Article

The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis

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Abstract

Swallowing problems can be relevant, even if underestimated, in Multiple Sclerosis (MS) patients. However, no specific questionnaire for the assessment of dysphagia in MS is available. We built a questionnaire (DYsphagia in MUltiple Sclerosis, DYMUS) that was administered to 226 consecutive MS patients (168 F, 58 M, mean age 40.5 years, mean disease duration 10.1 years, mean EDSS 3.1) during control visits in four Italian MS Centres. DYMUS was abnormal in 80 cases (35%). The patients who claimed to have swallowing problems had a significantly higher mean DYMUS score that the other patients (p<0.0001). Mean DYMUS scores were significantly higher in the progressive forms (p=0.003). DYMUS values were significantly correlated to EDSS (p=0.0007). DYMUS showed a very good internal consistency (Cronbach's alpha 0.877). Factor analysis allowed us to sub-divide DYMUS in two sub-scales, 'dysphagia for solid' and 'dysphagia for liquid', both of them had a very good internal consistency (Cronbach's alpha 0.852 and 0.870 respectively). DYMUS demonstrated to be an easy and consistent tool to detect dysphagia and its main characteristics in MS. It can be used for preliminary selection of patients to submit to more specific instrumental analyses, and to direct toward programs for prevention of aspiration.

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... Few instruments are available in order to screen ALS patients for dysphagia [10][11][12], and the approach is widely heterogeneous across the ALS centres in Italy. Dysphagia in multiple sclerosis (DYMUS) questionnaire has been created and subsequently validated in a large cohort of Italian MS patients as a reliable, manageable, and easy-to-administer tool [13,14]. ...
... DYMUS is a 10-item questionnaire, in which every answer is dichotomous ('yes' or 'no'). The questionnaire was created and validated in a large cohort of MS patients [13,14], demonstrating high internal consistency. Bergamaschi et al. performed a factor analysis that showed the presence of two subscales: 'dysphagia for solids' and 'dysphagia for liquids'. ...
... Bergamaschi et al. performed a factor analysis that showed the presence of two subscales: 'dysphagia for solids' and 'dysphagia for liquids'. Both the subscales had high internal consistency [13]. In the present study, we propose to confirm the consistency and the reliability of the questionnaire in a different cohort of neurological patients, affected by ALS, and to make external validation using the gold-standard scales for dysphagia (EAT-10, or ALSFRS-R). ...
Article
Background Dysphagia is a common symptom during the trajectory of ALS, and it can significantly impact on the quality of life and prognosis of patients. Nowadays, no specific tool for the screening of dysphagia in ALS is validated, and the approach is heterogeneous across the Italian centres.Objective To validate the DYALS (dysphagia in amyotrophic lateral sclerosis) questionnaire, adapting the DYMUS (dysphagia in multiple sclerosis) questionnaire, for the assessment of dysphagia in ALS patients, in order to uniform the evaluations across the Italian ALS network.Methods We included 197 patients diagnosed with ALS following the El Escorial criteria, in sixteen Italian ALS centres between 1st December 2019 and 1st July 2020. For each patient, we collected clinical and demographic data and obtained ALSFRS-r score, ALSAQ-5 score, DYMUS score, and EAT-10 score.ResultsAcross the 197 patients, the ratio M/F was 113/84, and the median age was 64 years (IQR 56–72.5). Bulbar patients were 20%, and spinal patients 80%. The median ALSFRSr total score of patients was 35 (IQR 28–39). DYALS score was statistically higher in bulbar ALS than in spinal ALS (median = 6, IQR 4.5–9 vs median = 1, IQR 0–5, z = 6.253, p < 0.0001). DYALS questionnaire showed a high internal consistency (Cronbach’s alpha = 0.88). There was a statistically significant correlation between DYALS and EAT-10 (rho = 0.90, p < 0.0001).ConclusionsDYALS scale is reliable, manageable, and easily usable for the screening of dysphagia in ALS. It can be shared with all the Italian ALS centres in order to collect uniform data for therapeutic strategies and clinical trials.
... To assess the prevalence of dysphagia, the following screening questionnaires were used: DYMUS (DYsphagia in MUltiple Sclerosis) (Bergamaschi et al., 2008), EAT-10 (Eating Assessment Tool) (Belafsky et al., 2008) and SDQ (Swallowing Disturbance Questionnaire) (Jacob et al., 2011). We used Polish version of these questionnaires The questionnaries had internal consistency and a reliability coefficient (Cronbach's alpha) of 0.79-0.83. ...
... • the SDQ score ≥12.5 points (Jacob et al., 2011); • the DYMUS score ≥3 points (Bergamaschi et al., 2008); • the EAT-10 score ≥3 points (Belafsky et al., 2008). ...
... Almost all questions referred to the effectiveness of swallowing, except the last question (number 15) about weight loss over the last 6 months. The patients were asked to respond 'yes' or 'no' to the questions to indicate that they had or, respectively, that they did not have the relevant symptom (Bergamaschi et al., 2008). The DYMUS score ≥3 points was taken as an abnormal result. ...
Article
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Background: Studies show that dysphagia is a common problem in patients with demyelinating diseases. However, there are no published studies on dysphagia in this group of patients, which would include the individual phases or the safety and effectiveness of the swallowing process. Objective: The main objective of this study was to assess the prevalence of swallowing disorders and to characterize them based on subjective assessment by the study subjects with multiple sclerosis and Devic's syndrome. Method: The study included 72 patients (47 F, 25 M). Patients at risk of dysphagia were identified using the DYMUS, EAT-10 and SDQ questionnaires. To assess the type of oral- and pharyngeal-stage dysphagia, questions in the questionnaires were classified into groups according to symptoms typical of each stage. Results: The risk of dysphagia and the need for instrumental examination were identified in 37.5% of the study subjects. Pharyngeal-stage dysphagia (repeated swallowing, increased effort of swallowing, cough, a feeling of food sticking in the throat) was reported to occur at a significantly higher frequency. However, no differences were found between difficulty in swallowing liquids and difficulty in swallowing solid food. Conclusion: There is a need for further research, which should include a detailed dysphagia-oriented diagnosis, with a view to gaining a detailed insight into the pathophysiology of deglutition in this group of patients.
... and significant correlation with the Kurtzke's Expanded Disability Status Scale, EDSS (p=0.0007). 11 As shown in Table 2, the DYSMUS has two reliable subscales: 1) Dysphagia for solid and 2) Dysphagia for liquid. 11 The second larger validation study (n=1734) confirmed the internal consistency reliability (Cronbach's alpha=0.914), ...
... 11 As shown in Table 2, the DYSMUS has two reliable subscales: 1) Dysphagia for solid and 2) Dysphagia for liquid. 11 The second larger validation study (n=1734) confirmed the internal consistency reliability (Cronbach's alpha=0.914), discriminant validity, and dimensionality of the original DYMUS questionnaire. ...
... 17 The shortened version of the DYMUS with five items showed high internal consistency reliability (alpha = 0.904) 17 ( Table 3). The scoring of the shortened DYMUS for identifying the presence of dysphagia is similar to the original ten-item version 11 such that the dysphagia can be identified by at least one "Yes" answer. 17 The shortened DYMUS is easy to use and quickly administer PRO questionnaire for screening of MS patients with dysphagia and has good reliability [internal consistency and test-retest reliability (Cohen's kappa=0.54-0.80)] ...
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Dysphagia after multiple sclerosis (MS) is a common disabling symptom which can lead to serious complications. Regular screening and assessment of dysphagia in patients with MS are important. Using valid and reliable instruments to measure dysphagia in MS patients is a crucial component in clinical practice and of research quality. There are various strategies to diagnose and assess the dysphagia in patients with MS. Screening strategies are for early diagnosis of the dysphagia. Clinical, non-instrumental strategies are used to verify the presence and to determine the severity and cause of dysphagia. Instrumental strategies are complementary to clinical examination to provide objective data on the various aspects of swallowing dysfunctions. This review revealed a few validated tools for dysphagia assessment in MS. The Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) and the Mann Assessment of Swallowing Ability (MASA) are the only validated MS-specific dysphagia tools. Further development of valid and reliable MS-specific screening and assessment tools that can be administered rapidly and scored easily to detect dysphagia and evaluate clinical outcomes in adults with MS is imperative. Until then, validation and metric evaluation of the screening and assessment tools currently available are required.
... Symptom control is an important part of the treatment of patients with MS, however, signs and symptoms of dysphagia are frequently neglected by patients and caregivers. [1][2][3][4][5] Swallowing disorders, or dysphagia, is related to any change in the swallowing process that hinders safe, efficient and comfortable oral ingestion of food or liquids and is due to neurological or structural impairments. The signs and symptoms are characterized according to phase and/ or between the phases of its dynamics. ...
... Moreover, there is a lack of consensus between those methods, differences in the severity classification of the disease and the results obtained. 1,[4][5] Therefore, recognize the patients with swallowing abnormalities in early stages of MS is essential in the prevention of pneumonias, laryngeal aspiration, malnutrition, dehydration, and its complications that can result in death. As well as the appropriate elaboration of the therapeutic treatment of the differents stages and difficulties in swallowing. ...
... Deglutition disorders are life-threatening factors and often underestimated or neglected by patients with MS. 1,2,5,10 This population presents a high risk of dehydration, malnutrition and pulmonary alterations, which can lead to death. 1,2 The management of swallowing with functional assessments allows the development of attention, care and rehabilitation programs in the early stages of the disease, reducing these risks and promoting a better quality of life. ...
... To our knowledge, there is one MS-specific speech-language pathology-related PROM, the DYsphagia in MUltiple Sclerosis (DYMUS) (Bergamaschi et al., 2008). In their initial article, Bergamaschi et al. (2008) set out to define and validate this tool and in conclusion reported a reliable and valid questionnaire. ...
... To our knowledge, there is one MS-specific speech-language pathology-related PROM, the DYsphagia in MUltiple Sclerosis (DYMUS) (Bergamaschi et al., 2008). In their initial article, Bergamaschi et al. (2008) set out to define and validate this tool and in conclusion reported a reliable and valid questionnaire. However, their methodology lacks rigour when compared to the quality criteria for evaluating HRQoL questionnaires developed by Terwee et al. (2007). ...
... As the current study is the first to validate a PROM that assesses a spectrum of speech-language pathology symptoms in PwMS, direct comparisons with other similar studies cannot be drawn. However, it is possible to draw some comparisons between this study and the validation of the DYMUS questionnaire to assess dysphagia in PwMS (Bergamaschi et al., 2008). The demographic and clinical characteristics of this study's participants are similar to those from the DYMUS study: 81.1% of participants in this study were female versus 74% in the DYMUS study; 61.6% of participants had relapsing-remitting MS in this study versus 72% in the DYMUS study; the mean age of participants in this study was 47.9 years versus 40.5 years in the DYMUS study; the mean disease duration of participants in this study was 12.9 years versus 10.1 years in the DYMUS study. ...
Article
Purpose: The aim of this study was to develop and validate the Speech pathology-specific questionnaire for persons with Multiple Sclerosis (SMS). Method: Forty-one items were generated through a literature review. Items were submitted to a preliminary psychometric validation process consisting of principal component analysis, internal consistency, test-retest reliability, and floor and ceiling effects using data from 164 participants. Criterion validity was assessed by comparing the SMS with the 12-item Short Form Health Survey (SF-12). Participants were recruited internationally through online channels and questionnaires were completed online. Result: The SMS contains 16 items describing three components: speech and voice, language, and swallowing. Internal consistency (Cronbach's alpha) of the three components was satisfactory (α = 0.89-α = 0.91). Criterion validity was evaluated using Spearman's rank correlation coefficient (ρ). A statistically significant weak to moderate correlation between the SMS and the SF-12 was identified (ρ = -0.004-ρ = -0.359). No floor or ceiling effects were present. The SMS demonstrated strong test-retest reliability. All items had an intra-class correlation coefficient ≥0.70. Conclusion: The SMS is a psychometrically robust patient-reported outcome measure to assess speech-language pathology symptoms in persons with MS.
... About MS, Bergamaschi et al. [29,30] developed and validated a simple 10-items questionnaire, called the DYMUS (dysphagia in MS), which is used in the clinical practice as measure for evaluating the presence of dysphagia in adults with MS. Very recently, it was tested the shortened (five items) versions of DYMUS in 100 consecutive people with MS, and it was found to be as valid as the original version in terms of internal consistency, test-retest reliability, and convergent validity [31]. ...
