Dysphagia Evaluation and Treatment : From the Perspective of Rehabilitation Medicine

The Japanese Society for Dysphagia Rehabilitationis the world’s largest multidisciplinary organization dedicated toresearch, education, and patient care in swallowing disorders. This team approachcontributes to both the effectiveness and efficiency of patient care.Fujita Health University (FHU) is one of the pioneering facilities where dysphagiarehabilitation is approached systematically and scientifically using the conceptof the team approach. Their new textbook, Dysphagia Evaluation and Treatment:From the Perspective of Rehabilitation Medicine, is designed to support the highestlevel of practice, scientifically, clinically, and ethically. The chapter authors and editorsare highly skilled experts in dysphagia rehabilitation.Along with the anatomy and physiology, this textbook highlights basic as well asadvanced principles of patient care, including the approach to the patient, bedsideexamination and screening, instrumental evaluation including traditional as well asnovel methods (such as swallowing CT and high resolution manometry), and anapproach to treatment based on the science of motor learning. Case studies illustratethe comprehensive team approach to patient care.This textbook serves as an excellent guide to the latest developments in the practiceof dysphagia rehabilitation. This approach, if implemented early and maintainedover time, can enhance the health and quality of life of people with dysphagia.It also points the way to improving our knowledge and practice in the future. Foreword 5 Overview 7 Acknowledgments 14 Contents 15 About the Editors 17 About the Authors 18 Abbreviations 19 Part I: Overview and Physiology 20 Chapter 1: Overview of Structures and Essential Terms 21 1.1 Terminology of Dysphagia 21 1.2 Overview of Structures 22 1.2.1 Anatomical Structures [1–3] 22 1.2.2 Neural Control of Swallowing [1, 4] 24 Appendix 25 Additional Terminology of Dysphagia 25 Swallowing Muscles Contributing to the Pharyngeal Stage 25 Neural Control of Swallowing 26 References 27 Chapter 2: Evolution and Development of Human Swallowing 28 2.1 Development of Swallowing in Humans 30 References 32 Chapter 3: Physiological Models of Swallowing 33 3.1 Four-Stage Model 34 3.1.1 Oral Preparatory Stage 34 3.1.2 Oral Propulsive Stage 35 3.1.3 Pharyngeal Stage 35 3.1.4 Esophageal Stage [1, 5, 12] 36 3.2 Process Model 37 3.2.1 Oral Stage 37 3.2.2 Stage I Transport 37 3.2.3 Food Processing 38 3.2.4 Stage II Transport 38 3.3 Two-Stage Model 39 3.4 Coordination of Deglutition and Respiration 40 References 41 Part II: Clinical Approaches 42 Chapter 4: Dysphagia from the Viewpoint of Rehabilitation Medicine 43 4.1 Dysphagia Team Development in Japan 45 References 46 Chapter 5: Clinical Evaluation of Dysphagia 48 5.1 Dysphagia Screening 50 5.1.1 Repetitive Saliva Swallowing Test 51 5.1.2 Modified Water Swallowing Test 51 5.1.3 Food Test 52 5.1.4 30-mL Water Swallowing Test 53 5.1.4.1 Drinking Episodes 53 5.1.4.2 Diagnosis 53 5.2 Clinical Swallowing Assessment 56 5.2.1 Medical History 57 5.2.2 Physical Examination 57 5.2.2.1 General Assessments 58 5.2.2.2 Assessment of Oromotor Control and Vocal Function 59 5.3 Instrumental Swallowing Assessment 60 5.3.1 Swallowing Examination by Videofluorography (VF) 61 5.3.1.1 Swallowing Study by VF: Anatomical Overview 65 5.3.1.2 Three Mandatory Evaluation Points During VF 66 Position of the Bolus Head at Swallow Initiation 66 Aspiration and Penetration 66 Pharyngeal residue 68 5.3.1.3 Other Abnormalities Identified by VF study 68 5.3.1.4 Analyses, Interpretation, and Reporting 71 5.3.1.5 Equipment 74 5.3.1.6 Oral Contrast Media for VF study 74 5.3.1.7 Performance of VF study 78 5.3.1.8 Radiation Safety 79 5.3.2 Swallowing Examination by Videoendoscopy (VE) 80 5.3.2.1 First View: Nasopharynx 82 5.3.2.2 Second View: Oropharynx 82 5.3.2.3 Third View: Hypopharynx or Laryngopharynx (Posterior to the Epiglottis) 84 5.3.2.4 VE Procedure at FHUR 84 Evaluation Before the Use of Bolus Materials 85 Evaluation with the Use of Bolus Materials 87 5.3.2.5 Equipment 88 5.3.2.6 Performance of VE study 89 5.3.2.7 Examination Safety 91 