Search Results (76)

Background: Poststroke dysphagia is a common condition that can lead to complications such as aspiration pneumonia and malnutrition, significantly affecting the quality of life. Most patients recover their swallowing function spontaneously, but in others difficulties persist beyond six months. Can we predict this in advance? On the other hand, there have been recent attempts to use machine learning to predict disease prognosis. Therefore, this study aims to investigate whether machine learning can predict the long-term prognosis for poststroke dysphagia using early videofluoroscopic swallowing study (VFSS) data. Methods: Data from VFSSs performed within 1 month of onset and swallowing status at 6 months were collected retrospectively in patients with dysphagia who experienced their first acute stroke at a university hospital. We selected 14 factors (lip closure, bolus formation, mastication, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallow, vallecular residue, laryngeal elevation, pyriform sinus residue, coating of the pharyngeal wall, pharyngeal transit time, and aspiration) from the VFSS data, scored them, and analyzed whether they could predict the long-term prognosis using five machine learning algorithms: Random forest, CatBoost classifier, K-neighbor classifier, Light gradient boosting machine, Extreme gradient boosting. These algorithms were combined through an ensemble method to create the final model. Results: In total, we collected data from 448 patients, of which 70% were used for training and 30% for testing. The final model was evaluated using accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC), resulting in values of 0.98, 0.94, 0.84, 0.88, and 0.99, respectively. Conclusions: Machine learning models using early VFSS data have shown high accuracy and predictive power in predicting the long-term prognosis of patients with poststroke dysphagia, and they are likely to provide useful information for clinicians. Full article

Background/Objectives: Tongue thrust (TT) occurs when abnormal tongue movements cause anterior tongue placement with pressure and contact against or between the teeth, potentially affecting the oral phase of swallowing, impacting eating, breathing and speaking. There is limited literature on the diagnostic and treatment approaches for TT, as well as involvement of health practitioners in its management. This study aims to examine the current knowledge and practices related to TT diagnosis and treatment among health professionals in Australia. Methods: A two-phase explanatory sequential mixed methods approach was adopted, comprising an online survey that collected participants’ demographic information and details on assessment, diagnosis, management, referral practices, and relevant experience and training. Phase one involved 47 health professionals from various disciplines in Australia who completed an online survey in its entirety. Phase two included in-depth interviews with seven speech-language pathologists (SLPs) to gain further insights into their experiences in managing TT. Survey data were analysed descriptively, and interview data was analysed thematically. Results: Most participants diagnosed TT using clinical assessments, such as general observation and oral motor examinations. Treatment approaches commonly included orofacial myofunctional therapy and the use of myofunctional devices. Interviews with SLPs identified four key themes: tongue thrust as a symptom rather than a diagnosis, facilitators to effective treatment, multidisciplinary approaches to management, and training and education gaps in clinical practice. Conclusions: This study provides valuable insights into how TT is identified, assessed, diagnosed, and managed by health professionals in Australia. It highlights the perspectives of SLPs on treatment approaches, as well as their views on the availability and adequacy of training and education in this field. The findings suggest the need for a broader understanding of TT management, emphasising the importance of multidisciplinary collaboration and professional development. These insights are globally relevant, as they stress the shared challenges and the value of international collaboration in improving TT diagnosis and treatment practices. Full article

The Inverted Swallow (IS) is a rare isometric upper-body skill in artistic gymnastics. Athletes use Preconditioning Strengthening Exercises (PSEs) to develop the strength necessary to hold the IS at competition rings. However, the specific muscle excitation and synergies typical of the IS and its PSEs remain unexplored. Thus, this study analyzed muscle excitations and synergies during the IS and its five common PSEs. Muscle excitation was recorded from the pectoralis major, latissimus dorsi, triceps brachii, infraspinatus, trapezius, serratus anterior, biceps brachii and posterior deltoid muscles in six elite calisthenics athletes (age: 24.5 ± 3.0 years; height: 168.6 ± 5.8 cm; body mass: 65.0 ± 4.7 kg). Non-Negative Matrix Factorization was used to extract synergies. The results showed a predominant role of the posterior deltoid and triceps brachii during the IS. Significant differences were observed in the muscle excitation of the triceps brachii between the IS and its PSEs (p ≤ 0.001; W = 0.765), and in the posterior deltoid (p = 0.002; W = 0.629). Muscle synergy patterns also differed in simultaneous muscle activation between the IS and its PSEs. These findings provide the first detailed evidence of the characteristics of the IS element, providing insights for optimizing strength training and gymnastics performance. Full article