... DYMUS is used to detect oropharyngeal dysphagia and identify individuals in need of more objective evaluations of swallowing and programs for prevention of aspiration. It was initially tested in a cohort of 226 consecutive people with all forms of MS, and the questionnaire was abnormal in 80 cases (35%) [29,30]. People who reported dysphagia had higher EDSS score and longer disease duration. ...
... Nevertheless, there was substantial heterogeneity across subjective and objective prevalence estimates. Several studies reported that the prevalence of dysphagia is related to the level of disability and the duration of the disease [11,47,48], while other reported that dysphagia can be present in patients with MS with low disability [29]. Diagnosis, based on clinical evaluations, is undoubtedly increased when patients are evaluated by means of instrumental investigations such as VFS that can show subclinical impairment [40,42]. ...
Article
Introduction: Multiple Sclerosis is characterized by extreme variability in both severity and clinical course. It can show severe disabling symptoms, and among them dysphagia is frequently described. However, its management still represents a challenge in the daily care. Areas covered: In this review we will focus on the clinical recognition and therapeutic strategies to identify and manage dysphagia in people with Multiple Sclerosis. In the view of a personalized approach, different interventions should be tailored to every single patient. Expert commentary: Multidisciplinary evaluation is mandatory in Multiple Sclerosis management, and dysphagia represents a perfect model of taking care of a disabling symptom in a chronic disease. Further research is required to better organize a personalized and long-term management of dysphagia phenomenon, through the different subtypes of Multiple Sclerosis.
... The lower strength of endorsement was motivated by methodological limitations: SDQ was tested on a small size of PD patients, while the SWAL-QOL was tested for dysphagia in neurodegenerative diseases in general, but not specifically in PD. Among available screening questionnaires, the DYMUS has already been validated for the early screening of dysphagia in Multiple Sclerosis [9,10]. DYMUS is composed by 10 items that require a binary response and has proved to be easily self-administered. ...
... DYMUS is composed by 10 items that require a binary response and has proved to be easily self-administered. It is useful to preliminary select patients who should be referred for more specific and comprehensive clinical and instrumental assessments and, if required, to rehabilitation [9]. ...
... Finally, very recently two different tools for dysphagia screening in PD failed to show a reliable performance as compared to a non invasive swallowing-respiration assessment system or to FEES, respectively [21,22]. Among the screening tests, the DYMUS had been already validated for another chronic and progressive neurological disorder, multiple sclerosis [9,10]. ...
Article
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Dysphagia is a common debilitating symptom in people with Parkinson’s Disease (PD), adequate screening of swallowing disorders is fundamental. The DYMUS questionnaire has shown very good characteristics for the screening of dysphagia in Multiple Sclerosis, and it might also prove useful for screening dysphagia in PD. The primary aim was to test and validate the DYMUS questionnaire in PD patients. This is an observational multicentric study involving 103 patients affected by PD. All subjects filled in the DYMUS and the Eating Assessment Tool (EAT-10) questionnaires. A subgroup of patients (n = 53) underwent a fiber-optic endoscopic evaluation of swallowing (FEES) and their dysphagia was scored by means of the Dysphagia Outcome Severity Scale (DOSS). DYMUS showed a relatively high level of internal consistency (Cronbach’s alpha 0.79). A significant positive correlation was found between the DYMUS and the EAT-10 scores (p < 0.001), while a negative correlation was found between the DYMUS and the DOSS scores (p < 0.001). DYMUS showed a good sensitivity and specificity compared to FEES for detecting dysphagia (area under the curve: 0.82, p < 0.001). The ROC curve analysis showed that a DYMUS score ≥ 6 represents a reliable cut-off for the risk of dysphagia. The DYMUS questionnaire proved to be a reliable screening tool to detect dysphagia in patients suffering from PD. It is easy to understand, it can be self-administered and therefore adequate for adoption in the clinical practice with the more convenient name of DYPARK.
... The validity and reliability of the questionnaire were evaluated in different groups of MS patients in Greek [14], Portuguese [15], French [16], and Turkish [17]. Based on the findings of factor analysis in the studies of Printza et al. [14] and Alali et al. [18], a modified 9-item version of the questionnaire has been proposed due to more favorable psychometric indices. ...
... The validity and reliability of the questionnaire were evaluated in different groups of MS patients in Greek [14], Portuguese [15], French [16], and Turkish [17]. Based on the findings of factor analysis in the studies of Printza et al. [14] and Alali et al. [18], a modified 9-item version of the questionnaire has been proposed due to more favorable psychometric indices. The Persian version of this questionnaire has been prepared recently [20,19] and confirmatory factor analysis has been used to test the two-factor structure of the questionnaire. ...
... Findings related to test-retest reliability showed that P-DYMUS questionnaire is a reliable tool in diagnosing swallowing disorders. The results in line with the findings of the present study for reliability by the testretest method have been reported in previous studies [14,18,19]. Based on the findings of KR-20 reliability coefficient, the present study showed that the Persian version of the questionnaire has high internal stability. ...
Article
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: Dysphagia is commonly encountered in multiple sclerosis (MS). It can consequently cause severe complications such as the increased risk of dehydration, malnutrition and aspiration pneumonia that associated with an increased risk of death in the late stages of the disease. These complications can be prevented with an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) is the only questionnaire developed specifically for patients with MS. The aim of the present study was translation and cross-culturally adaptation of DYMUS for the Persian population and estimation of the questionnaire's reliability and validity. Also, we investigated the frequency and severity of dysphagia in the patients referring to the Tehran MS Society and its association with the course of MS, disease duration, and Expanded Disability Status Scale (EDSS). Materials & Methods: This is a methodological and descriptive-analytic study. The statistical populations consist of the patients with MS referring to the Tehran Multiple Sclerosis Society in 2018. The study sample consisted of 108 patients who were selected through a convenient sampling method. The research instruments consisted of 10-items DYMUS questionnaire (in the first part of the study, translated and its psychometric properties examined), Dysphagia Handicap Index and a demographic information questionnaire. In methodological section, translation and cross-cultural adaptation were fulfilled and the confirmatory factor analysis (CFA) was used to assess the construct validity and to test the goodness-of-fit of the presented model. The association between the DYMUS and Dysphagia Handicap Index (DHI) scores investigated to convergent validity. ‏ The inter-item correlation matrix was calculated to assess the homogeneity of the questionnaire items. Kuder – Richardson (KR-20) was measured to assess the internal consistency of the questionnaire. Also, the test-retest procedure was conducted on the 19 subjects understudy to assess the reliability. Finally, the frequency and severity of dysphagia and its association with the course of MS, disease duration, and EDSS was investigated. KR-20 reliability coefficient, Intraclass correlation coefficient (ICC), inter-item correlation matrix, Mann–Whitney U test and rank correlation coefficient or Spearman's were used to inferential statistical analysis. Results: Analysis of the inter-item correlations matrix indicated a positive correlation between all items, exception item 10. Based on the results of the inter-item correlation, item 10 had the lowest correlation coefficient that was deleted from the questionnaire. CFA results confirmed the two-factor model of DYMUS, “dysphagia for solids” and “dysphagia for liquids”, and revealed that the item 10 was minimally contributing to the measurement of "dysphagia of solids" and internal consistency increased after the deletion of this item. Also, the solution of the 9-item Model was the best goodness-of-fit indicator for the sample. The obtained results from the convergent validity indicated a positive significant correlation between the DYMUS and DHI (rs = 0.693, p < 0.001). A KR-20 reliability coefficient of the DYMUS was 0.856, indicating high internal consistency of the Persian translation of the questionnaire items. Test-retest reliability was excellent with 0.965 value. The results also showed that 65.7% of multiple sclerosis patients had a swallowing disorder. In terms of the dysphagia severity, 25.9% of participants had mild dysphagia, and 39.8% of participants had alarming dysphagia. DYMUS values were significantly correlated with disease duration (rs = 0.198. p = 0.040), and EDSS (rs = 0.235. p = 0.014) and significantly higher mean scores were observed in the patients with secondary progressive than the other subgroups of multiple sclerosis. Conclusion: The Persian adjusted 9-item questionnaire was demonstrated to be a simple, consistent, valid and reliable tool for the detection of patients who need more specific instrumental evaluations of swallowing. Also, about the dysphagia is very frequent in these patients, it is important that clinicians monitor these patients carefully even in early stages of the disease‏ for early detection and planning a rehabilitation program to the prevention of serious subsequence complications
... MS hastalarında görülen belirti ve bulgular; sıklık ve şiddet yönünden hastadan hastaya değişebilmekle birlikte, genellikle kaslarda kuvvet kaybı, ağrı, kramp; ekstremite distallerinde uyuşma, karıncalanma, ağrı, yanma; görme bozuklukları; çiğneme ve disfaji (yutma güçlüğü); yürüme güçlüğü, ataksi olarak sıralanabilir. 3,4 Disfaji; MS hastalarında yaygın olarak görülmekte olup, hastaların yaşam kalitesini düşürmektedir. Ayrıca; aspirasyon pnömonisi, dehidratasyon, malnütrisyon, yutma kaygısı gibi akut ve kronik komplikasyonlara da yol açarak mortalite ve morbiditeyi artırmaktadır. ...
... MS hastalarında disfaji sıklıkla görülen bir durum olduğu için, hastaların düzenli aralıklarla objektif ve subjektif yöntemler ile taranmaları, disfajinin erken dönemde tanılanmasını olanaklı kılacaktır. 2,4,5 Bu bağlamda, MS hastalara bakım veren hemşirelerin, disfaji durumunu belirlemede ve uygun girişimler planlayarak bu bulgunun yönetimini sağlamada yetkin olması son derece önemlidir. Bu derlemede, MS hastalarında disfajinin tanılanması ve tedavisinde hemşirenin rolü güncel literatür ışığında tartışılmıştır. ...
... Disfaji, alınan gıdanın ağızdan mideye transferinin mekanik olarak engellenmesi, yutma hareketini sağlayan kas gücünün azalması veya koordinasyonunun bozulması sonucu oluşan bir durumdur. 4 ...
... MS hastalarında görülen belirti ve bulgular; sıklık ve şiddet yönünden hastadan hastaya değişebilmekle birlikte, genellikle kaslarda kuvvet kaybı, ağrı, kramp; ekstremite distallerinde uyuşma, karıncalanma, ağrı, yanma; görme bozuklukları; çiğneme ve disfaji (yutma güçlüğü); yürüme güçlüğü, ataksi olarak sıralanabilir. 3,4 Disfaji; MS hastalarında yaygın olarak görülmekte olup, hastaların yaşam kalitesini düşürmektedir. Ayrıca; aspirasyon pnömonisi, dehidratasyon, malnütrisyon, yutma kaygısı gibi akut ve kronik komplikasyonlara da yol açarak mortalite ve morbiditeyi artırmaktadır. ...
... MS hastalarında disfaji sıklıkla görülen bir durum olduğu için, hastaların düzenli aralıklarla objektif ve subjektif yöntemler ile taranmaları, disfajinin erken dönemde tanılanmasını olanaklı kılacaktır. 2,4,5 Bu bağlamda, MS hastalara bakım veren hemşirelerin, disfaji durumunu belirlemede ve uygun girişimler planlayarak bu bulgunun yönetimini sağlamada yetkin olması son derece önemlidir. Bu derlemede, MS hastalarında disfajinin tanılanması ve tedavisinde hemşirenin rolü güncel literatür ışığında tartışılmıştır. ...
... Disfaji, alınan gıdanın ağızdan mideye transferinin mekanik olarak engellenmesi, yutma hareketini sağlayan kas gücünün azalması veya koordinasyonunun bozulması sonucu oluşan bir durumdur. 4 ...
