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Silent aspiration in brain injury

Ji Young Lee, Don-Kyu Kim, Kyung Mook Seo, Si Hyun Kang
OBJECTIVE: To assess cough reflex sensitivity using the simplified cough test (SCT) and to evaluate the usefulness of SCT to screen for silent aspiration. METHODS: THE HEALTHY CONTROL GROUP WAS DIVIDED INTO TWO SUBGROUPS: the young (n=29, 33.44±9.99 years) and the elderly (n=30, 63.66±4.37 years). The dysphagic elderly group (n=101, 72.95±9.19 years) consisted of patients with dysphagia, who suffered from a disease involving central nervous system (ischemic stroke 47, intracerebral hemorrhage 27, traumatic brain injury 11, encephalitis 5, hypoxic brain damage 3, and Parkinson disease 8)...
August 2014: Annals of Rehabilitation Medicine
R Terré, F Mearin
BACKGROUND: The chin-down posture is generally recommended in patients with neurogenic dysphagia to prevent tracheal aspiration; however, its effectiveness has not been demonstrated. AIM: To videofluoroscopically (VDF) assess the effectiveness of chin-down posture to prevent aspiration in patients with neurogenic dysphagia secondary to acquired brain injury. METHODS: Randomized, alternating, cross-over study (with and without the chin-down posture) in 47 patients with a VDF diagnosis of aspiration [31 stroke, 16 traumatic brain injury (TBI)] and 25 controls without aspiration (14 stroke, 11 TBI)...
May 2012: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
Bernard R Garon, Tess Sierzant, Charles Ormiston
The purpose of this retrospective study of aspiration and the lack of a protective cough reflex at the vocal folds (silent aspiration) was to increase the awareness of nursing staffs of the diagnostic pathology groups associated with silent aspiration. Of the 2,000 patients evaluated in this study, 51% aspirated on the video fluoroscopic evaluation. Of the patients who aspirated, 55% had no protective cough reflex (silent aspiration). The diagnostic pathology groups with the highest rates of silent aspiration were brain cancer, brainstem stroke, head-neck cancer, pneumonia, dementia/Alzheimer, chronic obstructive lung disease, seizures, myocardial infarcts, neurodegenerative pathologies, right hemisphere stroke, closed head injury, and left hemisphere stroke...
August 2009: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Rosa Terré, Fermín Mearin
PRIMARY OBJECTIVE: To evaluate clinical, videofluoroscopic findings and clinical evolution of neurogenic dysphagia and to establish the prognostic factors. RESEARCH DESIGN: Prospective cohort study. METHODS AND PROCEDURES: Forty-eight patients with severe traumatic brain injury (TBI) and clinically-suspected oro-pharyngeal dysphagia were studied. Clinical evaluation of oro-pharyngeal dysphagia and videofluoroscopic examination were performed...
December 2007: Brain Injury: [BI]
R Terré, F Mearin
INTRODUCTION: Swallowing impairments are frequent after severe traumatic brain injury (TBI). OBJECTIVE: to define and prospectively quantify the videofluoroscopic symptoms in patients after TBI, and to evaluate the evolution of patients with laryngotracheal aspiration. METHOD: We studied 10 patients with TBI, and a clinical suspicion of aspiration confirmed by means of a videofluoroscopic exploration (VDF). VDF was repeated at 1, 3, 6, and 12 months thereafter...
January 2007: Revista Española de Enfermedades Digestivas
Victoria Mayer
Dysphagia, or the inability to swallow normally, is a feature of a number of neurological conditions. It is found in both paediatric and adult populations, but the scope of this article is limited to the adult neurogenic population. The normal swallow is a complex and highly coordinated activity, any part of which may be disturbed by neurological illness or injury. Assessment of dysphagia is normally undertaken by speech and language therapists in conjunction with the multidisciplinary team. A bedside screening assessment may be augmented by instrumental assessment, such as videofluoroscopy, in cases where silent aspiration of food or liquid into the lungs is suspected...
