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Pere Clave - One of the best experts on this subject based on the ideXlab platform.

  • Complications of Oropharyngeal Dysphagia: Malnutrition and Aspiration Pneumonia
    Dysphagia, 2020
    Co-Authors: Silvia Carrión, E Verin, Pere Clave, Alessandro Laviano
    Abstract:

    The prevalence of Oropharyngeal functional Dysphagia among older people and neurological patients is very high and and can cause two important types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify patients with Oropharyngeal Dysphagia in order to identify those patients who are at risk of aspiration or malnutrition, videofluoroscopy (VFS) being the gold standard. Their study must be completed with a nutritional assessment to determine the risk of malnutrition and the status of hydration. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in these patients. Therefore, diagnosis and management of Oropharyngeal Dysphagia needs a multidisciplinary approach.

  • Nursing interventions in adult patients with Oropharyngeal Dysphagia: a systematic review
    European Geriatric Medicine, 2017
    Co-Authors: Lorena Molina, Pere Clave, Susana Santos-ruiz, Esther Cabrera
    Abstract:

    Background Oropharyngeal Dysphagia is a geriatric syndrome of high prevalence. It requires screening, diagnosis and specific care to avoid possible complications. The objective of this study is to perform a systematic review of the literature to know what interventions are performed by nursing professionals in the care of adult patients with OD.

  • Oropharyngeal Dysphagia: when swallowing disorders meet respiratory diseases
    European Respiratory Journal, 2017
    Co-Authors: E Verin, Pere Clave, Maria R. Bonsignore, Jean Paul Marie, Chloé Bertolus, Thomas Similowski, Pierantonio Laveneziana
    Abstract:

    Patients with chronic respiratory diseases should be screened for Oropharyngeal Dysphagia to prevent complications http://ow.ly/JaXl309wdNG

  • The Effects of Sensory Stimulation on Neurogenic Oropharyngeal Dysphagia
    Journal of gastroenterology and hepatology research, 2014
    Co-Authors: Laia Rofes, Paula Cristina Cola, Pere Clave
    Abstract:

    Sensory input is crucial for the initiation and modulation of the swallow response. Patients with neurogenic Oropharyngeal Dysphagia present severe impairments in Oropharyngeal sensitivity associated with impaired motor responses. Several strategies have been used with the aim to modulate the swallow response by modifying the sensorial properties of the bolus (either chemically or physically) or by directly stimulating the sensory and motor neurons of the pharynx and larynx. Most of the stimuli described as swallow sensory stimulants (such as acid, capsaicin or piperine) are integrated by receptors of the multimodal transient receptor potential (TRP) channel family, mostly expressed in sensory nerves. Enhancing the sensorial stimuli may increase the sensorial input to the swallowing centre of the brain stem, thus triggering the swallow response earlier and protecting the respiratory airway. Moreover, sensorial stimuli may promote brain plasticity, facilitating the recovery of deglutition. The aim of this review is to briefly summarize the effects of swallow therapies focused on sensory stimulation and discuss their effects, rationality, action mechanism and perspectives in patients with neurogenic Oropharyngeal Dysphagia.

  • Oropharyngeal Dysphagia is a risk factor for readmission for pneumonia in the very elderly persons observational prospective study
    Journals of Gerontology Series A-biological Sciences and Medical Sciences, 2014
    Co-Authors: Mateu Cabre, Elisabet Palomera, Jordi Almirall, Mateu Serraprat, Ll Force, Pere Clave
    Abstract:

    BACKGROUND: To determine whether Oropharyngeal Dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit. METHODS: Observational prospective cohort study with data collection based on clinical databases and electronic clinical notes. All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31, 2010. All individuals were initially classified according to the presence of Oropharyngeal Dysphagia assessed by bedside clinical examination. Main outcome measure was readmission for pneumonia. Clinical notes were reviewed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia. RESULTS: A total of 2,359 patients (61.9% women, mean age 84.9 y) were recruited and followed for a mean of 24 months. Dysphagia was diagnosed in 47.5% of cases. Overall, 7.9% of individuals were readmitted for pneumonia during follow-up, 24.2% of these had aspiration pneumonia. The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years (95% CI 3.0-4.4) in individuals without Dysphagia and 6.7 (5.5-7.8) in those with Dysphagia, with an attributable risk of 3.02 readmissions per 100 person-years (1.66-4.38) and a rate ratio of 1.82 (1.41-2.36). Multivariate Cox regression showed an independent effect of Oropharyngeal Dysphagia, with a hazard ratio of 1.6 (1.15-2.2) for hospitalization for pneumonia, 4.48 (2.01-10.0) for aspiration pneumonia, and 1.44 (1.02-2.03) for nonaspiration pneumonia. CONCLUSION: Oropharyngeal Dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons.

Renee Speyer - One of the best experts on this subject based on the ideXlab platform.

  • Behavioral Treatment of Oropharyngeal Dysphagia
    Dysphagia, 2017
    Co-Authors: Renee Speyer
    Abstract:

    This chapter gives an overview of the most common behavioral techniques for treating Oropharyngeal Dysphagia, namely, bolus modification and management, motor behavioral techniques, sensory and neurophysiologic stimulation, postural adjustments, and swallow maneuvers. Each intervention is described along with its rationale. Furthermore, in light of the literature, the effects of Dysphagia treatment are discussed as well as some methodological issues that emerged from a review of outcome studies.

  • prevalence of Oropharyngeal Dysphagia in the netherlands a telephone survey
    Dysphagia, 2015
    Co-Authors: Berit Kertscher, Renee Speyer, Eric Fong, Anastasios M Georgiou, Moira Smith
    Abstract:

    Recent and specific data on the prevalence and/or incidence of Oropharyngeal Dysphagia in the general population are scarce. This study focuses on obtaining this data by means of a literature review and telephone survey. A literature review was performed to obtain data on the prevalence of Dysphagia in the general population. Secondly, a quasi-random telephone survey using the functional health status questionnaire EAT-10 was conducted with the aim of establishing prevalence data on Oropharyngeal Dysphagia in the Netherlands. The literature review revealed six articles which met the inclusion criteria. The prevalence data on Oropharyngeal Dysphagia in the general population varied between 2.3 and 16 %. For the telephone survey, a total of 6,700 individuals were contacted by telephone, of which, 2,600 (39 %) participated in the study. Of the 2,600 participants, as many as 315 (12.1 %) were identified as having swallowing abnormalities and showed increased risk of Oropharyngeal Dysphagia with age. Prevalence data on Oropharyngeal Dysphagia in the Dutch general population were as high as 12.1 %. This data are in line with the retrieved prevalence data from the literature.

  • Functional Health Status in Oropharyngeal Dysphagia
    Journal of gastroenterology and hepatology research, 2014
    Co-Authors: Renee Speyer, Berit Kertscher, Reinie Cordier
    Abstract:

    Patient self-evaluations on Functional Health Status (FHS) questionnaires are considered to be part of the assessment of Oropharyngeal Dysphagia. FHS questionnaires capture the unique personal perception of someone’s health, taking into account social, functional and psychological factors. Many FHS questionnaires have been reported on in literature. This paper describes a selection of FHS questionnaires in more detail; issues concerning the inclusion of Health Related Quality of Life (HRQOL) items, choices in target populations and the distinction between Oropharyngeal versus esophageal Dysphagia will be discussed. Recommendations are made about the evaluation and use of FHS questionnaires in daily clinical practice. In particular the psychometric properties of FHS questionnaires should be evaluated to determine if they meet quality criteria for measurement properties of health status questionnaires in order to guarantee valid and reliable outcome measurements.