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z Disfaji; multiple skleroz hastalarında sıklıkla görülen ve hayati komplikasyonlara neden olabilen bir bulgudur. Literatürde, disfajinin multiple skleroz hastalarında görülme sıklığının %33 ile %43 aralığında olduğu bildirilmektedir. Disfajinin; multiple sklerozun alevlenme dönemlerinde 2-3 haftadan 2-4 aya kadar sürebileceği, kronikleşerek remisyon dönemlerinde de devam edebileceği bildirilmiştir. Disfaji, hastada beslenmeyi olumsuz etkiler ve yaşam kalitesini düşürür. Aspirasyon pnömonisi, dehidratasyon, malnütrisyon, yutma kaygısı multiple skleroz hastalarında disfajiye bağlı gelişen önemli beslenme komplikasyonlarıdır. Bozulan beslenme örüntüsü, bu hastalarda mortalite ve morbiditeyi artıran nedenler arasında ilk sıralarda yer almaktadır. Multiple skleroz hastalarında disfajinin noninvaziv ve nonfarmakolojik hemşirelik yaklaşımları ile kontrol altına alınması mümkündür. Bu derlemede, Multiple Skleroz hastalarında önemli bir bulgu olan disfaji ve disfajinin tanılanması, tedavisi ve bakımı aşamalarında hemşirenin rolü tartışılmıştır. Anahtar Kelimeler: multiple skleroz, disfaji, yutma bozuklukları, hemşirelik, hemşirelik bakımı Dysphagia in multiple sclerosis and nursing approaches Abstract Dysphagia is a common symptom in multiple sclerosis patients and can cause life-threatening complications. In the literature, the incidence of dysphagia in patients with multiple sclerosis is reported to be 33% to 43%. Dysphagia: It has been reported that multiple sclerosis can last from 2-3 weeks to 2-4 months in relapsing periods and may continue in remission periods by becoming chronic. Dysphagia negatively affects nutrition and decreases the quality of life in the patient. Aspiration pneumonia, dehydration, malnutrition, swallowing anxiety are important nutritional complications due to dysphagia in patients with multiple sclerosis. Disrupted nutritional pattern is among the leading causes of increased mortality and morbidity in these patients. It is possible to control dysphagia in patients with multiple sclerosis with noninvasive and nursing approaches. In this review, the role of the nurse in the diagnosis, treatment and care stages of dysphagia is discussed.
... In addition, if needed, a rehabilitation program should be started to prevent or reduce its complications. 8,9 There is no specific questionnaire for the assessment of dysphagia in MS except DYMUS, which was developed in 2008 by Bergamaschi, et al. to identify the risk of dysphagia in patients with MS. 10 DYMUS questionnaire is an noninvasive instrument for screening dysphagia in patients with MS, and takes the advantages of easy administration and taking a short period of time to implement and in contrast to instrumental evaluations which are mostly not accessible, it can easily be available. Bergamaschi, et al. validated DYMUS among 1875 patients with MS in 2010. ...
... Confirmatory factor analysis (CFA) was used to investigate the original two-factor structure of the DYMUS questionnaire proposed by Bergamaschi, et al. 10 The weighted least squares mean and variance adjusted (WLSMV) estimation method was used in CFA due to dichotomous item scores. The goodness of fit was assessed using the chi-square, relative chi-square [χ 2 /degree of freedom (df)], the root mean square error of approximation (RMSEA), Tucker-Lewis index (TLI), the comparative fit index (CFI), and the weighted root mean square residual (WRMR). ...
... To our knowledge, this is the first study evaluating the factor structure of DYMUS by CFA. The twofactor model of DYMUS proposed by Bergamaschi, et al. 10 was tested and it was found that a two-factor model fit the data well and all standardized factor loadings were significant. ...
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Background: About one third of patients with multiple sclerosis (MS) experience dysphagia. Dysphagia can cause complications such as malnutrition, lung infections, aspiration pneumonia and dehydration, thus it is very helpful to diagnose dysphagia as soon as possible. The aim in this study was to translate dysphagia in multiple sclerosis (DYMUS) questionnaire into Farsi and and validate it. Methods: Forward-backward method was used to translate original English version of DYMUS into farsi, and then the questionnaire (one for each patient) was filled in through asking questions from 200 patients with MS by a speech and language pathologist. Confirmatory factor analysis (CFA) was used to examine the construct validity. Internal consistency and test-retest reliability of the DYMUS were evaluated using Cronbach’s alpha and the intraclass correlation coefficient (ICC), respectively. Results: CFA showed that a two-factor model of DYMUS including “dysphagia for solid” and “dysphagia for liquid” fitted the data well [relative chi-square [χ2/degree of freedom (df) = 1.55, CFI = 0.967, Tucker-Lewis index (TLI) = 0.957, root mean square error of approximation (RMSEA) = 0.053, and weighted root mean square residual (WRMR) = 0.874]. The Cronbach’s alpha for total score and liquid and solid subscales were 0.776, 0.557, and 0.725, respectively. The DYMUS showed adequate test-retest reliability for the total and subscales (ICC: 0.880-0.956). Moreover, this study has shown a significant relationship between DYMUS score and Expanded Disability Status Scale (EDSS) score, disease duration, type of MS, and self-reported dysphagia. Conclusion: The Persian version of DYMUS is a reliable and valid tool to screen dysphagia among patients with MS.
... The validity and reliability of the questionnaire were evaluated in different groups of MS patients in Greek [14], Portuguese [15], French [16], and Turkish [17]. Based on the findings of factor analysis in the studies of Printza et al. [14] and Alali et al. [18], a modified 9-item version of the questionnaire has been proposed due to more favorable psychometric indices. ...
... The validity and reliability of the questionnaire were evaluated in different groups of MS patients in Greek [14], Portuguese [15], French [16], and Turkish [17]. Based on the findings of factor analysis in the studies of Printza et al. [14] and Alali et al. [18], a modified 9-item version of the questionnaire has been proposed due to more favorable psychometric indices. The Persian version of this questionnaire has been prepared recently [20,19] and confirmatory factor analysis has been used to test the two-factor structure of the questionnaire. ...
... Findings related to test-retest reliability showed that P-DYMUS questionnaire is a reliable tool in diagnosing swallowing disorders. The results in line with the findings of the present study for reliability by the testretest method have been reported in previous studies [14,18,19]. Based on the findings of KR-20 reliability coefficient, the present study showed that the Persian version of the questionnaire has high internal stability. ...
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Objective: Dysphagia is commonly encountered in Multiple Sclerosis (MS). It can consequently cause severe complications such as the increased risk of dehydration, malnutrition and aspiration pneumonia that associated with an increased risk of death in the late stages of the disease. These complications can be prevented with an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) is the only questionnaire developed specifically for patients with MS. The aim of the present study was translation and cross-culturally adaptation of DYMUS for the Persian population and estimation of the questionnaire's reliability and validity. Also, we investigated the frequency and severity of dysphagia in the patients referring to the Tehran MS Society and its association with the course of MS, disease duration, and Expanded Disability Status Scale (EDSS). Materials & Methods: This is a methodological and descriptive-analytic study. The statistical populations consist of the patients with MS referring to the Tehran Multiple Sclerosis Society in 2018. The study sample consisted of 108 patients who were selected through a convenient sampling method. The research instruments consisted of 10-items DYMUS questionnaire (in the first part of the study, translated and its psychometric properties examined), Dysphagia Handicap Index and a demographic information questionnaire. In methodological section, translation and cross-cultural adaptation were fulfilled and the Confirmatory Factor Analysis (CFA) was used to assess the construct validity and to test the goodness-of-fit of the presented model. The association between the DYMUS and Dysphagia Handicap Index (DHI) scores investigated to convergent validity. ‏ The inter-item correlation matrix was calculated to assess the homogeneity of the questionnaire items. Kuder - Richardson (KR-20) was measured to assess the internal consistency of the questionnaire. Also, the test-retest procedure was conducted on the 19 subjects understudy to assess the reliability. Finally, the frequency and severity of dysphagia and its association with the course of MS, disease duration, and EDSS was investigated. KR-20 reliability coefficient, Intraclass Correlation Coefficient (ICC), inter-item correlation matrix, Mann-Whitney U test and rank correlation coefficient or Spearman's were used to inferential statistical analysis. Results: Analysis of the inter-item correlations matrix indicated a positive correlation between all items, exception item 10. Based on the results of the inter-item correlation, item 10 had the lowest correlation coefficient that was deleted from the questionnaire. CFA results confirmed the two-factor model of DYMUS, “dysphagia for solids” and “dysphagia for liquids”, and revealed that the item 10 was minimally contributing to the measurement of "dysphagia of solids" and internal consistency increased after the deletion of this item. Also, the solution of the 9-item Model was the best goodness-of-fit indicator for the sample. The obtained results from the convergent validity indicated a positive significant correlation between the DYMUS and DHI (rs=0.693, P
... Geographically, MS has the highest occurrence rates in northern Europe, North America, and Australia (0.05% to In 1877, dysphagia was identified as one of the clinical sign of MS [14]. According to a lot of studies, almost one third of PWMS suffer from dysphagia [7,[14][15][16][17][18][19][20][21][22][23][24], and many studies have demonstrated the prevalence of dysphagia in PWMS [25]. Tarameshlu et al. have established that dysphagia is a common difficulty among Iranian PWMS [26]. ...
... The risk of death due to pulmonary infections is 4.7 times higher among PWMS than in normal people [35]. Therefore, aspiration should be noted as a significantly dangerous consequence of dysphagia in PWMS, because it can increase the risk of mortality, especially in the late stages of the disease [7,18,23,31]. Aspiration can also take place silently (known as silent aspiration) in 50% of patients with neurological diseases such as MS [36]. ...
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Background: Multiple sclerosis (MS) is a disease of the central nervous system (CNS) which leads to various clinical signs and symptoms such as dysphagia. Given the prevalence and consequences of the disease, it is vital for patients with MS (PWMS) to be under medical supervision and receive specific care and services immediately. The present study aimed to comprehensively and inherently describe various Swallowing Rehabilitation Strategies (SRSs) and clarify the probable effects of each on the swallowing mechanism in PWMS suffering from dysphagia and to eventually answer the question: Which SRS(s) are effective on dysphagia in PWMS? Study design: This study is a literature review. Method: A search of the Web of Science, PubMed, and Science Direct databases was carried out for relevant studies published from 1990 to 2020 and written in English. The search resulted in 772 articles. Ultimately, 103 articles in total were selected for inclusion in the present study. Results: The clinical results show that using different SRSs in dysphagia management can help reducing dysphagia and the risk for aspiration. These approaches are classified in four categories: compensatory methods, stimulation techniques, exercises, and maneuvers. Conclusion: The current review reports the positive impact of SRSs such as electrical and sensory stimulation methods, maneuvers, and compensatory methods on dysphagia in PWMS. They can reduce the risk of aspiration for PWMS and, consequently, provide a better quality of life.
... The DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire was developed to screen dysphagia in MS patients [22]. DYMUS is a self-report questionnaire consisting of ten questions regarding dysphagia for solid (questions 1, 3, 4, 5, 7, 8, and 10) and dysphagia for liquids (questions 2, 6, and 9). ...
... The prevalence of dysphagia evidenced in the SPMS group (44%) of the present study is in line with the prevalence of 47% [18] and 38% [28] reported in previous studies. The prevalence of dysphagia in 42.9% of the PPMS group is in accordance with the values of 43% [18] and 34% [22,29] already described in the literature. ...
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Dysphagia is one of the most common symptoms in multiple sclerosis (MS) patients. It can reduce the quality of life and increase the risk of mortality by developing complications such as aspiration pneumonia. The present study was conducted to estimate the prevalence of dysphagia in MS patients and investigate the associations between dysphagia and disease characteristics. The Persian version of the DYMUS questionnaire was used to assess dysphagia in 865 patients with MS, including 738 (85.3%) relapsing–remitting MS (RRMS), 106 (12.3%) secondary progressive MS (SPMS), and 21 (2.4%) primary progressive MS (PPMS). Also, demographic and clinical data, including age, sex, smoking status, Expanded Disability Status Scale (EDSS) score, disease duration, disease-modifying therapies exposure, initial symptoms of MS, were recorded. The mean (SD) age was 37.95(9.25) years, and 83.1% of the participants were female. The prevalence of dysphagia was estimated to be 25.4% among all patients. According to the DYMUS questionnaire results, the prevalence of dysphagia in RRMS, SPMS, and PPMS patients was 22.2%, 44.3%, and 42.9%, respectively. After multivariate analysis the current EDSS score (OR = 1.197, CI: 1.062, 1.350, p = 0.003), cerebellar impairment (OR = 1.335, CI: 1.450, 4.716, p = 0.004) and motor dysfunction (OR = 1.651, CI: 1.004, 2.715, p = 0.048) emerged as the risk factors for dysphagia. Since dysphagia, as previously mentioned, is a common symptom in multiple sclerosis, particularly in SPMS and PPMS courses, active screening for this condition is recommended in all patients, particularly those with identified risk factors.
