderly individuals with a lower position of the hyoid bone at rest and those with decreased elevation of the hyoid bone during swallowing, which are known to be associated with an increased risk of aspiration.
... oral transit time, pharyngeal transit time) or kinematic parameters from motion analysis to overcome the qualitative nature of VFSS and to gain more data to classify the dysphagia, to predict the prognosis or to assess the treatment effect [5][6][7][8]. The hyoid bone is most commonly selected in kinematic analysis [9][10][11][12][13]. Both displacement and velocity of the hyoid bone excursion are associated with swallowing function and dysphagia; the maximum excursion and peak velocity of the hyoid bone motion are associated with bolus volume [14], the hyoid bone anterior displacement is reduced in patients with myopathy and irradiated nasopharyngeal carcinoma [5,15] and laryngeal elevation velocity was an independent predictor of aspiration in patients with acute ischemic stroke [16]. ...
Motion analysis of the hyoid bone via videofluoroscopic study has been used in clinical research, but the classical manual tracking method is generally labor intensive and time consuming. Although some automatic tracking methods have been developed, masked points could not be tracked and smoothing and segmentation, which are necessary for functional motion analysis prior to registration, were not provided by the previous software. We developed software to track the hyoid bone motion semi-automatically. It works even in the situation where the hyoid bone is masked by the mandible and has been validated in dysphagia patients with stroke. In addition, we added the function of semi-automatic smoothing and segmentation. A total of 30 patients' data were used to develop the software, and data collected from 17 patients were used for validation, of which the trajectories of 8 patients were partly masked. Pearson correlation coefficients between the manual and automatic tracking are high and statistically significant (0.942 to 0.991, P-value