Ankyloglossia causes impairment of normal tongue motility and disrupts the average balance of the muscle forces that form the orofacial complex. Inadequate swallowing from birth can cause long-term anatomical and functional consequences in adult life. Using the video presented herein, we describe the current knowledge about the long-term implications of ankyloglossia. After a literature review of the Medline, Google Scholar, and Embase databases on the relations between ankyloglossia and sleep-disordered breathing, we designed and created a three-dimensional (3D) video using Adobe After Effects based on the anatomical and functional changes produced by repeated deglutition, with and without ankyloglossia, from childhood to adulthood. The animated video (Blender 3D, Amsterdam, The Netherlands, 2024) presented herein was based on the most recent literature review of dentition, breathing, posture, and abnormal swallowing, emphasizing the importance of the potential consequences of sleep-disordered breathing. The resulting animated 3D video includes dynamic sequences of a growing child, demonstrating the anatomy and physiology of deglutition with and without ankyloglossia, and its potential consequences for the surrounding structures during growth due to untreated ankyloglossia. This visual instructional video regarding the impacts of ankyloglossia on deglutition/swallowing may help motivate early childhood diagnosis and treatment of ankyloglossia. This instrument addresses the main myofunctional aspects of normal deglutition based on the importance of free tongue motion and can be used by students or professionals training in myofunctional disorders. Full article

Background: Dysphagia is a common complication in myopathy, significantly impacting patients’ quality of life (QoL) and overall health. Caregivers play a critical role in identifying and addressing swallowing difficulties in this population. The main purpose of this study was to assess the knowledge and experiences of professional caregivers of patients with myopathy regarding the recognition and management of dysphagia in Cyprus. Methods: The study was designed as an anonymous, cross-sectional descriptive survey and involved 10 professional caregivers of patients with myopathy in Cyprus. Results: The most common dysphagia symptoms reported in myopathy patients were coughing, chewing difficulties, choking on fluids, and challenges with swallowing boluses. Only one caregiver reported difficulty managing swallowing issues, particularly in cases of reluctance to eat. Approximately 60% had received relevant training, primarily through workplace programs. Overall, caregivers did not perceive dysphagia as a significant burden. Conclusions: Dysphagia is a prevalent phenomenon in myopathy. The study reveals that caregivers of myopathy patients, regardless of their professional backgrounds, face hidden challenges in managing complex neurogenic dysphagia. They often misjudge the severity of the condition and overestimate their own competencies. Providing caregivers of patients with myopathy with targeted education would help them effectively manage swallowing difficulties associated with the condition. Encouragingly, our study also suggests that focused dysphagia education could reduce caregiver stress and enhance their overall well-being. Future efforts should concentrate on ensuring access to well-trained professionals, establishing specialized clinics, and promoting education to enhance MND-related dysphagia management and patient care. Full article

Speaking and eating are essential components of health management. To enable the daily monitoring of these behaviors, systems capable of simultaneously recognizing speech and eating behaviors are required. However, due to the distinct acoustic and contextual characteristics of these two domains, achieving high-precision integrated recognition remains underexplored. In this study, we propose a method that combines data augmentation through synthetic data creation with a two-stage fine-tuning approach tailored to the complexity of domain adaptation. By concatenating speech and eating sounds of varying lengths and sequences, we generated training data that mimic real-world environments where speech and eating behaviors co-exist. Additionally, efficient model adaptation was achieved through two-stage fine-tuning of the self-supervised learning model. The experimental evaluations demonstrate that the proposed method maintains speech recognition accuracy while achieving high detection performance for eating behaviors, with an F1 score of 0.918 for chewing detection and 0.926 for swallowing detection. These results underscore the potential of using voice recognition technology for daily health monitoring. Full article

