Creation and Initial Validation of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale

OBJECTIVE: To assess consensual validity, interrater reliability, and criterion validity of the International Dysphagia Diet Standardisation Initiative Functional Diet Scale, a new functional outcome scale intended to capture the severity of oropharyngeal dysphagia, as represented by the degree of diet texture restriction recommended for the patient. DESIGN: Participants assigned International Dysphagia Diet Standardisation Initiative Functional Diet Scale scores to 16 clinical cases. Consensual validity was measured against reference scores determined by an author reference panel. Interrater reliability was measured overall and across quartile subsets of the dataset. Criterion validity was evaluated versus Functional Oral Intake Scale (FOIS) scores assigned by survey respondents to the same case scenarios. Feedback was requested regarding ease and likelihood of use. SETTING: Web-based survey. PARTICIPANTS: Respondents (N=170) from 29 countries. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Consensual validity (percent agreement and Kendall tau), criterion validity (Spearman rank correlation), and interrater reliability (Kendall concordance and intraclass coefficients). RESULTS: The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed strong consensual validity, criterion validity, and interrater reliability. Scenarios involving liquid-only diets, transition from nonoral feeding, or trial diet advances in therapy showed the poorest consensus, indicating a need for clear instructions on how to score these situations. The International Dysphagia Diet Standardisation Initiative Functional Diet Scale showed greater sensitivity than the FOIS to specific changes in diet. Most (\u3e70%) respondents indicated enthusiasm for implementing the International Dysphagia Diet Standardisation Initiative Functional Diet Scale. CONCLUSIONS: This initial validation study suggests that the International Dysphagia Diet Standardisation Initiative Functional Diet Scale has strong consensual and criterion validity and can be used reliably by clinicians to capture diet texture restriction and progression in people with dysphagia

The Burden of Dysphagia on Family Caregivers of the Elderly: A Systematic Review

With the rapid increase in the elderly population, there is a simultaneous increased need for care provided by family caregivers. Research in the field of head and neck cancer has indicated that caring for patients with dysphagia can impact a caregiver’s quality of life. Given that many older adults present with dysphagia, one can assume that their caregivers are equally, if not more greatly, affected. The purpose of this systematic review was to examine all relevant literature regarding the caregiver burden in caregivers of community-dwelling older adults with dysphagia. A review of relevant studies published through April 2018 was conducted using search terms related to dysphagia, caregiver burden, and older adults. The search yielded 2331 unique abstracts. Of the 176 abstracts that underwent full review, four were accepted. All reported an increase in caregiver burden due to presence of dysphagia in care recipients. Worsening feeding-related behaviors were associated with burden, and the use of feeding tubes was more frequently associated with “heavy burden”. The presence of dysphagia in community-dwelling older adults is a factor leading to an increased burden among caregivers. Although aspects of dysphagia play a role in the caregiver burden, the specific reasons for the increased burden are unknown. Clinicians should be aware of dysphagia as a source of the burden, and future studies should further define the relationship between dysphagia and the caregiver burden in order to develop comprehensive approaches to care

Presbyphagia to Dysphagia: Multiple Perspectives and Strategies for Quality Care of Older Adults

The aging population is rapidly growing, requiring speech-language pathologists to better manage a caseload that includes older adults who have a variety of needs. The purpose of this review is to summarize and discuss the current available evidence that will allow speech-language pathologists to make informed clinical decisions when working with older adults. To facilitate this, this article first establishes an understanding of both normal and disordered swallowing physiology in older adults, including how to differentiate between functional changes to swallowing (presbyphagia) and dysphagia. Other important factors to consider, such as caregiver burden, are also discussed so that clinicians can learn how to best support aging in place. Best practices for screening both community-dwelling older adults and residents of long-term care are identified as part of a framework introduced to guide decision making. The critical components of clinical swallow assessments are reviewed, including the adoption of an ethnographic approach and why nutritional status, urinary tract infections, and delirium are important considerations when working with older adults. Factors contributing to, and associated with, aspiration and aspiration pneumonia are also discussed so that clinicians better understand how to take a comprehensive approach to care, as well as consider the impact and influence of a temporary dysphagia versus a more chronic presentation. Finally, the evidence for management of dysphagia in this specialized population is reviewed, highlighting the importance of identifying physiological deficits, feedback, and taking a multidisciplinary approach to care