  • bedside screening to detect Oropharyngeal Dysphagia in patients with neurological disorders an updated systematic review
    Dysphagia, 2014
    Co-Authors: Berit Kertscher, Renee Speyer, Maria Palmieri, Chris Plant
    Abstract:

    Oropharyngeal Dysphagia is a highly prevalent comorbidity in neurological patients and presents a serious health threat, which may le to outcomes of aspiration pneumonia ranging from hospitalization to death. Therefore, an early identification of risk followed by an accurate diagnosis of Oropharyngeal Dysphagia is fundamental. This systematic review provides an update of currently available bedside screenings to identify Oropharyngeal Dysphagia in neurological patients. An electronic search was carried out in the databases PubMed, Embase, CINAHL, and PsychInfo (formerly PsychLit), and all hits from 2008 up to December 2012 were included in the review. Only studies with sufficient methodological quality were considered, after which the psychometric characteristics of the screening tools were determined. Two relevant bedside screenings were identified, with a minimum sensitivity and specificity of ≥70 and ≥60 %, respectively.

  • Oropharyngeal Dysphagia screening and assessment
    Otolaryngologic Clinics of North America, 2013
    Co-Authors: Renee Speyer
    Abstract:

    This article provides an overview of bedside screening and assessment tools in patients with Oropharyngeal Dysphagia including the diagnostic performance of screening tools; the gold standards in assessment of Dysphagia (videofluoroscopic and fiberoptic endoscopic evaluation of swallowing); a variety of clinical assessment tools; patient self-evaluation questionnaires; and a list of supplementary methods. In addition, some methodologic issues are discussed, and the need for standardization of terminology, screening and assessment protocols, and the call for evidence-based clinical guidelines.

F Mearin - One of the best experts on this subject based on the ideXlab platform.

  • Oropharyngeal Dysphagia after the acute phase of stroke predictors of aspiration
    Neurogastroenterology and Motility, 2006
    Co-Authors: Rosa Terre, F Mearin
    Abstract:

    Abstract  Oropharyngeal Dysphagia is frequent during the acute phase of stroke, but most patients recover. Dysphagia is related to higher incidence of aspiration, pneumonia and death. Frequently neither clinical history nor neurological evaluation predicts the presence of aspiration. In 64 patients not recovered from severe stroke after the acute phase with clinically suspected Oropharyngeal Dysphagia we investigated: (i) the correlation between clinical manifestations and videofluoroscopic findings; (ii) predictive factors of aspiration and silent aspiration. Clinical examination showed that 44% had impaired gag reflex, 47% cough during oral feeding, and 13% changes in voice after swallowing. Videofluoroscopy revealed some abnormality in 87%: 53% in the oral phase and 84% in the pharyngeal phase (aspiration in 66%; half being silent). Impaired pharyngeal safety was more frequent in posterior territory lesions and patients with a history of pneumonia (P < 0.01). No correlation was found between clinical evaluation findings and presence of aspiration. Silent aspirations were more frequent in patients with previous orotracheal intubation (P < 0.05) and abnormalities in velopharyngeal reflexes (P < 0.05). We concluded that in patients not recovered from severe stroke after the acute phase and with suspected Oropharyngeal Dysphagia, clinical evaluation is of scant use in predicting aspiration and silent aspiration. Videofluoroscopic examination is mandatory in these patients.

  • Oropharyngeal Dysphagia after the acute phase of stroke: predictors of aspiration.
    Neurogastroenterology and Motility, 2006
    Co-Authors: Rosa Terre, F Mearin
    Abstract:

    Abstract  Oropharyngeal Dysphagia is frequent during the acute phase of stroke, but most patients recover. Dysphagia is related to higher incidence of aspiration, pneumonia and death. Frequently neither clinical history nor neurological evaluation predicts the presence of aspiration. In 64 patients not recovered from severe stroke after the acute phase with clinically suspected Oropharyngeal Dysphagia we investigated: (i) the correlation between clinical manifestations and videofluoroscopic findings; (ii) predictive factors of aspiration and silent aspiration. Clinical examination showed that 44% had impaired gag reflex, 47% cough during oral feeding, and 13% changes in voice after swallowing. Videofluoroscopy revealed some abnormality in 87%: 53% in the oral phase and 84% in the pharyngeal phase (aspiration in 66%; half being silent). Impaired pharyngeal safety was more frequent in posterior territory lesions and patients with a history of pneumonia (P 

Laia Rofes - One of the best experts on this subject based on the ideXlab platform.