Hardness is one of the dominant sensory characteristics of food. This study estimated the effect of sensitivity to hardness on the texture perception and chewing function using 2, 4, and 6% agar gels. Increasing the concentration of agar resulted in an increase in gel hardness and springiness, measured by texture profile analysis. Non-trained participants (n = 95) reported more subjective hardness and springiness during chewing gel samples as the agar concentration increased. Based on the relationship value of the instrumental and sensory data, all participants were divided into low-, medium-, and high-sensitivity groups (n = 25, 44, and 26). Low sensitivity to hardness was associated with low sensitivity to brittleness, springiness, chewiness, moisture, and swallowability. In all three groups, enhanced agar gel hardness increased the temporal chewing characteristics in a similar manner. However, in those with a high hardness sensitivity, the area amplitude of the masseter and temporalis muscles grew to a lesser extent than in those with a low or medium sensitivity. The activity of the suprahyoid muscles increased with the increasing agar gel hardness, regardless of sensitivity. All groups showed a similar salivation and bolus fragmentation while chewing gel. Thus, people’s sensitivity to hardness was associated with different perceptions of the gel’s textural properties and changes in masticatory muscle activity. Full article

Background/Objectives: Age-related dysphagia involves sarcopenia and nervous system changes affecting ingestion. The ACT-ING program, a novel task-based occupational therapy intervention, has been developed to improve strength, endurance, and ingestive skills using real-world eating and drinking tasks for older adults with age-related dysphagia. This narrative review evaluates the outcomes and neuromuscular adaptations of task-based eating and drinking interventions in aging animal models to inform potential refinements of the ACT-ING program and interpret results from an ongoing proof-of-concept study. Methods: Publications were obtained from PubMed, SCOPUS, CINAHL, and EMBASE, and selected following the PRISMA guideline. Thirteen randomized trials investigated a task-based fluid-licking intervention in rats, combining strength, endurance, and skill training. Results: Results suggested benefits in improving muscle strength, endurance, and swallowing skills in terms of quantity and speed. Although neuromuscular adaptations were less conclusive, the intervention appeared to induce cortical plasticity and increase fatigue-resistant muscle fibers in the involved muscles. Conclusions: While these findings are promising, methodological concerns and potential biases were identified. Therefore, further research is necessary to refine the ACT-ING program, including both clinical studies in humans and preclinical studies in aging animal models that clearly define interventions targeting all aspects of ingestion-related skills within a motor learning and strength training framework. Full article

Background/Objectives: Routine postoperative ICU admission following brain tumor surgery may not benefit selected patients. The objective of this study was to develop a risk prediction instrument for early (within 24 h) postoperative adverse events using machine learning techniques. Methods: Retrospective cohort of 1000 consecutive adult patients undergoing elective brain tumor resection. Nine events/interventions (CPR, reintubation, return to OR, mechanical ventilation, vasopressors, impaired consciousness, intracranial hypertension, swallowing disorders, and death) were chosen as target variables. Potential prognostic features (n = 27) from five categories were chosen and a gradient boosting algorithm (XGBoost) was trained and cross-validated in a 5 × 5 fashion. Prognostic performance, potential clinical impact, and relative feature importance were analyzed. Results: Adverse events requiring ICU intervention occurred in 9.2% of cases. Other events not requiring ICU treatment were more frequent (35% of cases). The boosted decision trees yielded a cross-validated ROC-AUC of 0.81 ± 0.02 (mean ± CI95) when using pre- and post-op data. Using only pre-op data (scheduling decisions), ROC-AUC was 0.76 ± 0.02. PR-AUC was 0.38 ± 0.04 and 0.27 ± 0.03 for pre- and post-op data, respectively, compared to a baseline value (random classifier) of 0.092. Targeting a NPV of at least 95% would require ICU admission in just 15% (pre- and post-op data) or 30% (only pre-op data) of cases when using the prediction algorithm. Conclusions: Adoption of a risk prediction instrument based on boosted trees can support decision-makers to optimize ICU resource utilization while maintaining adequate patient safety. This may lead to a relevant reduction in ICU admissions for surveillance purposes. Full article