... Recently, the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire was validated as a screening tool in MS patients and demonstrated excellent psychometric properties [8,9]. The questionnaire is easy to administer, reliable, and able to detect characteristics of dysphagia [10]. ...
... The Dysphagia in Multiple Sclerosis questionnaire (DYMUS) is a 10-item, self-administered screening tool to identify self-reported swallowing problems in adults with MS [8]. The questions assess dysphagia for solids and liquids. ...
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Multiple sclerosis (MS) refers to chronic inflammation of the central nervous system including the brain and spinal cord. Assessing for the presence of dysphagia in subjects with MS represents a challenge for neurologists in clinical practice. The aim of the present study was to verify the relationship between DYMUS scores, a patient-reported scale, and objective symptoms using the Dysphagia Outcome Severity Score (DOSS), based on fiber-optic endoscopy. Data were collected in a multicenter study. Two hundred and fifteen MS patients were enrolled, irrespective of self-reported dysphagia. DOSS revealed dysphagia in 122 subjects (56.7%). Compared with non-dysphagic subjects, the presence of dysphagia was related to more severe disability, longer disease duration, and a progressive form of the disease. A DYMUS score of 0 strongly correlated with a DOSS of 6 (sensitivity 100%) while DYMUS score of > 2 correlated with a DOSS < 7 (specificity 82%) of the self-reported scale. The DYMUS questionnaire can be a useful clinical tool for red-flagging patients who should undergo objective testing and referral to a otorhinolaryngologist.
... The recurrent-relapsing MS (81.1%, n=60) was the most frequent type of MS, while 85.1% (n=63) of the patients had total scores below 4 and 14.9% (n=11) had total scores above 4 in the EDSS. rosis) 19,20 , which is validated at internal consistency and test-retest reliability of the DYMUS questionnaire (DYsphagia in MUltiple Sclerosis) 21 . Both instruments are specific to the disease and are related to fatigue and swallowing, respectively. ...
... All responses are dichotomous and coded as 0 (no) or 1 (yes), depending on the absence or presence of risk of dysphagia. The total score is the sum of the two dimensions, ranging from 0 to 10 points, in which a score above 3 identifies the presence of risk of dysphagia 19,20 . As for the DYMUS-BR questionnaire, respondents scored on average 1.6 in the liquid domain and 0.5 in the solid domain. ...
Article
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Multiple Sclerosis is a disease that affects the Central Nervous System, it is prevalent in women and its evolution and the severity of symptoms are variable, affecting each individual differently. Clinical manifestations depend on the location of the lesion and tissue injury and patients may present a series of symptoms, including fatigue and dysphagia. Fatigue in Multiple Sclerosis is multidimensional, and dysphagia is one of the symptoms that can be linked to fatigue. Objective: To identify and correlate symptoms of fatigue and risk of dysphagia in patients with Multiple Sclerosis. Methods: Descriptive cross-sectional study in which patients with a diagnosis of Multiple Sclerosis treated at the Neurology Department of a University Hospital were included. Patients were assessed using the MFIS-BR scale and the DYMUS-BR questionnaire related to fatigue and swallowing, respectively. Results: 74 patients were included. There was a prevalence of females (56.8%) and age over 60 years (95.9%). The most frequent form of Multiple Sclerosis was Remitting-Recurrent (81.1%), the risk of dysphagia was identified in 19 patients (25.7%) and the presence of fatigue symptoms in 32 patients (43.2%). There was a positive and weak correlation between fatigue symptoms and risk of dysphagia (r <0.5). Conclusion: Although weak, there was a positive correlation between fatigue symptoms and risk of dysphagia. The greater the degree of fatigue, the greater the risk of changes in swallowing. Keywords: Multiple Sclerosis; Fatigue; Deglutition Disorders.
... In independent older people, coughing was the most perceivable symptom. Many selfadministered and question-based screening methods include questions about choking/coughing while eating [20][21][22]30]. It is inferred that this item is an important question to estimate the presence of dysphagia. ...
... It is inferred that this item is an important question to estimate the presence of dysphagia. Questions about swallowing of solids were also assigned high perceivable symptom, indicating that questions regarding difficulty when swallowing solids are effective for estimating the presence of dysphagia [20][21][22]30]. However, the differences between scores for these swallowing solid-related complaints and those for other questions decreased. ...
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Objective This study was carried out to determine the prevalence of suspected dysphagia and its features in both independent and dependent older people living at home. Materials and methods The 10-Item Eating Assessment Tool (EAT-10) questionnaire was sent to 1,000 independent older people and 2,000 dependent older people living at home in a municipal district of Tokyo, Japan. The participants were selected by stratified randomization according to age and care level. We set the cut-off value of EAT-10 at a score of ≥3. The percentage of participants with an EAT-10 score ≥3 was defined as the prevalence of suspected dysphagia. The chi-square test was used for analyzing prevalence in each group. Analysis of the distribution of EAT-10 scores, and comparisons among items, age groups, and care levels to identify symptom features were performed using the Kruskal-Wallis test and Mann-Whitney U test. Results Valid responses were received from 510 independent older people aged 65 years or older (mean age 75.0 ± 7.2) and 886 dependent older people (mean age 82.3 ± 6.7). The prevalences of suspected dysphagia were 25.1% and 53.8%, respectively, and showed significant increases with advancing age and care level. In both groups, many older people assigned high scores to the item about coughing, whereas individuals requiring high-level care assigned higher scores to the items about not only coughing but also swallowing of solids and quality of life. Conclusion In independent people, approximately one in four individuals showed suspected dysphagia and coughing was the most perceivable symptom. In dependent people, approximately one in two individuals showed suspected dysphagia and their specifically perceivable symptoms were coughing, difficulties in swallowing solids and psychological burden.
... Screening strategies consist of valid and reliable questionnaires designed to screen specifically MS patients for dysphagia, examples of such questionnaires include but are not limited to the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire, the Eating Assessment Tool (EAT-10) questionnaire, the 3-Ounce (90-cc) Water Swallow test, the Dysphagia Screening Questionnaire for MS (DSQMS), and the Northwestern Dysphagia Patient Check Sheet (NDPCS) questionnaire. (8,(14)(15)(16)(17) Non-instrumental methods are quite uncommon, therefore we coined the term "other methods" to represent studies whose main screening tests were either non-instrumental strategies, or any method other than instrumental, clinical, and screening methods. ...
... Literature on the association between MS and dysphagia is rapidly growing and previous studies have mentioned dysphagia as a common symptom of MS based on a number of techniques such as screening strategies, instrumental, non-instrumental, and clinical examinations. (5,16,24,(26)(27)(28)(29) Many articles also categorize dysphagia based on its severity into 5 classes including slight, alarming, mild, moderate, and severe, whereas others may choose to classify this disorder based on the anatomical location that is primarily affected, such as oral, oropharyngeal, pharyngeal, esophageal, etc. there are also neurogenic and functional types of dysphagia that are due to functional disturbances in the swallowing mechanisms rather than its anatomical structures. (18,23) Dysphagia is also reported to have associations with patients' age, MS type, and disease course. ...
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Objectives: Dysphagia is a major comorbidity observed in patients with multiple sclerosis, yet different prevalence rates are reported for it. Therefore, we have designed this systematic review to estimate the pooled prevalence of dysphagia in patients with MS. Method: We searched PubMed, Scopus, EMBASE, Web of Science, and gray literature including references from the identified studies, reviews studies, and conference abstracts which were published up to February 2021. Articles that were relevant to our topic and could provide information regarding the prevalence of dysphagia among MS patients were included; however, articles with self-report screening strategies were excluded. Results: The literature search found 1993 articles. After eliminating duplicates, 1272 articles remained. Sixteen abstract conference papers were included for final analysis. A total of 10846 MS cases and 4913 MS patients with dysphagia included in the analysis. The pooled prevalence of dysphagia in the included studies was 45.3% (95% CI: [40.7%-50%]) Conclusion: The results of this systematic review shows that the prevalence of dysphagia in MS patients is 45% which is greatly higher compared to the general population.
... DYMUS was a valid and reliable scale for evaluating oropharyngeal dysphagia in MS patients (Bergamaschi et al., 2008). DYMUS consisted of two subscales: dysphagia for solid food, dysphagia for the liquids. ...
... Scoring is made consisting of 10 questions with a scale score between 0 and 10. Answer "yes" to at least one of the items in the DYMUS indicates that the patient has dysphagia, 3 or more points as severe swallowing problem (Bergamaschi et al., 2008). MS patients who have 3 or more points according to the DYMUS scale allocated to the swallowing problem group (SP). ...
Article
Background Dysphagia occurring in the oral and pharyngeal phases of swallowing in MS patients may be caused by changes in muscles' viscoelasticity. The aim of this study was to compare the muscles' (sternocloideomastoideus and masseter) viscoelasticity properties by myotonometer between MS patients and healthy individuals. Methods This study design was a cross-sectional, non-interventional study. Ten healthy individuals were allocated to the control group, eleven MS patients without swallowing problems were allocated to the without swallowing group, ten MS patients with swallowing problems were allocated to the swallowing group. Disability was evaluated using the Expanded Disability Status Scale (EDSS), swallowing problem was assessed with Dysphagia in Multiple Sclerosis (DYMUS) scale, and to measure the viscoelastic parameters (tone, stiffness, elasticity) of sternocloideomastoideus (SCM) and masseter muscles bilaterally, MyotonPro® was used. The comparison between the groups was performed using the Kruskal-Wallis H test. Results It was observed that there was no difference in terms of viscoelastic properties of the masseter muscle in groups (p>0.05). There was no difference between the groups in terms of the elasticity of the SCM muscle (p>0.05). However, the tonus and stiffness of the SCM on the left side of the MS patients were higher than in other groups (p=0.050, p=0.005). Conclusion The increment level of tone and stiffness of SCM muscle is related to swallowing problems in patients with MS. Due to swallowing problems in MS, the orofacial and neck region's muscles' viscoelastic properties may change in time and may be affected by phases of swallowing problems.
... Há uma correlação significativa positiva do escore do questionário DYMUS com a atividade do músculo masseter, ou seja, quanto maior a dificuldade de deglutição, maior a atividade do masseter. O estudo de Alfonsi et al. (27) refere uma baixa relação dos seus achados com o escore do DYMUS, porém o estudo de Bergamaschi et al. (29) refere uma forte relação do escore do DYMUS com os achados da avaliação clínica da disfagia na EM. Também encontramos uma relação direta da dificuldade de deglutição com o aumento no tempo de deglutição. ...
Article
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Purpose: characterize the swallowing muscles electromyographic activity in EM. Methods: we evaluated 60 individuals being 30 with definitive diagnosis in EMG and 30 without neurologic changes. Volunteers provided personal data through interview, and we also obtained data from clinical records on the time of diagnosis, disease clinic form and the EDSS scale score. We then administered the DYMUS questionnaire. All evaluations occurred according to the Swallowing Electromyographic Evaluation Protocol. Results: Saliva swallowing, liquid swallowing with comfortable volume and continuous swallowing showed differences in the groups at the masseter, with higher averages in the comparison group. We verified differences between masseter and supra hyoid in each group, at rest, in saliva swallowing, liquid swallowing with comfortable volume and continued swallowing. In all situations the averages were higher in the supra hyoid, being that the smaller difference occurred at rest and the higher at continuous swallow. We recorded correlations between EDSS and the activity of supra hyoid at saliva swallow, liquid swallow with comfortable volume and swallow continuous. With the DYMUS, we observed correlations with the masseter activity and with the swallowing time. The high punctuation at the DYMUS presented correlations with the increase electrical activity of the masseter. Conclusion: patients with more severe conditions show lower supra hyoid electric activity, and the electric activity of the masseter is related to difficulty in swallowing.
... Neurogenic dysphagia (ND) typically occurs in patients with neurological diseases of varying etiologies, and it is associated with high mortality, morbidity, and social costs because of the increased risk of aspiration pneumonia and its sequelae. [1][2][3][4][5][6] Immediately, after stroke oropharyngeal dysphagia is seen in 50% of stroke patients. Of these, up to 40% remain dysphagic a year later 7 . ...