Quantifying Airway Invasion and Pharyngeal Residue in Patients with Dementia

Previous research has begun to elucidate the physiological impairments associated with dysphagia in patients with dementia, but in order to select the most appropriate targets of intervention we need to better understand consequences of dysphagia. The purpose of this study was to quantify penetration, aspiration, and residue in people with dementia, and confirm if residue was associated with airway invasion on subsequent swallows. Videofluoroscopy clips of sips of thin and extremely thick liquid barium from 58 patients with dementia were retrospectively analyzed. Ratings of swallowing safety, using the Penetration–Aspiration Scale (PAS), and efficiency, using Normalized Residue Ratio Scale in the valleculae (NRRSv) and pyriform sinuses (NRRSp), were made on all swallows. Over 70% of both thin and extremely thick liquid swallows were found to be safe (PAS < 3). Results also revealed that residue was generally more common in the valleculae. However, the proportion of thin liquid swallows with significant NRRSp that were unsafe on the subsequent swallow was significantly greater than the proportion of swallows with significant NRRSp that were safe on the subsequent swallow. As such, there was a 2.83 times greater relative risk of penetration–aspiration in the presence of thin liquid pyriform sinus residue. Future research should determine the impaired physiology causing aspiration and residue in this population

The Burden of Dysphagia on Family Caregivers of the Elderly: A Systematic Review

With the rapid increase in the elderly population, there is a simultaneous increased need for care provided by family caregivers. Research in the field of head and neck cancer has indicated that caring for patients with dysphagia can impact a caregiver’s quality of life. Given that many older adults present with dysphagia, one can assume that their caregivers are equally, if not more greatly, affected. The purpose of this systematic review was to examine all relevant literature regarding the caregiver burden in caregivers of community-dwelling older adults with dysphagia. A review of relevant studies published through April 2018 was conducted using search terms related to dysphagia, caregiver burden, and older adults. The search yielded 2331 unique abstracts. Of the 176 abstracts that underwent full review, four were accepted. All reported an increase in caregiver burden due to presence of dysphagia in care recipients. Worsening feeding-related behaviors were associated with burden, and the use of feeding tubes was more frequently associated with “heavy burden”. The presence of dysphagia in community-dwelling older adults is a factor leading to an increased burden among caregivers. Although aspects of dysphagia play a role in the caregiver burden, the specific reasons for the increased burden are unknown. Clinicians should be aware of dysphagia as a source of the burden, and future studies should further define the relationship between dysphagia and the caregiver burden in order to develop comprehensive approaches to care

Speech-Language Pathology Management for Adults With COVID-19 in the Acute Hospital Setting: Initial Recommendations to Guide Clinical Practice

Purpose This document outlines initial recommendations for speech-language pathology management of adult patients with COVID-19 in the acute hospital setting. Method The authors initially developed these recommendations by adapting those developed for physical therapists working with patients with COVID-19 by Thomas et al. (2020). The recommendations then underwent review by 14 speech-language pathologists and rehabilitation-focused academics representing seven countries (Belgium, Brazil, Canada, Ireland, Japan, New Zealand, the United States). The authors consolidated and reviewed the feedback in order to decide what should be included or modified. Applicability to a global audience was intended throughout the document. Results The authors had 100% agreement on the elements of the recommendations that needed to be changed/modified or added. The final document includes recommendations for speech-language pathology workforce planning and preparation, caseload management, service delivery and documentation, as well as recommendations for the selection of appropriate personal protective equipment and augmentative and alternative communication equipment in the acute care hospital setting. Conclusions Speech-language pathologists play a critical role in the assessment, management, and treatment of patients with COVID-19. Several important considerations need to be made in order to meet the needs of this unique patient population. As more is learned about the impact of the virus on swallowing and communication, the role of the speech-language pathologist on interdisciplinary care teams will remain paramount

Designing a Novel Interprofessional and Inter-University Education Session for Healthcare Trainees to Improve Interprofessional Practice

