The Intensive Dysphagia Rehabilitation approach applied to patients with neurogenic dysphagia: a case series design study.

The Intensive Dysphagia Rehabilitation approach applied to patients with neurogenic dysphagia: a case series design study.

Arch Phys Med Rehabil. 2015 Dec 19;

Authors: Malandraki GA, Rajappa A, Kantarcigil C, Wagner E, Ivey C, Youse K

Abstract
OBJECTIVE: To examine the effects of the Intensive Dysphagia Rehabilitation (IDR) approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia.
DESIGN: Intervention study; before-after trial with 4-week follow-up through an online survey.
SETTING: Outpatient university clinics.
PARTICIPANTS: A consecutive sample of 10 subjects recruited from outpatient university clinics. All were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subject withdrew from the study.
INTERVENTIONS: Participants completed the 4-week Intensive Dysphagia Rehabilitation, including: two oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice/week, and home practice for ∼45 minutes/day.
MAIN OUTCOME MEASURE(S): Outcome measures assessed pre- and post-IDR were: (1) airway safety using an 8-point Penetration Aspiration scale; (2) lingual isometric pressures; (3) self-reported swallowing-related quality of life (QOL), and (4) level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey).
RESULTS: IDR was effective in improving maximum and mean Penetration Aspiration scale scores (p<0.05, η(2)=0.8146; p<0.05, η(2)=0.799708); and level of oral intake (p<0.005, Cohen's d=-1.387). Of 5 patients who were feeding tube dependent initially, two progressed to total, and two to partial oral nutrition. One remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% CI [6.38, 14.5], p<0.00), but not at the post-IDR assessment. No adverse effects were observed/reported.
CONCLUSION(S): We conclude that IDR was safe and improved physiological and some functional swallowing outcomes in our sample, however further investigation is needed before it can be widely applied.

PMID: 26711168 [PubMed - as supplied by publisher]

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