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Aim And Objectives: To determine the effects of Neuro Muscular Electrical Stimulation in improving Muscles Function of Swallowing among subjects with post stroke dysphagia. Methodology: Quasi experimental study design was used this study. Total 30 Post stroke dysphagic patients were selected and all 30 patients underwent sEMG study for massator, sub mental and infra hyoid muscles. Neuromuscular electrical stimulation over the Pharyngeal muscles given for 4 weeks. End of the fourth week post test measurement was taken values were tabulated and statistically analyzed. Results: surface electro myography of bilateral massator, submental and infrahyoid muscle function in amplitude is improved in between pre and post intervention, test values that is P value is 0.001.Conclusion:Neuro muscular electrical stimulation is more beneficial effect in swallowing muscle activity in measures of amplitude on post stroke dysphagia.
... The tool that has had the most applications in finding the rate of prevalence is called "DYMUS" (DYsphagia in MUltiple Sclerosis), which is a questionnaire with 10 questions for screening dysphagia, that is filled by patients. 14 As previously stated in the "Results" section, compared with subjective methods, the rate of dysphagia prevalence is higher in the studies conducted by objective method. According to the inclusion criteria, we were able to include and analyze 6 studies by the objective method. ...
Article
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Background: Dysphagia is the most prevalent sign of Multiple Sclerosis (MS) which can reduce the quality of life and augment mortality in the final stages of MS.Objectives: We presented a systematic review to estimate the prevalence of dysphagia in general, and, separately, for each evaluation method (subjective & objective), and to analyze the causes of this rampant disease.Methods: Cross-sectional and prospective cohort studies were reviewed and scientific proofs were evaluated consistent with the pre-specified levels of certainty.Results: Twenty-two articles entered the meta-analysis phase; the estimation of the general prevalence of dysphagia in MS-affected patients was 43.33% related to all the 22 studies. Moreover, the estimate of the prevalence via the subjective (16 studies) and objective (6 studies) were 37.21% and 58.47%, respectively.Conclusion: This study obtained the prevalence rate of dysphagia in patients affected by MS globally, yet infinite statistical society and limited methodological quality. Thus, more extensive studies are required for a better understanding of the global epidemiology regarding dysphagia in MS.
... Previous studies have shown that the frequency of dysphagia in MS is relatively high and is observed in 30-40% of the MS population (Bergamaschi et al., 2008;Calcagno et al., 2002;De Pauw et al., 2002;Marchese-Ragona et al., 2006;Thomas and Wiles, 1999). Our findings confirm that 38% of adults with MS who participated in this study reported having swallowing problems, which is in agreement with the frequency reported in previous studies. ...
Article
Background: Multiple Sclerosis (MS) refers to a chronic inflammation of the central nervous system including the brain and spinal cord. Dysphagia is one of the symptoms that represent challenges in clinical practice for the management of MS patients. Dysphagia can result in serious complications leading to morbidity and death in late stages of MS. However, little attention is given to dysphagia, its symptoms and how it affects the quality of life of adults with MS. Objectives: The purpose of this study is to identify the frequency of dysphagia in adults with MS and determine the main symptoms suggestive of dysphagia and its impact on the patients' quality of life. Method: In total, 103 adults with MS agreed to participate in the study. Data were collected at the Multiple Sclerosis outpatient Clinic of a major metropolitan Australian hospital using patient reported questionnaires. Results: 38% of adults with MS reported having swallowing problems that resulted in various physical and social consequences including but not limited to coughing, throat clearing, choking on food and liquid, reduced eating desire, increased eating duration and mealtime anxiety. Conclusion: Adults with MS-related dysphagia had reduced scores across all domains of swallowing-related quality of life. These findings support referral to speech-language pathologists for management of dysphagia from the early stages of the disease. Further work is required to determine whether early intervention for dysphagia can sustain or improve swallowing function as well as swallowing-related quality of life domains further into the disease course.
... As OD may have significant effects on HR-QOL, it is important to measure HR-QOL when evaluating the efficacy of OD interventions. A range of assessments have been used to investigate HR-QOL in OD; they are typically self-assessment questionnaires [13,14] and several are specific to certain diseases, such as the Radboud Oral Motor Inventory for Parkinson's Disease [15]. Assessments which target the generic OD population include the Swallowing Quality of Life Questionnaire (SWAL-QOL) [16], Dysphagia Handicap Index (DHI) [17] and Deglutition Handicap Index (DHI) [18]. ...
Article
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The Swallowing Quality of Life questionnaire (SWAL-QOL) is widely used clinically and in research to evaluate quality of life related to swallowing difficulties. It has been described as a valid and reliable tool, but was developed and tested using classic test theory. This study describes the reliability and validity of the SWAL-QOL using item response theory (IRT; Rasch analysis). SWAL-QOL data were gathered from 507 participants at risk of oropharyngeal dysphagia (OD) across four European countries. OD was confirmed in 75.7% of participants via videofluoroscopy and/or fiberoptic endoscopic evaluation, or a clinical diagnosis based on meeting selected criteria. Patients with esophageal dysphagia were excluded. Data were analysed using Rasch analysis. Item and person reliability was good for all the items combined. However, person reliability was poor for 8 subscales and item reliability was poor for one subscale. Eight subscales exhibited poor person separation and two exhibited poor item separation. Overall item and person fit statistics were acceptable. However, at an individual item fit level results indicated unpredictable item responses for 28 items, and item redundancy for 10 items. The item-person dimensionality map confirmed these findings. Results from the overall Rasch model fit and Principal Component Analysis were suggestive of a second dimension. For all the items combined, none of the item categories were ‘category’, ‘threshold’ or ‘step’ disordered; however, all subscales demonstrated category disordered functioning. Findings suggest an urgent need to further investigate the underlying structure of the SWAL-QOL and its psychometric characteristics using IRT.
... The prevalence of dysphagia in the present large consecutive series of MS outpatients, based on an objective assessment, irrespective of the presence of reported symptoms, is consistent with data previously published, indicating that dysphagia is a relatively frequent symptom [3,[17][18][19]. ...
Article
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Introduction Multiple sclerosis (MS) refers to chronic inflammation of the central nervous system including the brain and spinal cord. Dysphagia is a symptom that represents challenges in clinical practice. The aim of the present study was to evaluate the prevalence of dysphagia in an Italian cohort of subjects with MS using the Dysphagia Outcome Severity Score (DOSS), based on fibre-optic endoscopy, and determine factors that correlate with the presence of swallowing problems. Matherials and Methods Data were collected in a multicentre study from a consecutive sample of MS patients, irrespective of self-reported dysphagia. The study included 215 subjects. Possible scores for DOSS range from 7 to 1, with 7 indicating normal swallowing. Results One hundred twenty-four (57.7%) subjects demonstrated abnormal swallowing and 57 (26.5%) of these had swallowing problems that required nutrition/diet modifications when evaluated objectively with fibre-optic endoscopy. Subjects with dysphagia were more severely disabled and more often had a progressive form of MS, compared to MS subjects with normal swallowing. In subjects with EDSS, < 4, 8 (13.3%), had a DOSS < 4. Seventy-five percent of subjects older than 60 years of age had dysphagia. Conclusion In this sample of MS patients, more nearly 60% showed swallowing problems.
... [26] In 2010, Bergamaschi et al. (with a group of Italian neurologists and MS-field experts) developed dysphagia in multiple sclerosis (DYMUS) questionnaire and validated it in MS patients to identify the risk of dysphagia in this population and is considered as a user-friendly and noninvasive method. [27,28] In this questionnaire, there are ten questions (yes or no questions), seven of which aim to examine swallowing disorder with solids, and three of them pertain to swallowing disorder with liquids. [28] This questionnaire is a useful tool for identifying oropharyngeal dysphagia, and the important features of these disorders in MS patients and also be used to identify patients in need of more instrumental evaluation and planning programs for the prevention of aspiration. ...
Article
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Background: This study is to evaluate swallowing problems (dysphasia) in multiple sclerosis (MS) patients; the importance of using tools that are durable and appropriate is well understood. One of the most trusted tools is the dysphagia in multiple sclerosis (DYMUS) test. The aim of this study was to prepare a Persian version and to evaluate the validity and reliability of the test. Materials and methods: This methodological study was conducted on 236 MS patients in Southeast of Iran from August 2015 to February 2016. After translation and cultural adaptation of the test in Persian, the validity of this test was determined using expert opinions accordance with the International Quality of Life Assessment Project. In addition, exploratory factor analysis (EFA) was performed with varimax rotation. The confirmatory factor analysis (CFA) was conducted and the goodness of fit indices was calculated. Moreover, to test the reliability, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were used. Results: In total, 236 MS patients were included in the study (81 males and 155 females). All the questions in the test's Persian version obtained an acceptable face and content validity (content validity ratio = 1, Scale content validity index/Ave = 1). EFA revealed that the scale has two factors (solid-liquid) with 67.5% cumulative variance. CFA indicated a good fit to the intended two-factor structure, and the ratio of Chi-square to the degree of freedom was 1.79, and the root mean square error of approximation was 0.058. The internal consistency of total test indicated the appropriate level (Cronbach's alpha coefficient = 0.775), and test-retest reliability total questionnaire was found to be ICC = 0.985, indicating its high reliability. Conclusion: The results of this study indicated that the Persian version of the DYMUS questionnaire had good reliability and validity for patients with MS.
... The review included questionnaires assessing children up to 18 years old and included high-risk groups such as neurologically and anatomically affected children. They identified and evaluated four PRO-based tools [13][14][15][16]; however, all of which were disease-specific and had not been clinically validated in SwD among otherwise healthy infants and toddlers (OHITs) who we define as children less than two years of age. ...
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Objectives There has been increasing interest in the management of oropharyngeal swallowing dysfunction (SwD). Its prevalence, particularly in otherwise healthy infants and toddlers (OHITs), is underappreciated. As the standard diagnostic tests are either invasive or scarce, valid parent-reported outcome (PRO) questionnaires could play a pivotal role in the understanding and managing SwD in this group. This article reviewed the literature on PRO questionnaires pertaining to SwD in OHITs. Data source A librarian searched Prospero, Cochrane Library, Embase, Medline, PsycINFO, HaPI, CINAHL, and SCOPUS until February 2021 using the MeSH terms for deglutition and screening methods. Review method Questionnaires that examined disease-specific or eating and feeding concerns or difficulties were excluded. Two reviewers independently identified PRO questionnaires for SwD that were used in OHITs and extracted the author names, publication year, questionnaire name, the studied population, and the reported psychometric assessments. A quality assessment was performed based on consensus-based standards for the selection of health measurement instruments (COSMIN) and updated criteria for good measurement properties. Results Of the 3488 screened articles, we identified only two questionnaires, the pediatric version of the Eating Assessment Tool (PEDI-EAT-10) and the PRO questionnaire for Swallowing Dysfunction in OHITs. The PEDI-EAT-10 authors assessed the validity and reliability on children with cerebral palsy. However, concerns were identified regarding the developmental process and the internal structure validity. The PRO questionnaire for SwD in OHITs meets criteria but has not yet been validated in the population of interest nor its psychometric properties assessed. Conclusion Two instruments were identified. The PED-EAT-10 exhibits methodological flaws, while Edmonton PRO questionnaire for SwD in OHITs awaits construct validation and could fill the current knowledge gap.
... Neurogenic dysphagia (ND) typically occurs in patients with neurological diseases of varying etiologies, and it is associated with high mortality, morbidity, and social costs because of the increased risk of aspiration pneumonia and its sequelae. [2][3][4][5][6][7] Recovery of ND in most of the central nervous system disorders is unpredictable and unlikely in some of the more progressive disorders. Moreover, even if it is probable that interventions that alter the overall course of the disease, such as the disease modifiers in multiple sclerosis (MS) and in Parkinson's disease and the reperfusion agents in stroke that may prevent or delay dysphagia, at this moment no pharmacological treatment has been shown to be directly effective at treating ND. ...