  • The Effects of Sensory Stimulation on Neurogenic Oropharyngeal Dysphagia
    Journal of gastroenterology and hepatology research, 2014
    Co-Authors: Laia Rofes, Paula Cristina Cola, Pere Clave
    Abstract:

    Sensory input is crucial for the initiation and modulation of the swallow response. Patients with neurogenic Oropharyngeal Dysphagia present severe impairments in Oropharyngeal sensitivity associated with impaired motor responses. Several strategies have been used with the aim to modulate the swallow response by modifying the sensorial properties of the bolus (either chemically or physically) or by directly stimulating the sensory and motor neurons of the pharynx and larynx. Most of the stimuli described as swallow sensory stimulants (such as acid, capsaicin or piperine) are integrated by receptors of the multimodal transient receptor potential (TRP) channel family, mostly expressed in sensory nerves. Enhancing the sensorial stimuli may increase the sensorial input to the swallowing centre of the brain stem, thus triggering the swallow response earlier and protecting the respiratory airway. Moreover, sensorial stimuli may promote brain plasticity, facilitating the recovery of deglutition. The aim of this review is to briefly summarize the effects of swallow therapies focused on sensory stimulation and discuss their effects, rationality, action mechanism and perspectives in patients with neurogenic Oropharyngeal Dysphagia.

  • Neuogenic and Oropharyngeal Dysphagia
    Annals of the New York Academy of Sciences, 2013
    Co-Authors: Laia Rofes, Pere Clave, Ann Ouyang, Martina Scharitzer, Peter Pokieser, Natalia Vilardell, Omar Ortega
    Abstract:

    Oropharyngeal Dysphagia (OD) is a swallowing disorder caused by congenital abnormalities and structural damage and disease-associated damage of the oral cavity, pharynx, and upper esophageal sphincter. Patients with OD lack the protective mechanisms necessary for effective swallowing, exhibiting difficulty controlling food in the mouth and initiating a swallow, leading to choking, coughing, and nasal regurgitation. OD is a major risk factor for malnutrition, dehydration, and aspiration pneumonia. The following on OD includes commentaries on the application of simulation of Oropharyngeal transient receptor potential vanilloid 1 (TRPV1) and maneuvers like the Shaker exercise to improve the safety and efficacy of swallow in OD patients; the prevalence of esophageal pathologies in OD patients and the need to evaluate the esophagus, esophagogastric junction, and stomach; and strategies for clinical screening to detect OD and aspiration among high-risk patients and to improve oral health care, maintain nutrition and hydration, and prevent aspiration pneumonia.

  • Oropharyngeal Dysphagia is a risk factor for community acquired pneumonia in the elderly
    European Respiratory Journal, 2013
    Co-Authors: Jordi Almirall, Pere Clave, Laia Rofes, Viridiana Arreola, Elisabet Palomera, Mateu Serraprat, Roser Icart
    Abstract:

    The aim of this study was to explore whether Oropharyngeal Dysphagia is a risk factor for community-acquired pneumonia (CAP) in the elderly and to assess the physiology of deglutition of patients with pneumonia. In the case–control study, 36 elderly patients (aged ≥70 years) hospitalised with pneumonia were matched by age and sex with two independently living controls. All subjects were given the volume–viscosity swallow test to identify signs of Oropharyngeal Dysphagia. In the pathophysiological study, all cases and 10 healthy elderly subjects were examined using videofluoroscopy. Prevalence of Oropharyngeal Dysphagia in the case–control study was 91.7% in cases and 40.3% in controls (p versus 0.200±0.059 s, p In elderly subjects, Oropharyngeal Dysphagia is strongly associated with CAP, independently of functionality and comorbidities. Elderly patients with pneumonia presented a severe impairment of swallow and airway protection mechanisms. We recommend universal screening of Dysphagia in older persons with pneumonia.