February 2004: British Journal of Community Nursing
Angela Morgan, Elizabeth Ward, Bruce Murdoch, Kate Bilbie
OBJECTIVE: To document the acute characteristics of swallowing impairment in a group of children post moderate/severe traumatic brain injury (TBI) by means of videofluoroscopy. PARTICIPANTS: Eighteen children with moderate/severe TBI. MAIN OUTCOME MEASURE: Videofluoroscopy at an average of 27.7 days post-injury. RESULTS: Subjects demonstrated a range of dysphagia severity levels: mild-moderate (n = 8), moderate (n = 6), moderate-severe (n = 3), and severe (n = 1) and had a combination of oral and pharyngeal phase characteristics...
June 2002: Journal of Head Trauma Rehabilitation
S B Leder
Dysphagia and aspiration in intensive care unit patients with acute traumatic brain injury (TBI) is a frequent and potentially life-threatening problem. Any diagnostic technique used with this population, therefore, must be able to be performed in a timely and efficient manner while providing objective information on the nature of the swallowing problem. The purpose of the present study was to investigate the utility of using the fiberoptic endoscopic evaluation of swallowing (FEES) technique to diagnosis pharyngeal stage dysphagia and determine aspiration status in patients who presented with acute TBI...
October 1999: Journal of Head Trauma Rehabilitation
M J Schurr, K A Ebner, A L Maser, K B Sperling, R B Helgerson, B Harms
BACKGROUND: The incidence of swallowing dysfunction after brain injury is unknown. The efficacy of dysphagia therapy is also unknown. We reviewed our experience to define the incidence of swallowing dysfunction and efficacy of therapeutic intervention. METHODS: Patients with brain injury sustained between January of 1996 and December of 1997 were reviewed. All were screened with trials of oral intake. Abnormal findings were confirmed with a videofluoroscopic swallow study...
May 1999: Journal of Trauma
F Mari, M Matei, M G Ceravolo, A Pisani, A Montesi, L Provinciali
OBJECTIVES: (1) To evaluate the predictive value of a detailed clinical screening of aspiration in patients with neurological diseases, both with and without symptoms of dysphagia taking videofluoroscopy as the gold standard; (2) to assess the existence of risk factors for silent aspiration, measuring the cost-benefit ratio of radiological examination. METHODS: 93 consecutive patients meeting the diagnostic criteria for a neurological disease with a risk of swallowing dysfunctions (cerebrovascular accidents, brain injury, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, myotonic dystrophy, and abiotrophic diseases) underwent a detailed clinical assessment using a 25 item form to check for symptoms of dysphagia and impairment of the oropharyngeal swallowing mechanism...
October 1997: Journal of Neurology, Neurosurgery, and Psychiatry
M L Splaingard, B Hutchins, L D Sulton, G Chaudhuri
This paper reports the results of a blinded study comparing videofluoroscopy with bedside clinical evaluations by speech/language pathologists in the diagnosis of aspiration. One hundred and seven inpatients from a general rehabilitation hospital were evaluated over a four-month period. Of the total patient population, 43 (40%) aspirated at least one consistency of food during videofluoroscopy. Bedside evaluation identified only 18 (42%) of these patients. The positive predictive value of bedside assessment was 0...
August 1988: Archives of Physical Medicine and Rehabilitation
M M Brooke, M T Andary, P M Mitsuda, T M Therriault
The initiation of speech is often delayed in the early stages of recovery from a serious brain injury. We have found a high percentage of patients with both speech and swallowing problems. This makes bedside assessment of swallowing safety difficult because one cannot listen for the sound of aspirated material on the vocal cords when a patient is at high risk for silent aspiration and is often unable to cooperate with a videofluoroscopic study. The use of the telephone has been described several times for aphasia treatment, but not to elicit speech or assess swallowing safety early after brain injury...
February 1991: Archives of Physical Medicine and Rehabilitation
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