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Domenico A Restivo,1 Shaheen Hamdy2 1Neurological Unit, Garibaldi Hospital, Catania, Italy; 2School of Translational Medicine—Inflammation Sciences, Faculty of Medical and Human Sciences, University of Manchester, Salford Royal Hospital, Salford, UK Abstract: Neurogenic dysphagia (ND) can occur in patients with nervous system diseases of varying etiologies. Moreover, recovery from ND is not guaranteed. The therapeutic approaches for oropharyngeal ND have drastically changed over the last decade, mainly due to a better knowledge of the neurophysiology of swallowing along with the progress of neuroimaging and neurophysiological studies. For this reason, it is a priority to develop a treatment that is repeatable, safe, and can be carried out at the bedside as well as for outpatients. Pharyngeal electrical stimulation (PES) is a novel rehabilitation treatment for ND. PES is carried out via location-specific intraluminal catheters that are introduced transnasally and enable clinicians to stimulate the pharynx directly. This technique has demonstrated increasingly promising evidence in improving swallowing performance in patients with ND associated with stroke and multiple sclerosis, probably by increasing the corticobulbar excitability and inducing cortical reorganization of swallowing motor cortex. In this article, we update the reader as to both the physiologic background and past and current studies of PES in an effort to highlight the clinical progress of this important technique. Keywords: pharyngeal electrical stimulation, swallowing, neurogenic dysphagia, swallowing motor cortex, pharynx, catheter
... 29 Currently, there are no validated PRO tools for assessing SwD in OHITs; this is in contrast to the availability of tools for children with diagnoses that affect swallowing (such as multiple sclerosis and eosinophilic esophagitis). [30][31][32][33][34] According to our systematic review, the PEDI-EAT-10 is the only proposed tool for assessing OHITs. 16 However, this tool has some deficiencies. ...
Article
Objectives There is limited epidemiological information on swallowing dysfunction (SwD) in otherwise healthy infants and toddlers (OHITs). Cost, invasiveness, expertise, and resources constrain the repeatability and utility of instrumental diagnostic tests. A parent-reported outcomes (PRO) tool has the potential to mitigate these disadvantages. Hence, we set out to develop and validate a novel PRO tool to assess SwD in OHITs. Study Design A mixed-method study. Setting Tertiary pediatric center. Methods We recruited parents of OHITs with SwD and excluded those with a confounding diagnosis (syndromes or neurological impairment). Interviews were conducted and thematically analyzed to extract the relevant domains and items. A similar analytical method was performed on the reports from a systematic review and literature search. Four verification sessions of parents and experts were conducted to maintain rigor. A panel of experts assessed and established the content validity of the items using a modified Delphi technique. Results We achieved information saturation after interviewing 10 parents and generated 7 domains with 72 items. Over the course of 3 rounds of modified Delphi content validation, the domains were reduced to 3 (swallowing, breathing, and illness) containing 21 items; a content validity index of 82.1% was achieved. Conclusion We validated the content of a new PRO instrument to assess SwD in OHITs. The instrument is composed of 3 primary domains representing 21 items. This tool has the potential to screen for swallowing dysfunction and can assess management outcomes specifically for this population at a community level.
... The study researchers developed the multi professional protocol for screening for dysphagia in HIV patients based on the content of articles in the literature (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) the authors' experience in formulating the division of items and scoring them. ...
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Purpose: To elaborate and validate a multiprofessional protocol to identify the risk of dysphagia in people with HIV at the time of hospitalization. Methods: After bibliographic review, the dysphagia screening protocol created was submitted to the analysis of HIV/ Aids expert judges and target audience in the application of this instrument to perform content validity. These evaluators could suggest changes to the protocol, judging clarity, pertinence, and comprehensiveness. The CVI 0.78 was used to confirm the validity of the results. Results: The protocol was created including aspects related to oral and pharyngeal swallowing, and the final score was calculated based on the risks for clinical complications. The instrument presented CVI above 0.78 for all items in the two validation phases, as well as total CVI of 0.92. Conclusion: Based on the obtained data, it was possible to create and validate the screening protocol from the point of view of appearance and content, once it presented total CVI above the minimum value stipulated in the validation of the expert judges and the target public, obtaining an adequate result for the protocol. Therefore, we can consider the resolution instrument, with the capacity to fulfill what was proposed.
... For the current study, we used the Persian version of the ERQ [40], which has good internal consistency (0.81 to 0.91) and good test-retest reliability (0.51 to 0.77). 3. The Dysphagia in Multiple Sclerosis (DYMUS) questionnaire [41] consists of 10 yes/no questions for which a positive answer is related to the presence of dysphagia. The factor structure, concurrent validity and reliability have been examined amongst Iranian samples [42,43]. ...
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Dysphagia and symptoms of depression, anxiety and stress are common in persons with multiple sclerosis (MS). We posited a relationship between dysphagia and increased frequency of psychological symptoms. Therefore, the aim of the present study was to examine associations between symptoms of psychological difficulties, use of emotional suppression and cognitive reappraisal strategies, and dysphagia status in persons with MS. One hundred persons with MS were prospectively assessed in multiple domains of functioning: cognitive, psychological, and dysphagia-related. Participants underwent cognitive screening with the Mini Mental State Examination and completed two psychological inventories: The depression, anxiety and stress scale (DASS)-21 and the Emotion Regulation Questionnaire. Further, they completed the dysphagia in Multiple Sclerosis questionnaire. A speech-language pathologist evaluated persons suspected of having dysphagia with the Mann Assessment of Swallowing Ability. Dysphagia was present in 29 persons with MS, and the sample was split accordingly. The two groups differed at baseline with respect to Expanded Disability Status Scale scores. There were significant between-group differences for mental health symptoms and for use of emotional regulation strategies. Accordingly, multivariate logistic regressions showed that increased symptoms of psychological stress, decreased use of cognitive reappraisal strategies, and increased indicators of emotional suppression independently predicted the presence of dysphagia. There was a clear pattern towards poorer psychological well-being in persons with dysphagia compared to those without. Psychological difficulties may contribute to the manifestation or worsening of dysphagia and should be addressed in treatment planning and future investigations. Therapeutic interventions that promote improvement in mental state alongside swallowing function may be highly beneficial.
... Concerns around content validity are raised when assessments that have been developed and validated for specific target populations are used in different populations. For example, the MD Anderson Dysphagia Inventory (MDADI) is a dysphagia-specific quality of life questionnaire targeting patients with head and neck cancer [49], whereas the Dysphagia in MUltiple Sclerosis questionnaire (DYMUS) is a FHS selfreport assessment for adults with multiple sclerosis [103]. Assessments like the MDADI and DYMUS that have been developed and validated for a specific clinical population cannot be used in another population without the risk of compromising its content validity [102]. ...
Article
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This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.
... Türkçe geçerlilik-güvenirlilik çalışmaları yapılmış T-EAT-10 veya T-DYMUS gibi klinik rutinde kolay ve pratik olarak uygulanabilen anketler de değerlendirmeye dâhil edilebilir. [28][29][30][31] Yutma bozukluğu olan hastaların, olası yutma problemlerine dair erken tanı, uygun beslenme özelliklerinin belirlenmesi morbidite ve mortalite oranlarını azaltacaktır. Özellikle COVID-19 tanılı hastalarda mevcut pnömoni tablosunu daha da ağırlaştırabilecek olan aspirasyon pnömonisi engellenmiş olacaktır. ...
... According to the literature, although not generalizable to all patients with MS, the prevalence of dysphagia varies between 33% and 43%, especially in groups with high symptom severity. It has been reported that dysphagia may last from 2-3 weeks to 2-4 months in exacerbation periods and may continue in remission periods by becoming chronic (5,6,7). ...
Article
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Dysphagia, which is frequently seen in patients with multiple sclerosis (MS) and defined as difficulty in swallowing, can lead to serious complications such as aspiration pneumonia, dehydration, malnutrition, and increases morbidity and mortality rates and decreases quality of life. In patients with MS, dysphagia can be intervened by pharmacologic or surgical methods; this symptom can also be controlled by nonpharmacologic and non-invasive methods such as sensory stimulation techniques, swallowing maneuvers, dietary modifications, and positional swallowing techniques. No previous systematic reviews on the effects of non-pharmacologic or non-invasive methods on dysphagia in MS have been published. The main objective of this study was to summarize and qualitatively analyze published studies on non-pharmacologic or non-invasive methods effects for dysphagia in MS. Within the scope of the study, a detailed literature review was performed and four studies were examined considering the inclusion criteria. The non-pharmacologic applications in the studies are as follows: Traditional dysphagia rehabilitation methods, which include methods such as oral motor exercises and swallowing maneuvers; electrical stimulation, and respiratory muscle exercises. In these studies, dysphagia and/or swallowing-related quality of life were measured with similar scales. It is seen that all of the related interventions have a significant effect on dysphagia and/or swallowing-related quality of life in patients with MS. In conclusion, in light of the information in the literature, non-pharmacologic methods can be said to be effective in the control of dysphagia in patients with MS. In addition, it may be suggested to conduct experimental and more comprehensive studies in this field.
Article
Neurogene orofaringealne disfagije su vrlo čest simptom i posljedica akutnih i kroničnih neuroloških bolesti, posebice cerebrovaskularnih, ekstrapiramidnih i demijelinizacijskih bolesti. Poremećaj gutanja uzrokuje niz sekundarnih komplikacija - malnutriciju, dehidraciju i aspiracijsku pneumoniju - ali i one suptilnije, često nedovoljno osviještene, psihološke i socijalne posljedice koje dugoročno utječu na kvalitetu života bolesnika. Prepoznavanje i liječenje bolesnika s poremećajem gutanja nerijetko je izazov, zato se cjelokupan postupak odvija u okviru multidisciplinarnog tima. Klinički logoped je sastavni dio multidisciplinarnog tima koji dijagnosticira i liječi poremećaje gutanja, svojim znanjem i kompetencijama utječe na povoljan rezultat liječenja. Logoped, kao član multidisciplinarnog tima, prilagođava konzistenciju hrane koju će uzimati bolesnik s neurogenom disfagijom i omogućuje sigurno hranjenje terapijskim postupcima. Logoped inicijalno provodi testove procjene gutanja, kojima prepoznaje bolesnike s rizičnim čimbenicima za aspiraciju. Ako je kod bolesnika uočen nesiguran obrazac gutanja, provodi se detaljna logopedska dijagnostika kojom se utvrđuje dalji način prehrane, kako bi se bolesniku omogućilo sigurno gutanje. Logoped odabire jednu ili više rehabilitacijskih tehnika koje će primijeniti, ovisno o bolesnikovu općem zdravstvenom stanju, suradljivosti i mogućnosti korištenja naučenim tehnikama nakon otpusta iz bolnice. Ovaj rad daje uvid u načine na koje se logoped brine o bolesnicima s poremećajem gutanja – od primitka do otpusta iz bolnice – i naglašava važnost logopeda u multidisciplinarnom timu, koji se bavi neurogenom disfagijom.
Article
Background Transtemporal Doppler (TTD) with middle cerebral artery (MCA) is widely used for right-to-left shunt (RLS) detection. However, an alternative method for patients without suitable temporal bone windows should be established. The present study prospectively evaluated the effectiveness of transorbital Doppler (TOD) with carotid siphon (CS) monitoring in detecting RLS. Methods A total of 357 subjects with sufficient temporal bone windows underwent simultaneous TTD with MCA and TOD with CS. After injection of microbubbles, the numbers of artificial high-intensity signals were recorded at rest and after Valsalva maneuver. Results TOD with CS detected RLS in 146 patients. Sensitivity was 97.1%, specificity 95%, positive predictive value 92.5%, and negative predictive value 98.1%. The total positive rates for RLS detection by CS (40.9%) and MCA (37.8%) monitoring were comparable without significant difference, but TOD with CS detected significantly more grade 2 and 3 RLS than TTD with MCA (p = 0.001). The RLS rates of cryptogenic stroke patients was significantly higher than that of healthy controls, and RLS in cryptogenic stroke was remarkably higher than that in transient ischemia attack patients (p < 0.05). TOD with CS examined significantly more grade 2 and 3 RLSs than the MCA approach in the cryptogenic stroke patients (p = 0.037). Conclusion TOD with CS monitoring is able to detect RLS effectively in different populations including healthy subjects, cryptogenic stroke, transient ischemia attack, and migraine patients. In comparing to the TTD with MCA approach, TOD with CS monitoring could detect comparable rate of RLS, but more high grades of RLS.
