Seoyon Yang, Jin-Woo Park, Kyunghoon Min, Yoon Se Lee, Young-Jin Song, Seong Hee Choi, Doo Young Kim, Seung Hak Lee, Hee Seung Yang, Wonjae Cha, Ji Won Kim, Byung-Mo Oh, Han Gil Seo, Min-Wook Kim, Hee-Soon Woo, Sung-Jong Park, Sungju Jee, Ju Sun Oh, Ki Deok Park, Young Ju Jin, Sungjun Han, DooHan Yoo, Bo Hae Kim, Hyun Haeng Lee, Yeo Hyung Kim, Min-Gu Kang, Eun-Jae Chung, Bo Ryun Kim, Tae-Woo Kim, Eun Jae Ko, Young Min Park, Hanaro Park, Min-Su Kim, Jungirl Seok, Sun Im, Sung-Hwa Ko, Seong Hoon Lim, Kee Wook Jung, Tae Hee Lee, Bo Young Hong, Woojeong Kim, Weon-Sun Shin, Young Chan Lee, Sung Joon Park, Jeonghyun Lim, Youngkook Kim, Jung Hwan Lee, Kang-Min Ahn, Jun-Young Paeng, JeongYun Park, Young Ae Song, Kyung Cheon Seo, Chang Hwan Ryu, Jae-Keun Cho, Jee-Ho Lee, Kyoung Hyo Choi
Ann Rehabil Med 2023;47(Suppl 1):S1-S26. Published online July 30, 2023
Objective Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia.
Methods Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology.
Results Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended.
Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.
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Methods Medical records of 78 individuals with CSCIs were retrospectively reviewed. The pulmonary function was evaluated using spirometry and peak flow meter, whereas the swallowing function was assessed using a videofluoroscopic swallowing study. Participants were divided into the non-penetration-aspiration group (score 1 on the Penetration-Aspiration Scale [PAS]) and penetration-aspiration group (scores 2–8 on the PAS). Individuals with pharyngeal residue grade scores >1 were included in the pharyngeal residue group.
Results The mean age was significantly higher in the penetration-aspiration and pharyngeal residue groups. In this study, individuals with clinical features, such as advanced age, history of tracheostomy, anterior surgical approach, and higher neurological level of injury, had significantly more penetration-aspiration or pharyngeal residue. Individuals in the penetration-aspiration group had significantly lower peak cough flow (PCF) levels. Individuals in the pharyngeal residue group had a significantly lower forced expiratory volume in 1 second (FEV1). According to the receiver operating characteristic curve analysis of PCF and FEV1 on the PAS, the cutoff value was 140 L/min and 37.5% of the predicted value, respectively.
Conclusion Low PCF and FEV1 values may predict the risk of dysphagia in individuals with CSCIs. In these individuals, active evaluation of swallowing is recommended to confirm dysphagia.
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