Includes bibliographical references / South Africa has a high incidence of injury-related disorders, such as traumatic brain injury (TBI) as a result of motor vehicle accidents and assault. Dysphagia is a common sequela of TBI, which may result in malnutrition or aspiration pneumonia. There is limited epidemiological data available for TBI and dysphagia in South Africa which is important for health care planning. There is also inadequate literature reporting predictive factors for dysphagia and health outcomes of patients with TBI and swallowing disorders for the South African context, which would provide management guidelines for Speech-Language Pathologists (SLPs) for patients with TBI and dysphagia. This study aims to begin to provide up-to-date information regarding the incidence of TBI and the prevalence of dysphagia in the population with TBI in Bloemfontein, South Africa. Predictive factors for dysphagia and health outcomes were also investigated in order to provide management guidelines for TBI-related dysphagia for SLPs. A prospective cohort study followed 77 participants aged 18 to 68 years (M = 33.1) with mild to severe traumatic brain injury, admitted to 2 state and 2 private hospitals in the Bloemfontein metropole, South Africa, to investigate the incidence of TBI and the prevalence of TBI-related dysphagia in the adult population in 2013. Participants were tracked from admission to hospital to discharge. Demographic and medical data was collected for each participant, including: gender, age, TBI aetiology, means of nutritional intake, respiratory status, length of hospital stay, and number of speech therapy sessions. Glasgow Coma Scale (GCS) scores at time of admission, swallowing evaluation, and discharge were noted as an indicator of TBI severity and each participant was assessed with the Mann Assessment of Swallowing Ability on admission and prior to discharge to assess the presence of dysphagia. The incidence of TBI for the Bloemfontein metropole was 353 per 100,000 people and was greater in the male than in the female population (11.83:1). The main mechanism for TBI in Bloemfontein was interpersonal violence (67.53%), followed by road traffic accidents (motor and pedestrian vehicle accidents; 23.38%). The prevalence rate for dysphagia was 32%. Twenty-eight percent of those who presented with dysphagia also aspirated. Severe TBI (GCS ≤ 8) was identified as a predictive factor for dysphagia. Participants with dysphagia had longer hospital stays (days; M = 22.04, SD = 17.67) than those with normal swallowing (M = 6.23, SD = 4.28), t(75) = 6.13, p < .001, and took significantly more days to achieve oral intake (M = 6.23, SD = 10.32) than those without dysphagia (M = .31, SD = 1.41), t(75) = 4.08, p < .001. Ventilation was associated with longer hospital stays, rs(25) = -.47, p = .02 and longer duration until achievement of oral intake, rs(22) = -.80, p < .001. Tracheotomised participants also had significantly longer hospital stays, rs(25) = -.67, p < .001, and took longer to achieve oral intake, rs(22) = -.52, p = .01. An increased period of time with a tracheostomy was also significantly associated with mortality, χ2(2, n = 11) = 6.52, p = .04. Participants with dysphagia (M = 3.84, SD = 5.44) required significantly more therapy sessions with an SLP than those without dysphagia (M = .15, SD = .64), t(75) = 4.85, p < .001, and those with low GCS scores were significantly less likely to achieve oral intake prior to discharge, rs(25) = -.45, p = .02, and had longer hospital stays than participants with mild head injuries, rs(25) = -.49, p = .01. All participants who received nutrition via nasogastric tubes returned to oral intake; however, individuals who had percutaneous endoscopic gastrostomies did not achieve oral intake prior to discharge. It is recommended that objective swallowing evaluations be conducted for patients admitted with severe TBIs, and patients with mild and moderate TBIs be screened to determine the presence of dysphagia. TBI prevention initiatives should be developed to reduce the incidence of TBI, specifically in the young adult male population.

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No description available.