Thesis
Le Burkina Faso (BF) connait les phénomènes de transitions nutritionnelle et épidémiologique. Les hospitalisations pour AVC ou pour HTA et diabète sont en augmentation progressive, atteignant en 2016 trois fois les valeurs de 2012. Pour réduire la morbi-mortalité liée aux AVC, il faut réduire l’incidence des troubles de la déglutition (TD) et la dénutrition liée à la maladie. Les données sur ces sujets sont rares ou absentes en Afrique subsaharienne et au BF. Les objectifs des travaux étaient de i) déterminer la prévalence des troubles nutritionnels et des TD à l’admission pour AVC au BF, ainsi que leur évolution dans les 14 premiers jours de suivi ii) explorer au premier niveau de soins les connaissances et attitudes des infirmiers concernant les TD et les troubles nutritionnels des patients hémiplégiques, potentiellement victimes d’AVC. L’état nutritionnel et les TD de 222 patients victimes d’AVC consécutivement admis aux CHU de Ouagadougou et de Bobo-Dioulasso étaient étudiés à l’inclusion J0, au 8ème jour J8, et au 14ème jour J14. Les prévalences de la dénutrition étaient respectivement de 25,2%, 29,4% et 31,0%, et celles des TD de 37,4%, 28,4% et 15,8%. Tous les critères anthropométriques baissaient entre J0 et J14. A J14, les facteurs associés à la présence d’une dénutrition étaient le sexe féminin (OR=7,01; IC95% :1,51-32,56), le faible poids à J0 (OR=0,69; IC95%: 0,60- 0,79), et le faible pli cutané tricipital tricipital à J0 (OR=0,85; IC95%: 0,74-0,99). La dénutrition était un problème de santé important dès J0 chez ces patients, et les personnes de sexe féminin et les patients les plus dénutries à J0 devraient être particulièrement surveillées et pris en charge. Un questionnaire d’exploration des connaissances et pratiques concernant les TD et les troubles nutritionnels était administré à 125 infirmiers de centres de soins primaires urbains travaillant dans les centres dont le niveau de référence reçoit le plus de patients hémiplégiques au BF. 57% des infirmiers avaient des connaissances modestes sur le rôle du cerveau dans le contrôle de la déglutition et la survenue d’une hémiplégie. Concernant le dépistage des TD, 58,4% donnaient de bonnes réponses sur le chapitre portant sur la toux et 56,0% sur le chapitre portant sur la voix. 42,3% des infirmiers faisaient le lien entre pneumopathie d’inhalation et TD, 36,0% connaissaient une manoeuvre d’urgence à appliquer en cas de fausse route trachéale. Seulement 1,6% des infirmiers savaient que les adaptations des textures, les modifications de goût ou de température des boissons pouvaient influer sur les TD, et 65,6% reconnaissaient l’impact des adaptations posturales. L’impact des TD sur l’état nutritionnel étaient connu par 39,2% des infirmiers. Pour dépister un TD, seulement 11,6% des infirmiers utilisaient à la fois un interrogatoire et un test de réalimentation. 30,1% des infirmiers ne prodiguaient pas de conseils hygiéno-diététiques aux patients. Lors du transfert du malade vers l’échelon supérieur, 41,7% ne renseignaient jamais l’existence ou non des TD. En multivarié, seule la bonne connaissance du chapitre voix était associée à la capacité de détecter un TD (OR=3,5; IC95%: 1,4-8,1). Les éléments du cursus professionnel des infirmiers n’intervenaient pas. L’enseignement de neurologie et celui portant sur la nutrition des patients hémiplégiques devrait intégrer des données spécifiques sur les TD, avec en particulier leurs modalités de dépistage et des conseils simples de textures et de postures. Ces études ont permis de préciser pour la première fois l’état nutritionnel et la prévalence des TD chez les patients post-AVC au BF. Elles suggèrent que les parcours de soins des patients pourraient être sécurisés, grâce en particulier à la mise en place de programmes de formations des personnels de santé, à une meilleure information des patients, quand c’est possible, et des entourages, et également à la mise à disposition de matériels et techniques simples.
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Background: Dysphagia is frequently observed in patients with multiple sclerosis (MS). Dysphagia and its complications are common causes of morbidity and mortality in final stages of MS disease. This study aimed at determining the prevalence of dysphagia in Iranian patients with MS and identifying predictors associated with dysphagia. Methods: A total of 230 MS patients were enrolled in this cross-sectional study. Dysphagia was evaluated using Mann Assessment of Swallowing Ability (MASA). Demographic characteristics (age and gender), duration of the disease, disease course, and Expanded Disability Status Scale (EDSS) were recorded for all participants. Results: In total, dysphagia was found in 85 participants (37%) with mild to severe dysphagia (mild 50.6%; moderate 29.4%; and severe 20%). The logistic regression model demonstrated that disability status in EDSS (OR= 2.1; 95% CI 0.5-1.2) and disease duration (OR= 2.3; 95% CI 0.4-1.1) predicts a high risk for dysphagia in MS patients. Conclusion: Dysphagia is prevalent in Iranian patients with MS. Disability level and disease duration are significant predictors of dysphagia after MS.
Article
Background: Recent research confirmed that at least a third of people with multiple sclerosis (MS) are suffering from swallowing difficulties. Dysphagia is associated with significant morbidity and mortality, and has profound impact on physical ability and quality of life. Dysphagia related complications can be prevented through an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) questionnaire is the first dysphagia questionnaire developed specifically for patients with MS. The aim of the present study was the cultural adaptation of DYMUS for the Greek population, evaluation of the questionnaire's reliability and validity and normative data generation for DYMUS, which has not been published before. Methods: DYMUS was completed by 200 participants: 108 MS patients and 92 asymptomatic subjects (60 male and 140 female). Patients with MS were consecutively recruited from the Multiple Sclerosis Centre during regular visits. Asymptomatic participants were community-dwelling healthy persons. All data were collected prospectively. MS patients were invited to complete DYMUS and the Greek versions of the Eating Assessment Tool-10 (EAT-10), and the Swallowing-Quality of Life (SWAL-QoL) questionnaires. Healthy subjects completed DYMUS and the Greek EAT-10. The study consisted of item generation for the Greek DYMUS, internal consistency and reliability analysis, normative data generation, and validity analysis. Criterion validity was assessed by comparing scores between groups with expected differences: MS patients and healthy participants. Construct validity was assessed by comparison of DYMUS scores of dysphagic and non dysphagic patients. DYMUS was also validated against EAT-10, and SWAL-QoL to assess its convergent validity. Results: DYMUS was completed by all participants in less than 3 min. The internal consistency was excellent (Cronbach's alpha was 0.866). Test-retest reliability was good (Pearson's correlation coefficient was 0.637). The mean DYMUS score for the healthy cohort was 0.23 ± 0.471. The upper limit of normal was 1.172. MS patients had statistically significantly higher score than controls (Mann Whitney test, p < 0.001). DYMUS mean score was statistically significantly higher in the dysphagic compared to the non dysphagic MS patients (Mann Whitney test, p < 0.001). There was a strong positive and statistically significant correlation between DYMUS and EAT-10 (Pearson's Correlation coefficient, r = 0.754, p = 0). In the MS patients cohort 25.9% reported themselves as dysphagic, 34.3% were classified as dysphagic according to EAT-10 and 44.4% according to DYMUS. The DYMUS score had a statistically significant positive correlation with the EDSS score, (Mann Whitney, p < 0.001) whereas age, sex, type of MS and disease duration were not significantly correlated. Based on our data analysis we propose the modification of DYMUS to a 9-items tool eliminating the question about weight loss. A DYMUS score of 2 or higher is indicating dysphagia for both the original DYMUS and the modified DYMUS. Conclusions: The Greek version of DYMUS was found to be a valid, reliable and practical for clinical use questionnaire for the detection of dysphagia in Multiple Sclerosis. The first reported normative data for DYMUS suggest a cut-off for the diagnosis of dysphagia at 2 and our findings support a modification of DYMUS eliminating the question about weight loss.
Article
Swallowing difficulties are a common symptom of multiple sclerosis (MS). The early detection and treatment of dysphagia is critical to prevent complications, including poor nutrition, dehydration, and lung infections. Recently, transcranial direct current stimulation (tDCS) has been proven to be effective in ameliorating swallowing problems in stroke patients. In this pilot study, we aimed to assess safety and efficacy of transcranial direct current stimulation (tDCS) in the treatment of dysphagia in MS patients. We screened 30 patients by using the 10-item DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire, and patients at risk for dysphagia underwent a clinical and fiberoptic endoscopic evaluation of swallowing (FEES). Six patients who presented with mild to moderate dysphagia underwent the experimental procedures. These consisted of 5 sessions of anodal tDCS applied in consecutive days over the right swallowing motor cortex. Patients were followed-up at 1 week, 1 month and 3 months after treatment, and changes in the Dysphagia Outcome and Severity Scale (DOSS) score between baseline and post-tDCS were assessed. Our results showed that in all patients, the tDCS treatment determined a mild but significant clinical benefit (one-point improvement in the DOSS score) lasting up to 1 month. In conclusion, our preliminary results show that anodal tDCS has therapeutic potential in the treatment of swallowing problems in patients suffering with MS. However, future double-blind, randomized, and sham-controlled studies are needed to confirm the present findings.
Article
Purpose This clinical focus article considers the roles of the clinical swallow examination (CSE) as a clinically meaningful assessment method used in both adult and pediatric populations. Method This clinical focus article explores the utility of the CSE across the life span. Specifically, components, reliability, standardized assessments, and limitations of the CSE within the adult and pediatric populations are highlighted. Conclusions The CSE remains a crucial assessment tool for the speech-language pathologist. The experienced clinician can make important judgments regarding patient safety and function. If the CSE is conducted mindfully and methodically, findings can help chart the course of care for individuals needing additional assessment and possibly intervention.
Article
Purpose This tutorial will provide speech-language pathologists with foundational knowledge about systematic reviews and their importance in everyday practice. It will also assist clinicians in developing critical appraisal skills so that current research can be translated judiciously to clinical environments for patient care. Systematic reviews are often regarded as the highest level of research evidence for implementing best evidence-based practice, because they synthesize research findings from multiple high-quality research studies, identify methodological weaknesses and biases from the studies included, and assist in illuminating areas for future research work based on current gaps in the literature. While systematic reviews can provide comprehensive knowledge to inform clinical practice, few speech-language pathologists receive training on appraising and applying the findings from systematic reviews appropriately within clinical settings. Conclusion Clinicians within the field of speech-language pathology can use the framework provided in this tutorial to evaluate systematic reviews as a preliminary step for determining appropriate assessment and treatment methods for implementing evidence-based practice within clinical settings.
Article
Background : It is known that many body systems are affected as a result of dysphagia. The aim of this study is to investigate the relationship between clinical features, respiratory functions, anthropometric measurements and dysphagia in patients with multiple sclerosis (MS). Method : Seventy-five MS patients and 50 healthy controls were included in this prospective case-control study. Disability was assessed with expanded disability status scale (EDSS), and swallowing was assessed with questionnaire for the assessment of dysphagia (solid, liquid and total) for disease. Respiratory functions were demonstrated with computerized spirometry device. Body weight, height, waist, hip, and mid-arm circumference are measured. Body mass index and body fat percentage were calculated. The relationship of all these parameters with disease activity and dysphagia was investigated. Results : There were 75 MS patients with a mean age of 38.40 ± 11.27 years, and 50 (66.70%) were female in the study. The all type of dysphagia scores were higher in MS patients than control group (p = 0.001). Many respiratory function test scores and only hip circumference were lower in MS patients. However, especially low forced expiratory volume-1st second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) values were associated with disability. In addition, dysphagia scores were higher in progressive MS patients with severe disability and high frequency attacks (p = 0.001). Increased severity of dysphagia are associated with many lower anthropometric measurements (not height-especially mid-arm circumference) and respiratory function test scores. Conclusion : MS affects swallowing and respiratory systems functions. They are associated with MS disease activity. Dysphagia and its severity are associated with many anthropometric measurements and respiratory functions test scores.
Chapter
This chapter systematically introduces the neurological disorders that can result in neurogenic dysphagia. The special findings of instrumental dysphagia diagnostics that can be observed in the different forms of neurogenic dysphagia are described, and practical recommendations for diagnostics in clinical practice are provided. Only neurological diseases that are important in adulthood are included. A structured differential diagnosis for neurological patients with dysphagia as a main symptom is presented at the end of the chapter.