(1) Background: Swallowing disorders are common following a stroke. This study aims to evaluate the effects of a home-based daily intervention focused on inspiratory and expiratory muscle training on swallowing outcomes in patients with chronic stroke. (2) Methods: This manuscript presents the protocol of a single-blind randomized clinical trial. Patients with chronic stroke will be randomly assigned to either an experimental or a control group. The experimental group will undergo daily home-based respiratory muscle training in addition to standard speech and language therapy, while the control group will receive only the standard intervention. The main outcome measures will include the aspiration risk, the strength of respiratory muscles, and peak cough flow. (3) Results: It is hypothesized that patients receiving home-based respiratory training in addition to standard therapy will achieve significant improvements in aspiration risk, respiratory muscle strength, and cough efficacy in comparison with those included in the control group. The results will be published as a manuscript. (4) Conclusions: This study aims to provide evidence on the effectiveness of home-based respiratory muscle training in enhancing swallowing function and respiratory parameters in patients with chronic stroke. Full article

Tree swallow nest boxes were deployed at sites proximal to two putative aqueous film forming foam (AFFF) sources in the Duluth, MN area, as well as along the St. Louis River and a reference lake for comparative purposes in 2019, 2020 and 2021. The two AFFF sites were the current Duluth Air National Guard Base (ANG) and the Lake Superior College Emergency Response Training Center. Between 13 and 40 per- and polyfluoroalkyl substances (PFAS), depending on year, were detected and quantified in tree swallow egg, nestling carcasses, and stomach contents. Assessments were made of oxidative stress and ethoxyresorufin-O-dealkylase activity in liver tissue, thyroid hormone levels in plasma and thyroid glands, DNA damage in red blood cells, and two measures of immune response (haptoglobin-like activity and immunoglobulin) in plasma of the nestlings. Additionally, other contaminants, such as polychlorinated biphenyls, legacy organochlorine pesticides, and trace elements, were assessed at sites with no previous data. Total egg PFAS concentrations at the ANG site and north of that site were 30–40 times higher than at the reference lake, while nestling PFAS concentrations were 10–15 times higher. In contrast, the St. Louis River sites had slightly, but non-statistically significant, elevated egg and nestling PFAS concentrations relative to the reference lake (2–5 times higher). One PFAS, perfluorohexane sulfonate (PFHxS), was higher, as a proportion of total PFAS, at sites with a known AFFF source compared to the reference lake, as well as compared to sites along the St. Louis River with mainly urban and industrial sources of PFAS. The ratio of total carboxylates to total sulfonates also distinguished between PFAS sources. There were few to no differences in biomarker responses among sites, and no association with PFAS exposure. Full article

Swallowing is a complex neuromuscular activity regulated by the autonomic central nervous system, and impairment can lead to dysphagia, which is difficulty in swallowing. This research presents a novel approach that utilizes wireless, wearable technology for the continuous mechano-acoustic tracking of respiratory activities and swallowing. To address the challenge of accurately tracking swallowing amidst potential confounding activities or significant body movements, we employ two accelerometers. These accelerometers help distinguish between genuine swallowing events and other activities. By monitoring movements and vibrations through the skin surface, the developed device enables non-intrusive monitoring of swallowing dynamics and respiratory patterns. Our focus is on the development of both the wireless skin-interfaced device and an advanced algorithm capable of detecting swallowing dynamics in conjunction with respiratory phases. The device and algorithm demonstrate robustness in detecting respiratory patterns and swallowing instances, even in scenarios where users exhibit periodic movements due to disease or daily activities. Furthermore, peak detection using an adaptive threshold automatically adjusts to an individual’s signal strength, facilitating the detection of swallowing signals without the need for individual adjustments. This innovation has significant potential for enhancing patient training and rehabilitation programs aimed at addressing dysphagia and related respiratory issues. Full article

