Thesis (M. Med. Sc.)--University of Hong Kong, 2004. / Also available in print.

Thesis (Ph. D.)--University of Canterbury, 2006. / Typescript (photocopy). "April 2006." Includes bibliographical references (p. 223-258). Also available via the World Wide Web.

Chan, Sze Ling. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 145-156). / Abstracts in English and Chinese; some appendixes in Chinese. / Declaration of Originality --- p.i / Acknowledgements --- p.ii / Abstract --- p.iv / 摘要(Abstract in Traditional Chinese) --- p.vii / Table of Contents --- p.ix / Abbreviations --- p.xvi / List of Figures --- p.xviii / List of Tables --- p.xix / Chapter Chapter 1 --- Literature Review --- p.1 / Chapter 1.1 --- What is neurogenic dysphagia? --- p.2 / Chapter 1.2 --- Prevalence of neurogenic dysphagia --- p.3 / Chapter 1.2.1 --- The prevalence of dysphagia in stroke --- p.3 / Chapter 1.2.2 --- The prevalence of dysphagia in dementias --- p.4 / Chapter 1.2.3 --- The prevalence of dysphagia in PD --- p.5 / Chapter 1.2.4 --- The prevalence of dysphagia in progressive supranuclear palsy (PSP) --- p.5 / Chapter 1.2.5 --- The prevalence of dysphagia in age-related changes --- p.5 / Chapter 1.3 --- Characteristics of neurogenic dysphagia --- p.6 / Chapter 1.3.1 --- Characteristics of dysphagia in stroke --- p.7 / Chapter 1.3.2 --- Characteristics of dysphagia in PD --- p.8 / Chapter 1.3.3 --- Characteristics of dysphagia in dementias --- p.9 / Chapter 1.3.4 --- Characteristics of dysphagia in age-related changes --- p.9 / Chapter 1. 4 --- Complications and prognosis of neurogenic dysphagia --- p.10 / Chapter 1.4.1 --- Complications --- p.10 / Chapter 1.4.2 --- Prognosis --- p.11 / Chapter 1.5 --- Managements of dysphagia --- p.13 / Chapter 1.5.1 --- Treating the underlying diseases --- p.13 / Chapter 1.5.2 --- Non-oral feeding --- p.13 / Chapter 1.5.3 --- Swallowing therapies --- p.14 / Chapter 1.5.3.1. --- Compensatory strategies --- p.14 / Chapter 1.5.3.2 --- Direct strategies --- p.16 / Chapter 1.5.3.3 --- Indirect strategies --- p.17 / Chapter 1.5.4 --- Medications --- p.19 / Chapter 1.5.5 --- Surgical interventions --- p.19 / Chapter 1.6 --- Management of dysphagia in Chinese medicine --- p.20 / Chapter 1.6.1 --- "Diagnosis, mechanisms and locations of dysphagia in Traditional Chinese medicine (TCM)" --- p.20 / Chapter 1.6.2 --- Use of acupoints in treating dysphagia in ancient Chinese medicine liteatures --- p.21 / Chapter 1.6.3 --- Use of acupuncture in treating dysphagia in recent Chinese medicine liteatures --- p.22 / Chapter 1.6.4 --- Reviews on the use of acupuncture in treating dysphagia --- p.25 / Chapter 1.7 --- Conslusion --- p.30 / Chapter Chapter 2 --- Methodology --- p.31 / Chapter 2.1 --- Study design --- p.32 / Chapter 2.2 --- Hypotheses of this study --- p.32 / Chapter 2.3 --- Objectives of this study --- p.32 / Chapter 2.4 --- Ethics approval --- p.32 / Chapter 2.5 --- Qualification & experience of the acupuncturists --- p.33 / Chapter 2.6 --- Subjects --- p.33 / Chapter 2.6.1 --- Setting --- p.33 / Chapter 2.6.2 --- Inclusion criteria --- p.33 / Chapter 2.6.3 --- Exclusion criteria --- p.34 / Chapter 2.7 --- Method of randomization and blinding --- p.35 / Chapter 2.7.1 --- Experimental group and control group1 --- p.35 / Chapter 2.7.2 --- Control group2 --- p.36 / Chapter 2.8 --- Sample size --- p.36 / Chapter 2.9 --- Procedures --- p.37 / Chapter 2.9.1 --- Screening and recruitment of subjects --- p.37 / Chapter 2.9.2 --- Baseline --- p.37 / Chapter 2.9.2.1 --- Chinese medicine diagnoses --- p.37 / Chapter 2.9.2.2 --- Western medicine diagnoses --- p.40 / Chapter 2.9.2.3 --- Clinical bedside assessment --- p.40 / Chapter 2.9.2.4 --- Procedure of fiberoptic endoscopic evaluation of swallowing --- p.41 / Chapter 2.9.3 --- Interventions --- p.43 / Chapter 2.9.3.1 --- Experimental group --- p.44 / Chapter 2.9.3.2 --- Control group1 --- p.53 / Chapter 2.9.3.3 --- Control group2 --- p.53 / Chapter 2.9.4 --- On completion of acupuncture treatments --- p.54 / Chapter 2.9.5 --- Follow-up assessment --- p.54 / Chapter 2.10 --- Adverse effects --- p.55 / Chapter 2.11 --- Outcome measures --- p.56 / Chapter 2.11.1 --- Primary outcome --- p.56 / Chapter 2.11.2 --- Secondary outcome --- p.58 / Chapter 2.11.3 --- Data collection --- p.59 / Chapter 2.12 --- Treatment compliance --- p.60 / Chapter 2.13 --- Statistical analysis --- p.60 / Chapter Chapter 3 --- Results --- p.62 / Chapter 3.1 --- Baseline data --- p.63 / Chapter 3.2 --- Diagnoses --- p.67 / Chapter 3.2.1 --- Western medicine diagnoses --- p.67 / Chapter 3.2.2 --- Chinese medicine diagnoses --- p.71 / Chapter 3.3 --- Data of acupuncture treatments --- p.72 / Chapter 3.3.1 --- Days of onset to the day of acupuncture treatment --- p.72 / Chapter 3.3.2 --- Sessions of acupuncture completed by experimental group and control group1 --- p.73 / Chapter 3.3.3 --- Follow-up compliance --- p.75 / Chapter 3.4 --- Primary outcome measures --- p.75 / Chapter 3.4.1 --- The Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS) --- p.75 / Chapter 3.4.1.1 --- Correlations of diagnoses and RBHOMS --- p.80 / Chapter 3.4.2 --- The Penetration-Aspiration Scale (PAS) --- p.81 / Chapter 3.5 --- Secondary outcome measures --- p.83 / Chapter 3.5.1 --- The food and fluid consistencies --- p.83 / Chapter 3.5.2 --- The body mass index (BMI) --- p.90 / Chapter 3.5.3 --- Aspiration pneumonia --- p.92 / Chapter 3.5.4 --- Mortality rate --- p.93 / Chapter 3.6 --- Other outcomes --- p.94 / Chapter 3.6.1 --- Nasogastric tube feeding --- p.94 / Chapter 3.7 --- Adverse effects --- p.95 / Chapter Chapter 4 --- Discussion --- p.99 / Chapter 4.1 --- The therapeutic effect and appropriate course of treatment of acupuncture on neurogenic dysphagia --- p.101 / Chapter 4.1.1 --- The therapeutic effect and long-term efficacy of acupuncture on neurogenic dysphagia --- p.101 / Chapter 4.1.2 --- The suggested course of acupuncture treatment --- p.117 / Chapter 4.2 --- The implications of the study --- p.119 / Chapter 4.3 --- The limitations of the study --- p.123 / Chapter 4.4 --- Conclusion and prospective for further study --- p.127 / Appendices --- p.128 / References --- p.145