Article
Objective: we investigated the effect of anodal transcranial direct current stimulation (tDCS) applied over the pharyngeal motor area in dysphagia associated with multiple sclerosis (MS). Methods: Eighteen MS patients with dysphagia associated with brainstem involvement were randomized to receive either "real" or "sham" tDCS. Primary outcome: The Penetration/Aspiration Scale (PAS). Secondary outcomes: changes in electromyographic (EMG) parameters and pharyngeal cortical motor evoked potentials (MEPs). Patients were evaluated at baseline (T0), at the end of 5-session cycle of tDCS stimulations (T1), after two (T2), and four (T3) weeks. Results: the PAS values were significantly lower in the active group than in "sham" group at T1, and at T3. Over the post-stimulation periods, PAS significantly improved only in the "real" group. As regards the secondary outcomes, we observed a statistically significant difference between the 2 groups only in the MEPs amplitude at T1. The comparison between baseline and each of the post-stimulation times showed significant differences only of the "real" group across all the secondary parameters. Conclusions: Our findings support a beneficial effect of anodal tDCS applied to the pharyngeal motor cortex in MS-associated dysphagia. Significance: Considering its safety and efficacy, tDCS may represent an important resource in MS-associated dysphagia.
Chapter
La sclérose en plaques-clinique et thérapeutique
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Swallowing is a function that starts with acceptance of food into the mouth and is completed by delivery to the stomach. Dysphagia (swallowing disorders) refers to the disorders that occur during the period of food delivery from the mouth to the stomach. Dysphagia may result in malnutrition, dehydration, decreased quality of life, or even death. Dysphagia should be detected and treated at an early stage due to these complications. Dysphagia evaluation can be divided into clinical and instrumental evaluation. The aim of this review was to determine the clinical evaluation steps of swallowing function, define the scales that are frequently used in clinical evaluations, and guide clinicians working in the field of swallowing disorders. Keywords: Dysphagia, Clinical evaluation, Evaluation tools
Article
The purpose of this article is to describe normal, age-related changes in the swallowing mechanism, clinically referred to as “presbyphagia.” The authors compare presbyphagia in the oral, pharyngeal, and esophageal phases of the swallow to abnormal, or impaired swallowing, termed “dysphagia.” This article focuses on how older persons with Parkinson disease and multiple sclerosis frequently have dysphagia symptoms, such as food residue, delayed swallow trigger, penetration, and/or aspiration, superimposed over presbyphagia. Information on the psychosocial and emotional impacts of dysphagia on persons with Parkinson disease and/or multiple sclerosis, along with common treatment approaches to alleviate swallowing difficulties, has also been discussed.
Article
Background : Oropharyngeal dysphagia is a common symptom of many neurological diseases, including Multiple Sclerosis (MS). Early identification of the risk of dysphagia in neurological patients is very important for early referral for specialized evaluations of oropharyngeal swallowing and treatments. The Dysphagia in Multiple Sclerosis (DYMUS) questionnaire has been translated and validated in different countries over the last 10 years. We aimed to analyze the accuracy of the Brazilian Portuguese version of the DYMUS (DYMUS-BR) questionnaire in identifying dysphagia in patients with MS. Methods : The DYMUS questionnaire and a videofluorographic swallowing study (VFSS) were conducted in 30 patients with MS. Dysphagia was identified by at least one abnormal response and was considered alarming when the DYMUS scores were equal to or higher than 3. Patients were considered to have dysphagia in the VFSS when one or more signs of impairment in the efficiency and/or safety of swallowing were detected. Results : According to the initial self-assessment, 37% (N=11) of patients with MS self-reported with dysphagia. According to the DYMUS-BR scores, 53% (N=16) of the patients with MS were classified as having dysphagia. The sensitivity, specificity, and positive and negative predictive values of the DYMUS-BR questionnaire for the detection of dysphagia as measured by the VFSS were 50% [95% confidence interval (CI) 29–71], 78% (95% CI 61–90), 60% (95% CI 42–76), and 70% (95% CI 60–78), respectively. The area under the receiver-operating characteristic curve for detecting dysphagia was 64% (95% CI 49–79). Conclusion : The accuracy of the DYMUS-BR questionnaire is poor to detect mild swallowing impairment in patients with MS. However, we suggest longitudinal follow-up in patients with low DYMUS-BR scores for early detection of oropharyngeal dysphagia.
Article
Introduction There is no patient‐reported outcome (PRO) questionnaire specifically designed to assess oropharyngeal dysphagia in oculopharyngeal muscular dystrophy (OPMD). To select a suitable questionnaire, content validity of the existing questionnaires must be assessed. This study aims to: (1) identify dysphagia‐related symptoms in OPMD, and (2) assess content validity of currently available PRO for the assessment of dysphagia severity in OPMD. Methods A two‐steps literature review was conducted of dysphagia‐related symptom identification and oropharyngeal dysphagia‐related PRO. Symptoms were validated with an expert panel using a Delphi survey. Content validity of PRO questionnaires was documented through content analysis. Results Ten PRO questionnaires were identified. None of the questionnaires cover the entire symptom spectrum in OPMD and thus lack content validity. Discussion The development and validation of a new PRO questionnaire to assess dysphagia in OPMD is required to establish the importance of symptomatic relief from new treatments. This article is protected by copyright. All rights reserved.
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Five hundred and twenty-five consecutive outpatients with a confirmed diagnosis of multiple sclerosis were screened for symptoms of dysphagia. Forty percent of the sam ple acknowledged that they had swallowing problems. Forty-three percent of the sam ple reported symptoms suggestive of dysphagia, including coughing (26%), choking (19%), anxiety about swallowing (19%), and change in swallowing function (11%), with 11% currently having difficulty swallowing. No differences were found between the age and sex distributions of the symptomatic MS subjects and the total sample of outpatients with MS studied. Comparative analyses found that the symptomatic sub jects were significantly more disabled as measured by the Extended Disability Status Scale and had significantly greater impairment to cerebellar, brainstem, and mental (cognitive) function as measured by the Functional Systems scale than the MS sub jects asymptomatic for dysphagia on self-report. Higher report of dysphagic symptoms and mental and cerebellar dysfunction differentiated the symptomatic subjects who were having difficulty swallowing from those who were swallowing with ease at the time of report. Key Words: Multiple sclerosis—Dysphagia—Deglutition disorder.
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In this observational study of patients with multiple sclerosis (MS) admitted to a regional neurology centre we assessed the frequency of dysphagia (objectively defined), dysphagia related symptoms, bulbar signs and nutritional status. We studied 79 consecutive admissions with MS (24 at diagnostic admission and 55 more advanced cases admitted for treatment and/or rehabilitation): normative swallowing data were from 181 healthy controls. Swallowing symptoms and signs were semi-quantitatively measured and compared to healthy controls. Dysphagia was defined by a quantitative water test. Disability was determined by Kurtzke's Expanded Disability Status Scale and Barthel's index. Nutritional status was assessed by body mass index, estimated percentage body fat from skin fold thickness measurements at four sites, a global evaluation of nutrition, the presence of pressure sores and the pressure sore risk using the Waterlow score. Patients with MS were more likely to complain of abnormal swallowing, of coughing when eating, and of food 'going down the wrong way' than healthy controls (P < 0.005). These significantly associated symptoms had high specificity but relatively low sensitivity. 43% of patients had abnormal swallowing, almost half of whom did not complain of it: abnormal swallowing was associated with several factors including abnormal brainstem/cerebellar function, disability, vital capacity, and depression score. Those with abnormal swallowing had higher Waterlow scores (P < 0.001), but, overall, abnormal swallowing was not associated with a difference in nutritional indices or incidence of pressure sores. In summary, abnormal swallowing is common in MS although often not complained of. It is associated with disordered brainstem/cerebellar function, overall disability, depressed mood and low vital capacity. It was not associated with major nutritional failure or pressure sores in this study.
Article
The International Panel on MS Diagnosis presents revised diagnostic criteria for multiple sclerosis (MS). The focus remains on the objective demonstration of dissemination of lesions in both time and space. Magnetic resonance imaging is integrated with clinical and other paraclinical diagnostic methods. The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including “monosymptomatic” disease suggestive of MS, disease with a typical relapsing-remitting course, and disease with insidious progression, without clear attacks and remissions. Previously used terms such as “clinically definite” and “probable MS” are no longer recommended. The outcome of a diagnostic evaluation is either MS, “possible MS” (for those at risk for MS, but for whom diagnostic evaluation is equivocal), or “not MS.”
Article
A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should be so divided before using the formula. The index [`(r)]ij\bar r_{ij} , derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches. Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial group-factor clusters within a subtest. Scalability is not a requisite.
Article
Multiple sclerosis (MS) is one of the most common diseases capable of producing severe disability in the young adult population. In fact, only rheumatic disorders and trauma exceed MS in this respect. Because the total population of patients in the United States is probably 250,000 to 500,000 and as a substantial number suffer severe disability, MS is a disease of considerable social and economic impact. The authors discuss the treatment of many of the most troubling symptoms of MS, including disorders of gait, bladder and bowel, upper extremities, speech, and deglutition. Such treatment entails careful assessment of the patient's neurologic and other symptoms; knowledge of his or her intellectual, emotional, and social skills and demands; and an understanding of the patient's support network.
Article
One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
Article
A survey of approximately 460 patients with Parkinson's disease (PD) or multiple sclerosis (MS) shows that speech and swallowing difficulties are very frequent within these groups. Seventy percent of the PD patients and 44% of the MS patients had experienced impairment of speech and voice after the onset of their disease. Forty-one percent of the PD patients and 33% of the MS patients indicated impairment of chewing and swallowing abilities. The speech disorder was regarded as one of their greatest problems by 29% of the PD patients and by 16% of the MS patients. Only a small number of patients, 3% of the PD and 2% of the MS group, had received any speech therapy.
Article
Dysarthria occurs in approximately 40% of all patients with MS. When speech and voice disturbances do occur, they usually present as a spastic-ataxic dysarthria with disorders of voice intensity, voice quality, articulation, and intonation. While language disturbances such as aphasia, auditory agnosia, anomia, dysgraphia, and dyslexia are very rare in MS, cognitive deficits and swallowing disorders are common. Treating dysarthria, dysphagia, and cognitive deficits in MS patients is effective for reestablishing functional daily activities. The types, severity, and rates of deterioration in MS are highly variable; complete restoration to normal functioning is therefore not always expected. For these reasons, careful documentation of clinical-treatment outcomes and the factors influencing these outcomes should be regularly collected and reported.
Article
The aim of the study was to analyse swallowing function and to identify reliable prognostic factors associated with dysphagia in a consecutive series of patients with multiple sclerosis (MS). Swallowing examination was performed by means of indirect and direct methods (fiberendoscopic evaluation) in 143 consecutive patients with primary and secondary progressive MS. Dysphagia was found in 49 patients (34.3%). A close relationship with dysphagia was found in the patients with severe brainstem impairment (OR=3.24; 95% CI 1.44-7.31) as compared to the patients without. There was also a significant correlation with pronounced severity of illness (OR=2.99; CI 1.36-6.59). Compensatory strategies were sufficient to resolve the dysphagia in 46 cases (93.8%). The potential risk of aspiration and malnutrition and the high efficacy of swallowing rehabilitation suggests that all MS patients should have a careful evaluation of deglutition functionality, especially those with brainstem impairment and a high grade of disability level.
Article
(1) To determine the prevalence of swallowing problems in MS patients and its relation to the overall disability. (2) To define the most frequent symptoms suggestive of dysphagia. (3) To describe the abnormalities on manofluoroscopy (MFS). Three hundred and eight consecutive MS patients were asked whether they ever had swallowing problems. If so the questionnaire of the Johns Hopkins Swallowing Centre was applied to qualify the dysphagia. A MFS was performed in 30 patients with dysphagia covering the entire spectrum of MS. Overall disability was assessed using the Expanded Disability Status Scale (EDSS). Seventy-three of our 309 patients had permanent dysphagia (24%). Another 5% had a history of transitory swallowing problems only. Permanent dysphagia started to be a problem in mildly impaired patients (EDSS 2-3). Prevalence increased together with rising disability to reach 65% in the most severely disabled subjects (EDSS 8-9). Two alarming symptoms of patients with swallowing problems, coughing or choking during the meal and a history of pneumonia were present in 59%, respectively, 12% of these patients. MFS showed deficiency of the oral phase in all patients, while only the patients with an EDSS higher than 7.5 showed abnormalities of the pharyngeal phase. Permanent dysphagia may already develop in mildly impaired MS patients but becomes a rather frequent finding in MS patients with moderate or severe disability. MFS is a sensitive and useful ancillary examination. Important qualitative changes of the pharyngeal phase on MFS are seen in patients with an EDSS higher than 7.5.
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