<p>  </p> <p>With fewer speech-language pathology (SLP) clinical training opportunities, it is difficult for students to gain the experience necessary to display proficiency and confidence in treating patients with dysphagia. To address this gap, many educators have turned to simulation-based training (SBT). This project examined the impact of a novel computer-based simulation dysphagia training implemented into Purdue University’s core Dysphagia course on students’ confidence and competence. During this training, students completed a comprehensive bedside swallowing evaluation and analysis of a videofluoroscopic swallow study (VFSS) of 2 simulated patients. </p> <p>A repeated measure design was utilized. Data were collected on 27 SLP graduate students (n=27; 26 females, 1 male; age range: 21-27 years) at baseline, Post-Simulation 1 and Post-Simulation 2. We evaluated confidence and clinical knowledge through the following outcome measures: students’ self-rated confidence levels rated using an adapted Self-Efficacy survey, and agreement levels with our gold standard rater on clinical evaluation forms. Data for students’ self-rated confidence were collected at three time points (baseline, Post-Simulation 1, Post-Simulation 2), and organized into three composite areas (Treatment, Evaluation, and Personal & Interpersonal Skills). Clinical knowledge was measured at two time points (Post-Simulation 1 and Post-Simulation 2 ) using clinical evaluation forms, which were completed for each of our two simulated patients. Clinical evaluation forms included a cranial nerve exam form, a videofluoroscopic swallow study (VFSS) analysis form, and an Overall Impressions and Recommendations form, including the Functional Oral Intake Scale (FOIS) and a recommendation list. </p> <p>Significant increases in confidence in the Evaluation (t(26)= -8.22, p < .0001), Treatment (t(26)= -5.06 , p < .0001) and Personal & Interpersonal (t(26)= -10.31, p < .0001) composite areas of the Self-Efficacy survey were seen from baseline to Post-Simulation 2. While students did not show significant improvements in clinical performance for FOIS ratings and VFSS analysis, they did show significant improvements in their ratings for the cranial nerve exam (t(26)= -5.728, p < .0001), and in their choice of recommendations (t(26) = -5.247, p < .000 1) between the first and the second simulation. </p> <p>In this sample of participants, students had significant improvements in confidence and clinical competence in several clinical knowledge areas. These paired results suggest that these participants benefitted from completing our SBT dysphagia training. Although our findings provide some initial insight into the impact of this novel computer-based SBT for graduate dysphagia education, additional research is required to further validate these findings. </p>

In patients with a functional gastrointestinal (GI) tract, enteral feeding is preferred over parenteral feeding as it has fewer complications and a relatively lower cost. Nasogastric and nasoenteric feeding tubes are available options but when long-term enteral feeding is desired, a percutaneous endoscopic gastrostomy (PEG) tube is more convenient. PEG tube can be associated with multiple complications; however, its displacement which causes gastric outlet obstruction (GOO) is a rare one. Here we present a case of an 81-year-old woman with dementia who presented with upper GI bleeding and was found to have GOO causing reflux esophagitis due to PEG tube displacement.

Bakgrund: Dysfagi innebär svårigheter att svälja och orsakerna till att drabbas varierar. Vardagen kan förändras drastiskt och måltiderna innefattar ofta stora utmaningar. Även spontaniteten i vardagen kan påverkas och planering inför sociala aktiviteter mer omfattande. Skam kan påverka den sociala samvaron och föranleda självisolering. Med dysfagin kommer ökade risker vid måltider som att sätta i halsen vilket i värsta fall kan leda till döden. Syfte: Syftet med studien var att belysa hur vuxna patienter som lever med dysfagi upplever sin livskvalité. Metod: Studien genomfördes som en allmän litteraturstudie, vilken baserades på tio resultatartiklar som bearbetades. Resultat: Analysen resulterade i två huvudkategorier: Dysfagin upptar hela mitt liv och Interaktion är avgörande för min livskvalité och fyra underkategorier: Dysfagin kräver all min uppmärksamhet, Känslor kring situationer i vardagen med dysfagi, Copingstrategier bidrar till hopp om framtiden samt Mina behov av stöd från vård och omsorg. Konklusion: Upplevelser som påverkade livskvaliteten hos patienterna var bland annat förändrade kostvanor och den självupplevda sociala samvaron. Goda relationer och tydlig kommunikation visade sig också ge goda förutsättningar för att förbättra livskvaliteten. / Background: Dysphagia means swallowing difficulties and the causes of the problem vary. Everyday life can change drastically, and meals often involve major challenges. Even spontaneity in everyday life can be affected and planning for social activities more extensive. Shame can affect social interaction and lead to self-isolation. With dysphagia comes increased risks during meals such as choking, which in the worst case can lead to death. Purpose: The purpose of the study was to describe how adult patients living with dysphagia experience their quality of life. Method: The study was conducted as a general literature study, which was based on ten result articles that were processed and analyzed. Results: The results generated in two main categories: Dysphagia occupies my whole life and Interaction is crucial for my quality of life and four subcategories: Dysphagia requires all my attention, Feelings about situations in everyday life with dysphagia, Coping strategies contributes hope for the future and My needs for support from care and welfare. Conclusion: Experiences that affected the quality of life included changes in dietary habits and perceived social interaction. Good relationships and clear communication also proved to provide good conditions for improving the quality of life.