Undernutrition and dysphagia in the institutionalized elderly are well documented in the literature. However, the clinical efficacy of diets to treat dysphagia have not been established. To offer a better understanding of the textural characteristics of the new Sainte-Anne's Hospital (SAH) modified texture reformed foods, rheological evaluations were performed. Apparent viscosity, consistency coefficient, flow behavior index and yield stress values were calculated for the thickened beverages. Texture profile analyses were performed on the reformed foods. Secondly, to evaluate the impact of SAH's reformed foods on nutritional intake and weight, a 12-week clinical trial was undertaken. Dysphagic frail elderly subjects (n = 17) of a long-term care facility of Montreal were randomly assigned to receive SAH reformed foods or traditional care. The experimental group demonstrated a significant increase in nutritional intake resulting in significant weight gain. These findings suggest that dysphagic frail elderly could reach healthy weight when adequately fed.

No description available.

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

Made available in DSpace on 2014-06-11T19:22:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-08-22Bitstream added on 2014-06-13T19:27:14Z : No. of bitstreams: 1 fioravanti_mp_me_botfm.pdf: 623692 bytes, checksum: 5ec64d660f1df53219efc1f3b21de315 (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / O aumento da expectativa de vida preocupa os profissionais de saúde quanto à qualidade da mesma em idosos. Entre os problemas que surgem com o envelhecimento estão aqueles relacionados com as condições orais e os distúrbios da deglutição. Os distúrbios da deglutição orofaríngea em idosos, particularmente naqueles institucionalizados, causam desnutrição, desidratação e disfagia, aspiração e pneumonia. A dificuldade para deglutir pode ser avaliada inicialmente por testes clínicos fonoaudiológicos da deglutição, os quais apresentam grande heterogeneidade quanto aos sinais clínicos observados e às consistências e volume de alimentos usados. Objetivo: Caracterizar e classificar a deglutição orofaríngea do idoso institucionalizado. Pacientes e Métodos: Foram estudados 47 moradores de uma casa de repouso que ingeriram 4 consistências de alimentos e foram observados quanto à presença de 7 sinais clínicos sugestivos risco de disfagia e de aspiração. As condições oral e nutricional foram determinadas, foram estabelecidas correlações entre consistências e presença de alterações clínicas e foi criada classificação das alterações segundo grau de severidade. Resultados: Foram encontrados 43 indivíduos desdentados, 40% deles com prótese dentária, 38 dos quais com alteração à mastigação para sólido entre 78 alterações nas 4 consistências. Dos 47 indivíduos, cerca de 69% apresentaram alterações à mastigação de sólidos, enquanto que alteração na elevação da laringe e alteração na qualidade vocal foram apresentados, cada uma, por 15,6% deles. Na consistência pastoso grosso cerca de 19% dos idosos apresentavam deglutições múltiplas, enquanto que alteração na elevação da laringe e da qualidade vocal estiveram presentes, cada uma, em 13%. Foram classificados como portadores de alteração de grau leve a moderado... / The increase in life expectancy concerns health care professionals with regard to the quality of life of the elderly population. Problems arising from ageing include those related to oral condition and deglutition disorders. Oropharyngeal swallowing disorders particularly in institutionalized elderly individuals, cause malnutrition, dehydration, aspiration and pneumonia. Swallowing impairment can be initially evaluated by clinical tests, which present great heterogeneity regarding the clinical signs observed and the consistency and volume of the food used. Objective: To characterize and classify oropharyngeal deglutition in institutionalized elderly individuals by means the bedside clinical evaluation. Patients and methods: Forty-seven nursing home residents were evaluated during ingestion of foods of four consistencies. They were assessed for the presence of 7 clinical signs suggestive of risk dysphagia. Oral and nutritional conditions were determined; correlations between the consistencies and the presence of clinical changes were established and a classification of the alterations according to levels of severity was done. Forty-three toothless individuals were found, of whom 40% had dental prostheses and 38 presented alteration in mastication for solid food among the 78 alterations found for the 4 consistencies. Of the 47 individuals, approximately 69% showed alteration for solid food and impairment of larynx elevation and of vocal quality were each found in 15.6% of the subjects. In thick consistency 19% of the elderly showed repetitive swallowing and alteration in larynx elevation and vocal quality were each present in 13% of the elderly. Seventy-four percent of the individuals were classified as presenting mild to moderate alteration, and 38% of them were malnourished, without differences between age ranges. Discussion: The presence... (Complete abstract click electronic access below)

Thesis (Ph.D.)--University of Canterbury, 2009. / Typescript (photocopy). "29th April 2009." Includes bibliographical references (p. 256-277). Also available via the World Wide Web.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Thesis (M.S.L.T.)--University of Canterbury, 2007. / Typescript (photocopy). Includes bibliographical references (p. 30-34). Also available via the World Wide Web.