5.3.3 Systematic Evaluation in an Acute-Care Hospital (FHUR): Swallowing Ward Rounds with VE 92 5.4 New Perspectives in Swallowing Assessment 95 5.4.1 Swallowing Computed Tomography 95 5.4.1.1 Equipment and Performance 96 5.4.1.2 Analysis and Clinical Utility 96 5.4.1.3 Examination Safety 101 5.4.2 High-Resolution Manometry 102 5.4.2.1 Equipment and Analysis 102 5.4.2.2 HRM Combined with VF or Swallowing CT 102 5.4.3 Tongue Pressure Measurement 105 5.4.3.1 Equipment and Performance 106 Appendix 107 Other Available Dysphagia Screening Tools 107 TOR-BSST© [4, 43, 44] 108 Barnes Jewish Hospital Stroke Dysphagia Screen [45, 46] 108 Volume-Viscosity Swallowing Test [47] 108 References 109 Part III: Treatment 112 Chapter 6: Oral Hygiene Care 113 References 118 Chapter 7: Swallowing Exercises 120 7.1 Successful Rehabilitation Strategies Based on Motor Learning in Patients with Swallowing Disorders 122 7.1.1 Evaluation of Rehabilitation Strategies Based on Motor Learning 122 7.2 Swallowing Exercises 124 7.2.1 Element-Based Exercises 126 7.2.1.1 Oral Element-Based Exercises 126 7.2.1.2 Pharyngeal Element-Based Exercises 127 Shaker Exercise 127 Tongue Base Retraction Exercise 128 Tongue-Hold Swallow Exercise (Masako Maneuver) 128 7.2.1.3 Other Exercises 129 Expiratory Muscle-Strengthening Exercise 129 7.2.2 Behavior-Based Exercises 129 7.2.2.1 Facilitation Techniques (Including Similar Effects) 130 Thermal-Tactile Stimulation [3, 6, 13] 130 K-Point Stimulation [14] 131 Balloon Dilatation 132 7.2.2.2 Target-Oriented Exercises 133 Swallowing Maneuvers 133 Supraglottic and Super-Supraglottic Swallow 133 Mendelsohn Maneuver 134 Effortful Swallow 134 Postural Modification 134 Reclining Position [31, 32] 135 Head Rotation or Head Turn 136 Combination of Reclining and Head Rotation 137 Head and Neck Flexion 139 Diet Modification (Texture Modification and Thickened Liquids) 140 Texture-Modified Food 141 New Innovation of Dysphagia Diet: Advanced Commercially Food Texture Modification in Japan 145 Thickened Liquids 147 Appendix 149 Tongue Range-of-Motion Exercise [6] 149 Tongue Resistance-Strengthening Exercise 150 Devices to Facilitate Tongue-Strengthening Exercise 151 Pecopanda (JMS Co., Ltd., Hiroshima, Japan) 151 Tongue Pressure Measurement Device [4, 40] 151 Isometric Progressive Resistance Oropharyngeal Therapy 152 Oromotor Control Exercise [6] 153 Shaker Exercise [2] 154 Jaw-Opening Exercise [5] 155 Tongue Base Retraction Exercise 156 Tongue-Holding Swallow Exercise (Masako Maneuver) 156 Expiratory Muscle-Strengthening Exercise 157 Device 1: Acapella® 157 Device 2: Threshold Positive Expiratory Pressure Device (Threshold PEPTM) 157 Thermal-Tactile Stimulation 158 K-Spoon 159 Balloon Dilatation 159 Supraglottic and Super-Supraglottic Swallow 161 Supraglottic Swallow 161 Super-Supraglottic Swallow 161 Mendelsohn Maneuver 163 Effortful Swallow [26, 27] 163 References 164 Chapter 8: Other Swallowing Treatments 167 8.1 Assistive System 167 8.1.1 Intermittent Oral Catheterization 167 8.1.2 Dental Prostheses 168 8.2 Surgical Treatment 169 Appendix 171 UES Myotomy Combined with Laryngeal Suspension 171 Indications 171 Contraindications 171 Surgical Procedure 172 References 173 Part IV: Case Studies 174 Chapter 9: Case Studies 175 9.1 Case Study 1 176 9.1.1 Instrumental Swallowing Assessment 177 9.1.2 Course of Treatment and Recovery 179 9.2 Case Study 2 183 9.2.1 Instrumental Swallowing Assessment 184 9.2.2 Course of Treatment and Recovery 186 9.3 Case Study 3 190 9.3.1 Instrumental Swallowing Assessment 192 9.3.2 Course of Treatment and Recovery 194 Index 202 Annotation This book presents a comprehensive approach to treating dysphagia, which has been successfully applied in actual rehabilitation settings. Dysphagia is a major complaint following neurogenic diseases and in elderly patients, and often results in serious health complications including pneumonia, malnutrition, and increased mortality risk. This life threatening morbidity in ageing societies has sparked the rapid development of dysphagia rehabilitation in recent years, as a result of which it is now firmly established in the area of rehabilitation medicine. The purpose of this book