Background: Head and neck cancer (HNC)-specific symptoms have a substantial impact on health-related quality of life. The aim of this study was to determine whether self-reported dysphagia, voice problems and pain of HNC patients changed over time and whether specific clinical or sociodemographic variables were associated with these symptoms. Methods: HNC patients (n = 299) in an outpatient setting answered questionnaires (Eating Assessment Tool-10; questions from the EORTC QLQ-C30 and EORTC H&N35) on dysphagia, voice problems and pain, collected with the software “OncoFunction” at three different timepoints (t1–t3) after diagnosis. The mean score changes from t1 to t3 were expressed in terms of effect sizes d. The impact of sociodemographic and clinical factors on the course of the variables was tested with multivariate analyses of variance. Results: Dysphagia, voice impairment and pain in HNC survivors significantly improved over a period of approximately 14 months after diagnosis. Tumor site, stage, treatment modality, occupational state and ECOG state were significantly correlated with self-reported functional outcome. The pain level of the HNC patients was rather low. Conclusions: Patients suffer from functional impairments after HNC treatment, but an improvement in self-reported symptoms could be demonstrated within this time period.

Background: Due to a lack of prospective research in South Africa's Speech-Language Therapy (SLT) private healthcare sector, this prospective cohort study investigated associations between speech, language, and swallowing conditions (i.e. dysarthria, apraxia of speech, aphasia, dysphagia), risk factors, and outcomes post-stroke (i.e. length of hospital stay, degree of physical disability according to the Modified Rankin Scale [mRS], functional level of oral intake according to the Functional Oral Intake Scale [FOIS], dehydration, weight loss, aspiration pneumonia, mortality). Methods: Adults with a new incident of stroke without pre-existing speech, language or swallowing difficulties (N=68) were recruited. Convenience sampling was used to select participants. A prospective design was used to determine the incidence of speech, language, and swallowing conditions poststroke and association with outcomes from admission to discharge. Results: Co-occurring speech, language, and swallowing conditions frequently occurred post-stroke (88%). Participants who were referred to SLT greater than 24 hours post-admission (52.94%) stayed in hospital for a median of three days longer than those who were referred within 24 hours (p=.042). Dysphagia was significantly associated with moderate to severe physical disability. Dysphagia with aspiration was significantly associated with poor functional level of oral intake (i.e. altered consistency diets and enteral nutrition), at admission and at discharge (p<. 01). Dysphagia had a higher likelihood of mortality (OR=2.86) (p=.319). At discharge, aspiration pneumonia was significantly associated with severe physical disability (p< .01, r=0.70). Risk factors; poor oral hygiene (p=1.00), low level of consciousness (p=1.00), dependent for oral intake (p=.040), and enteral nutrition (p=.257); were not associated with aspiration pneumonia. Conclusion: In South Africa's private sector, cooccurring speech, language, and swallowing conditions commonly occurred post-stroke, and dysphagia was strongly associated with physical disability and poor functional level of oral intake. Length of hospital stay was increased by delayed SLT referrals.

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No description available.