Background: Patients with severe dysphagia are usually fed using a nasogastric tube (NGT). Many patients who receive long-term NGT feeding are unable to obtain sufficient nutrients orally immediately after NGT removal. Thus, a transitional period involving oral diet training is required to transition from NGT feeding to exclusive oral feeding. We aimed to investigate the therapeutic effect of oral diet training in indwelling NGT patients with prolonged dysphagia. Methods: A total of 175 patients who were fed using an NGT for more than 4 weeks were enrolled. Their swallowing function was evaluated by a videofluoroscopic swallowing study (VFSS). During the VFSS, patients received thick and thin barium while the NGT was inserted. Then, the patients underwent a VFSS without an NGT thirty minutes after NGT removal. If a patient had no aspiration with NGT inserted during the VFSS, oral diet training combined with NGT feeding was recommended. Results: Of the 49 indwelling NGT patients who were recommended to receive oral diet training, 39 (79.6%) transitioned to exclusive oral feeding. A transition period of 2–8 weeks was required for them to achieve full oral feeding. Patients who were eligible for oral feeding trials showed no significant aspiration during the VFSS with an NGT inserted and had sufficient cough function. Patients who required prolonged NGT feeding and who could not complete oral trials showed significant aspiration during the VFSS when an NGT was inserted. Conclusions: This study demonstrated that oral diet training combined with NGT feeding is safe in patients with prolonged dysphagia who have sufficient cough function and no aspiration during VFSS. We suggest that if the patient is a proper candidate for NGT removal, direct oral feeding training with an NGT inserted could be a useful therapeutic strategy during the transitional period from long-term NGT feeding to successful oral feeding. Full article

The gold standard test for diagnosing dysphagia is the videofluoroscopic swallowing study (VFSS). However, the accuracy of this test varies depending on the specialist’s skill level. We proposed a VFSS-based artificial intelligence (AI) web application to diagnose dysphagia. Video from the VFSS consists of multiframe data that contain approximately 300 images. To label the data, the server separated them into frames during the upload and stored them as a video for analysis. Then, the separated data were loaded into a labeling tool to perform the labeling. The labeled file was downloaded, and an AI model was developed by training with You Only Look Once (YOLOv7). Using a utility called SplitFolders, the entire dataset was divided according to a ratio of training (70%), test (10%), and validation (20%). When a VFSS video file was uploaded to an application equipped with the developed AI model, it was automatically classified and labeled as oral, pharyngeal, or esophageal. The dysphagia of a person was categorized as either penetration or aspiration, and the final analyzed result was displayed to the viewer. The following labeling datasets were created for the AI learning: oral (n = 2355), pharyngeal (n = 2338), esophageal (n = 1480), penetration (n = 1856), and aspiration (n = 1320); the learning results of the YOLO model, which analyzed dysphagia using the dataset, were predicted with accuracies of 0.90, 0.82, 0.79, 0.92, and 0.96, respectively. This is expected to help clinicians more efficiently suggest the proper dietary options for patients with oropharyngeal dysphagia. Full article

An investigation of comprehensive service requirements and their importance across various stakeholders is needed to develop systematic swallowing healthcare services. The present study examined the service requirements and their importance in developing comprehensive swallowing healthcare services from diverse stakeholders, including healthy seniors, individuals at risk, patients, guardians, and medical professionals, within the context of dysphagia. A series of survey-based interviews with 35 participants from the 5 stakeholder groups identified a comprehensive array of requirements pertinent to swallowing healthcare. Subsequently, a larger survey of 125 participants was administered using a 7-point Likert scale to evaluate the perceived importance of the identified requirements. A total of 46 distinct requirements were identified across the prevention/screening, evaluation/diagnosis, and treatment/training stages of swallowing healthcare. Accessibility, customization, usability, practicality, and information availability were features commonly identified across the three stages. Evaluation of the importance of these requirements yielded ratings ranging from 5.0 to 6.6. Significantly higher ratings were found for requirements associated with the evaluation/diagnosis and treatment/training stages, underscoring the stakeholder groups’ pronounced preference for services directed at these specific stages of the healthcare continuum. The study offers insights into the multifaceted requirements of stakeholders in swallowing healthcare, emphasizing the necessity for personalized, easily accessible, and comprehensive services. These findings serve as a foundational framework on targeted interventions and tailored services designed to address the diverse requirements of stakeholders for swallowing healthcare. Full article