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.
Purpose: To create a crosswalk between the Functional Independence Measure (FIM) motor items and the Korean version of the Modified Barthel Index (K-MBI). Method: Korean community-dwelling adult patients (n = 276) completed the FIM and K-MBI on the same day in outpatient rehabilitation hospitals. We used a single group design with the Rasch common person equating and conducted a factor analysis of the co-calibrated item pool using the two measures. Rasch analysis was used to investigate the psychometrics of the equated test items in the identified factor structure(s). The correlation between FIM raw scores and converted K-MBI scores was examined. Results: Three measurement constructs were identified: self-care, mobility, involuntary movement. The equated test items in the three constructs demonstrated good person separation reliability (r = 0.94–0.96) and good internal consistency (Cronbach’s alpha =0.93–0.97). The three crosswalks between the FIM raw scores and converted K-MBI scores demonstrated good correlations (r = 0.91–0.93, all p < 0.0001). Conclusions: The Rasch equating method successfully created three crosswalks between the FIM motor items and K-MBI, with the equated test items demonstrating good psychometrics. The crosswalks would address the incomparable scoring systems between the FIM motor items and K-MBI.
Background: Deficiencies in oral motor function and feeding skills are common in children with cerebral palsy (CP). Oral motor therapy is a useful method to improve oral motor function and feeding skills. Oral motor facilitation technique (OMFT) is a newly designed comprehensive oral motor therapy, including postural control, sensory adaptation, breathing control, sensorimotor facilitation, and direct feeding. Methods: This study was performed to identify the effect of OMFT on oral motor function and feeding skills in children with CP. A total of 21 children with CP (3–10 years, GMFCS III–V) participated in 16 weeks (16 sessions) of OMFT. The effects on oral motor function and feeding skills were assessed using the Oral Motor Assessment Scale (OMAS) before the treatment, 8 and 16 weeks after OMFT. Data were analyzed using the Friedman test and post-hoc analysis. Results: Significant improvement was found in oral motor function and feeding skills including mouth closure, lip closure on the utensil, lip closure during deglutition, control of the food during swallowing, mastication, straw suction, and control of liquid during deglutition after OMFT. Mouth closure was the most effective and mastication was the least effective item. Sixteen weeks is more effective than 8 weeks of OMFT. Conclusion: OMFT could be an effective and useful oral motor therapy protocol to improve oral motor function and feeding skills in children with CP.
5 February 2019 in Restorative Neurology and Neuroscience
Background: Cognitive orientation to daily occupational performance (CO-OP) is a task-specific training applied using a cognitive behavioral approach to improve performance in daily activities and to enable the patient to overcome limitations related to them. Objectives: The purpose of this study was to investigate the effects of the CO-OP approach in comparison with task-specific upper extremity training (TUET) on performance related to daily and functional activities in individuals with chronic hemiparetic stroke. Methods: Forty-nine participants diagnosed with stroke for the first time underwent 30 minutes of either the CO-OP approach or TUET 5 days a week for 4 weeks. We evaluated their performance on the box-and-block test (BBT), Canadian occupational performance measure (COPM), and community integration questionnaire (CIQ) and Wolf motor function test-functional score (WMFT-F) before and after the training. Results: Our results show a significantly improvement in the WMFT-F, COPM-P, COPM-S, BBT, and CIQ scores after training in the CO-OP group, but only COPM-S score was significantly improvement after training in TUET group ( p < 0.05). This study also found higher increases in the mean WMFT-F, COPM-P, COPM-S and BBT scores in the CO-OP group than in the TUET group, but CIQ score did not have a significantly higher increase between-group after training. Conclusions: The results of this study suggest that the CO-OP approach resulted in a positive therapeutic effect on self-selected occupational performance and daily and functional activities in individuals with chronic hemiparetic stroke.
The hand plays a crucial role in our daily lives and affects the quality of life. Sensory stimuli can affect the activation of the autonomic nervous system to control body homeostasis and finger motions. This study aimed to determine the optimal thermal and auditory stimuli that affect hand dexterity. The experiment included thirty healthy adults. In the experiment, the thermal stimuli were classified into 20, 30, and 40 °C. The auditory stimuli were classified into fast- and slow-tempo music. Each stimulus was randomly provided for 5 min and hand dexterity was tested with the Groove and Purdue pegboard tests. After each stimulus and test was conducted, a resting time of 20 min was provided before the next stimulus. When the thermal stimulus of 30 °C and auditory stimulus of fast-tempo music was provided, the completion duration of the hand dexterity test was the shortest. Except the thermal stimulus of 20 °C, all thermal and auditory stimuli induced increased hand dexterity, compared to the non-stimulated condition. Among the five categories of thermal and auditory stimuli, the thermal stimulus of 30 °C and auditory stimulus of fast-tempo music were the most effective in improving hand dexterity.