Dysphagia, which refers to difficulties in swallowing, is a common clinical dysfunction with high morbidity in the ageing population. At least four validated questionnaires are available for assessing swallowing-related quality of life. These include the M. D. Anderson Dysphagia Inventory (MDADI), the Swallow Quality-of-Life Questionnaire (SWAL-QOL), the Sydney Swallowing Questionnaire (SSQ) and the Dysphagia Handicap Index (DHI). However, these questionnaires are either designed for some specific dysphagic populations or only focused on the impact of swallowing disorders at the impairment level. The Swallowing Activity and Participation Profile (SAPP) has been developed and validated as a self-reported tool for dysphagic population to assess the effects of swallowing problems on the physical, functional and social aspects of quality of life. It is common to find the elderly population exhibiting cognitive impairment. Elderly people with cognitive impairment may have difficulties completing the questionnaire by themselves. In such cases, family members or caregivers are often asked to judge how the dysphagic individuals are affected by the swallowing dysfunction. There are, however, most of the previous studies failed to investigate the validity and reliability of such proxy method. Thus, the objective of this study was to verify the reliability of proxy method in assessing swallowing-related quality of life for frail elderly people who are not able to finish the self-reported questionnaire because of their cognitive impairment. Forty-six elderly individuals (24 males and 22 females) and their respective caregivers (six males and 36 females) participated in this study. All the elderly received a clinical swallowing assessment to confirm the existence and the severity of dysphagia. They were assigned into the dysphagic group and the non-dysphagic group according to the results of swallowing assessment, and then asked to complete a quality of life questionnaire (SAPP) and a swallowing function scale, called Eating Assessment Tool (EAT-10). Their caregivers were invited to complete the same assessment tasks from the perspective of the elderly and to report how they perceived the elderly persons’ swallowing–related quality of life as the proxies. The scores obtained from the questionnaires filled out by the elderly participants and their caregivers were compared. The findings showed that there was no statistically significant agreement between the elderly and the caregivers. The association between the responses of the elderly and the caregivers on quality of life was not as strong as what was hypothesized at the beginning of this study. However, the test-retest reliability of the instrument of this study was good, as shown by the intra-class correlation coefficient in the elderly group. The current study found that dysphagia had a negative impact on the dysphagic elderly’s emotional well-being, but was not clear if the proxy method could be used as a valid and reliable method for assessing the elderly’s swallowing-related quality of life. Further studies with a larger sample size and a wider range of dysphagia severity are needed. / published_or_final_version / Speech and Hearing Sciences / Master / Master of Philosophy

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Background: One of the common complications of stroke is dysphagia. Dysphagia can be a disabling problem with negative psycho-social consequences. The effect of dysphagia on quality-of-life is not well understood among the stroke survivors. The Chinese version of Swallow Quality-of-Life Questionnaire can be a reliable instrument to provide a multidimensional evaluation on the impact of post-stroke dysphagia in the population of Hong Kong Chinese older adults. Objective: To investigate factors associated with the swallowing-related quality-of-life in Hong Kong Chinese older adults with the history of stroke during the post-acute phase, using a disease-specific quality-of-life questionnaire (CSWAL-QOL). Method: This was a cross-sectional study of 92 stroke survivors, aged over 55. They were recruited from the inpatient wards and out-patient clinics. They were assessed for any dysphagia and its severity by the bedside swallow assessment. The Mini-Mental State Examination and the Chinese version of Swallow Quality-of-Life Questionnaire were used for cognitive and quality-of-life assessment respectively. Results: The test-retest reliability of the test was moderately correlated (Spearman’s rho 0.62).Participants on modified diet/fluid, on tube-feeding, older age and post-stroke for 1-2 years were observed to have lower CSWAL-QOL score across scales. Conclusion: The effect of ageing appeared to be a factor affecting swallowing-related QOL in stroke survivors, with better QOL in younger participants(age ranged from 55 to 69) and similar QOL in old (age ranged from 70 to 85) and very old (age above 85)participants. No gradual change of QOL was found as post-stroke duration increases. The oral feeding mode and normal food and fluid consistency resulted a better QOL in stroke survivors. / published_or_final_version / Medicine / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Expiratory muscle strength training (EMST) is a resistance exercise targeting the expiratory musculature that has predominated rehabilitation research for cough and swallowing. While there have been consistent improvements in expiratory muscle strength with EMST, and promising findings in cough and swallowing, there remains a substantial gap in our understanding of the physiologic adaptations associated with training and how to optimize rehabilitative outcomes. This dissertation consists of two studies aimed at refining EMST protocols for cough and swallowing rehabilitation. Chapter 1 is an introduction that provides an overview of exercise prescription principles, outlines what is known related to exercise protocols and EMST outcome measures, and finally describes the current research gaps and dissertation aims. Chapter 2 focuses on quantifying the relationship between resistive load and ratings of perceived exertion (RPE) during EMST, examines variability in RPE in healthy adults, and compares RPE using two respiratory devices. In Chapter 3, we examine the impact of modifying exercise parameters on physiologic adaptations and RPE, while also beginning to establish links between EMST, cough, and swallowing by assessing task specificity. Chapter 4 synthesizes the research findings into the greater scientific literature, discusses the clinical implications of this work, outlines limitations, and suggests avenues for future research.