  • diagnosis and management of Oropharyngeal Dysphagia and its nutritional and respiratory complications in the elderly
    Gastroenterology Research and Practice, 2011
    Co-Authors: Laia Rofes, Renee Speyer, Viridiana Arreola, Jordi Almirall, Mateu Cabre, Lluis Campins, Pilar Garciaperis, Pere Clave
    Abstract:

    Oropharyngeal Dysphagia is a major complaint among older people. Dysphagia may cause two types of complications in these patients: (a) a decrease in the efficacy of deglutition leading to malnutrition and dehydration, (b) a decrease in deglutition safety, leading to tracheobronchial aspiration which results in aspiration pneumonia and can lead to death. Clinical screening methods should be used to identify older people with Oropharyngeal Dysphagia and to identify those patients who are at risk of aspiration. Videofluoroscopy (VFS) is the gold standard to study the oral and pharyngeal mechanisms of Dysphagia in older patients. Up to 30% of older patients with Dysphagia present aspiration—half of them without cough, and 45%, Oropharyngeal residue; and 55% older patients with Dysphagia are at risk of malnutrition. Treatment with dietetic changes in bolus volume and viscosity, as well as rehabilitation procedures can improve deglutition and prevent nutritional and respiratory complications in older patients. Diagnosis and management of Oropharyngeal Dysphagia need a multidisciplinary approach.

  • pathophysiology of Oropharyngeal Dysphagia in the frail elderly
    Neurogastroenterology and Motility, 2010
    Co-Authors: Laia Rofes, Viridiana Arreola, M Romea, Elisabet Palomera, Jordi Almirall, Mateu Cabre, Mateu Serraprat, Pere Clave
    Abstract:

    BACKGROUND: Oropharyngeal Dysphagia is a major complaint among the elderly. Our aim was to assess the pathophysiology of Oropharyngeal Dysphagia in frail elderly patients (FEP). METHODS: A total of 45 FEP (81.5 +/- 1.1 years) with Oropharyngeal Dysphagia and 12 healthy volunteers (HV, 40 +/- 2.4 years) were studied using videofluoroscopy. Each subject's clinical records, signs of safety and efficacy of swallow, timing of swallow response, hyoid motion and tongue bolus propulsion forces were assessed. KEY RESULTS: Healthy volunteers presented a safe and efficacious swallow, faster laryngeal closure (0.157 +/- 0.013 s) upper esophageal sphincter opening (0.200 +/- 0.011 s), and maximal vertical hyoid motion (0.310 +/- 0.048 s), and stronger tongue propulsion forces (22.16 +/- 2.54 mN) than FEP. By contrast, 63.63% of FEP presented Oropharyngeal residue, 57.10%, laryngeal penetration and 17.14%, tracheobronchial aspiration. Frail elderly patients with impaired swallow safety showed delayed laryngeal vestibule (LV) closure (0.476 +/- 0.047 s), similar bolus propulsion forces, poor functional capacity and higher 1-year mortality rates (51.7%vs 13.3%, P = 0.021) than FEP with safe swallow. Frail elderly patients with Oropharyngeal residue showed impaired tongue propulsion (9.00 +/- 0.10 mN), delayed maximal vertical hyoid motion (0.612 +/- 0.071 s) and higher (56.0%vs 15.8%, P = 0.012) 1-year mortality rates than those with efficient swallow. CONCLUSION & INFERENCES: Frail elderly patients with Oropharyngeal Dysphagia presented poor outcome and high mortality rates. Impaired safety of deglutition and aspirations are mainly caused by delayed LV closure. Impaired efficacy and residue are mainly related to weak tongue bolus propulsion forces and slow hyoid motion. Treatment of Dysphagia in FEP should be targeted to improve these critical events.

Rosa Terre - One of the best experts on this subject based on the ideXlab platform.