is firstly to equip readers with a strong conceptual understanding of swallowing evaluation and treatment, secondly to provide guidance on the procedure of practical comprehensive dysphagia rehabilitation in real-world settings, and thirdly to update readers on the latest diagnostic and treatment technologies. To do so, it employs the concept of swallowing rehabilitation pioneered at Fujita Health University Rehabilitation, which has been the most prominent, fully equipped academic center for dysphagia patients for over twenty years. The book is divided into 4 major parts, the first of which introduces readers to the general aspects and the principle of deglutition. In turn, Part II offers clinical approaches to both non-instrumental and instrumental evaluation of swallowing. Part III addresses treatment options in swallowing rehabilitation, especially exercises based on motor learning. Lastly, Part IV highlights three clinical cases demonstrating clinical approaches in dysphagic patients. Readers will find this text useful both as an initial guide and a reference work for assisting clinicians, allowing them to further expand swallowing assessment and treatment, and facilitating the development of swallowing rehabilitation in real-world settings in education and rehabilitation Front Matter ....Pages i-xxiii Front Matter ....Pages 1-1 Overview of Structures and Essential Terms (Kannit Pongpipatpaiboon, Yoko Inamoto, Koichiro Matsuo, Yoichiro Aoyagi, Seiko Shibata, Hitoshi Kagaya)....Pages 3-9 Evolution and Development of Human Swallowing (Kannit Pongpipatpaiboon, Yoko Inamoto, Koichiro Matsuo, Yoichiro Aoyagi, Seiko Shibata, Hitoshi Kagaya)....Pages 11-15 Physiological Models of Swallowing (Kannit Pongpipatpaiboon, Yoko Inamoto, Koichiro Matsuo, Yoichiro Aoyagi, Seiko Shibata, Hitoshi Kagaya)....Pages 17-25 Front Matter ....Pages 27-27 Dysphagia from the Viewpoint of Rehabilitation Medicine (Kannit Pongpipatpaiboon, Yoko Inamoto, Yoichiro Aoyagi, Seiko Shibata, Hitoshi Kagaya, Koichiro Matsuo)....Pages 29-33 Clinical Evaluation of Dysphagia (Kannit Pongpipatpaiboon, Yoko Inamoto, Yoichiro Aoyagi, Seiko Shibata, Hitoshi Kagaya, Koichiro Matsuo)....Pages 35-98 Front Matter ....Pages 99-99 Oral Hygiene Care (Yoko Inamoto, Kannit Pongpipatpaiboon, Seiko Shibata, Yoichiro Aoyagi, Hitoshi Kagaya, Koichiro Matsuo)....Pages 101-107 Swallowing Exercises (Yoko Inamoto, Kannit Pongpipatpaiboon, Seiko Shibata, Yoichiro Aoyagai, Hitoshi Kagaya, Koichiro Matsuo)....Pages 109-155 Other Swallowing Treatments (Yoko Inamoto, Kannit Pongpipatpaiboon, Seiko Shibata, Yoichiro Aoyagai, Hitoshi Kagaya, Koichiro Matsuo)....Pages 157-163 Front Matter ....Pages 165-165 Case Studies (Yoko Inamoto, Kannit Pongpipatpaiboon, Seiko Shibata, Yoichiro Aoyagai, Hitoshi Kagaya, Koichiro Matsuo)....Pages 167-193 Back Matter ....Pages 195-200 This book presents a comprehensive approach to treating dysphagia that has been successfully applied in actual rehabilitation settings. Its main purposes are firstly to equip readers with a strong conceptual understanding of swallowing evaluation and treatment, secondly to provide guidance on the procedure of practical comprehensive dysphagia rehabilitation in real-world settings, and thirdly to update readers on the latest diagnostic and treatment technologies. To do so, it employs the concept of swallowing rehabilitation pioneered at Fujita Health University Rehabilitation. The book is divided into 4 major sections, the first of which introduces readers to the general aspects and the principle of deglutition. In turn, Part II offers clinical approaches to both non-instrumental and instrumental evaluation of swallowing. Part III addresses treatment options in swallowing rehabilitation, especially exercises based on motor learning. Lastly, Part IV highlights three clinical cases demonstrating clinical approaches in dysphagic patients. Readers will find this text useful both as an initial guide and a reference work for assisting clinicians, allowing them to further expand swallowing assessment and treatment, and facilitating the development of swallowing rehabilitation in real-world settings in education and rehabilitation.