  • Oropharyngeal Dysphagia after the acute phase of stroke: predictors of aspiration.
    Neurogastroenterology and Motility, 2006
    Co-Authors: Rosa Terre, F Mearin
    Abstract:

    Abstract  Oropharyngeal Dysphagia is frequent during the acute phase of stroke, but most patients recover. Dysphagia is related to higher incidence of aspiration, pneumonia and death. Frequently neither clinical history nor neurological evaluation predicts the presence of aspiration. In 64 patients not recovered from severe stroke after the acute phase with clinically suspected Oropharyngeal Dysphagia we investigated: (i) the correlation between clinical manifestations and videofluoroscopic findings; (ii) predictive factors of aspiration and silent aspiration. Clinical examination showed that 44% had impaired gag reflex, 47% cough during oral feeding, and 13% changes in voice after swallowing. Videofluoroscopy revealed some abnormality in 87%: 53% in the oral phase and 84% in the pharyngeal phase (aspiration in 66%; half being silent). Impaired pharyngeal safety was more frequent in posterior territory lesions and patients with a history of pneumonia (P 

  • Oropharyngeal Dysphagia after the acute phase of stroke predictors of aspiration
    Neurogastroenterology and Motility, 2006
    Co-Authors: Rosa Terre, F Mearin
    Abstract:

    Abstract  Oropharyngeal Dysphagia is frequent during the acute phase of stroke, but most patients recover. Dysphagia is related to higher incidence of aspiration, pneumonia and death. Frequently neither clinical history nor neurological evaluation predicts the presence of aspiration. In 64 patients not recovered from severe stroke after the acute phase with clinically suspected Oropharyngeal Dysphagia we investigated: (i) the correlation between clinical manifestations and videofluoroscopic findings; (ii) predictive factors of aspiration and silent aspiration. Clinical examination showed that 44% had impaired gag reflex, 47% cough during oral feeding, and 13% changes in voice after swallowing. Videofluoroscopy revealed some abnormality in 87%: 53% in the oral phase and 84% in the pharyngeal phase (aspiration in 66%; half being silent). Impaired pharyngeal safety was more frequent in posterior territory lesions and patients with a history of pneumonia (P < 0.01). No correlation was found between clinical evaluation findings and presence of aspiration. Silent aspirations were more frequent in patients with previous orotracheal intubation (P < 0.05) and abnormalities in velopharyngeal reflexes (P < 0.05). We concluded that in patients not recovered from severe stroke after the acute phase and with suspected Oropharyngeal Dysphagia, clinical evaluation is of scant use in predicting aspiration and silent aspiration. Videofluoroscopic examination is mandatory in these patients.

  • approaching Oropharyngeal Dysphagia
    Revista Espanola De Enfermedades Digestivas, 2004
    Co-Authors: Pere Clave, Rosa Terre, M De Kraa, M Serra
    Abstract:

    Dysphagia is a symptom that refers to difficulty or discomfort during the progression of the alimentary bolus from the mouth to the stomach. From an anatomical standpoint Dysphagia may result from Oropharyngeal or esophageal dysfunction and from other structure-related or functional causes from a pathophysiological viewpoint. The prevalence of Oropharyngeal functional Dysphagia is very high in patients with neurological disease: it includes more than 30% of patients having had a CVA; its prevalence in Parkinson’s disease is 52-82%; it is the first symptom for 60% of patients with amyotrophic lateral sclerosis (ALS); it affects 40% of patients with myasthenia gravis, up to 44% of patients with multiple sclerosis; up to 84% of patients with Alzheimer’s disease, and more than 60% of elderly institutionalized patients (1-5). The severity of Oropharyngeal Dysphagia may vary from moderate difficulty to complete inability to swallow. Oropharyngeal Dysphagia may give rise to two groups of clinically relevant complications: 1. When a decrease in deglutition efficacy occurs, patients present with malnutrition and/or dehydration. 2. When a decrease in deglutition safety occurs, choking and airway obstruction develop, most commonly as a tracheobronchial aspiration that may result in pneumonia in 50% of cases, with an associated mortality up to 50% (1).