[EN] Interprofessional education is widely acknowledged as critical for training successful clinicians, however logistical challenges often interfere with its implementation. The aim of this paper is to describe the procedures developed to enable students in different health professional programs in different geographic regions within the same country to learn about each other’s professions and apply this knowledge to optimize outcomes for patients. Principles from the Rehabilitation Treatment Specification System and Universal Design for Learning were combined to design an efficient and effective virtual approach to achieving interprofessional knowledge and collaborative skill outcomes. Application of these principles resulted in a 3-stage approach combining synchronous and asynchronous learning as well as didactic and problem-based learning. This paper describes the design and implementation for speech-language pathology and pharmacy students learning about swallowing disorders, but the procedures are applicable to a broad range of professions and academic content when interprofessional education is the goal.Hamilton, J.; Namasivayam-Macdonald, A.; Shackel, L.; Macphee, H. (2022). Designing a Novel Interprofessional and Inter-University Education Session for Healthcare Trainees to Improve Interprofessional Practice. En 8th International Conference on Higher Education Advances (HEAd'22). Editorial Universitat Politècnica de València. 47-55. https://doi.org/10.4995/HEAd22.2022.14286475

Factors influencing LVC in healthy adults (Werden Abrams et al., 2023)

Purpose: Our study aims were (a) to examine laryngeal vestibular closure (LVC) temporal measures in healthy adults across tasks used in the Modified Barium Swallow Impairment Profile (MBSImP) protocol to establish normative reference values and (b) to examine influences of age, gender, and swallow task on LVC temporal measures.Method: A retrospective analysis of 195 healthy adults (85 men, 110 women; age range: 21–89 years) who participated in a videofluoroscopic swallowing study was completed. Seven swallow tasks of standardized viscosities and volumes, as per the MBSImP protocol, were analyzed to measure time-to-LVC and LVC duration (LVCd). Descriptive statistics were employed for all measures of interest. Regression modeling was used to explore relationships between LVC temporal measures (time-to-LVC, LVCd) with age, gender, and swallow task. The relationship between time-to-LVC and LVCd was also explored.Results: Significant findings included an increasing trend in LVCd across age (older individuals had a longer LVCd), with women demonstrating a greater increase. Related to viscosity, LVCd was significantly shorter for pudding compared to thin liquid. Furthermore, when compared to 5-ml tasks, LVCd was significantly longer in cup tasks, while time-to-LVC was significantly shorter. An association was also observed between time-to-LVC and LVCd: As time-to-LVC decreased, LVCd increased.Conclusions: LVCd was influenced by age, gender, and swallow task. Longer time-to-LVC was observed in older individuals, particularly older women, and with thin liquids. Study findings contribute to adult normative reference values for LVC temporal measures (time-to-LVC and LVCd) across MBSImP swallowing tasks.Supplemental Material S1. Descriptive analyses across age category, gender, and swallow tasks.Werden Abrams, S., Petersen, C., Beall, J., Namasivayam-MacDonald, A., Choi, D., & (Focht) Garand, K. L. (2023). Factors influencing laryngeal vestibular closure in healthy adults. Journal of Speech, Language, and Hearing Research, 66(10), 3844–3855. https://doi.org/10.1044/2023_JSLHR-22-00741</p

Claves estéticas de la primera recepción de la teoría wagneriana en Madrid

En la década de 1860, la crítica musical española planteó una oposición total entre dos sistemas considerados excluyentes: la ópera italiana y el drama musical wagneriano. El debate discutió sobre la relación que debía existir entre la música y el texto en el género de la ópera, es decir, cuál de las dos disciplinas debía prevalecer en la composición. La ópera italiana dio una preeminencia total a la música, reflejando una «concepción idealista». En el lado opuesto estaba el punto de vista de Wagner, quien dio al texto una posición de superioridad, pues creía que la música debía someterse al poema para lograr un espectáculo creíble, «realista», enlazando así con las teorías de Gluck. Esto significaba que la música debía secundar al texto para reforzar su verosimilitud dramática. Sin embargo, en la década de 1870 se produjo un cambio debido a la influencia de una filosofía importada a España, el Krausismo, cuyo nombre proviene del alemán Karl Christian Friedrich Krause. El entorno del krausismo, que ambicionaba la consecución de una ópera española, abordó el problema desde la perspectiva de armonización de contrarios, buscando resolver la oposición entre tradición y modernidad, nación y universalidad. En cuanto a esta última cualidad, se pretendía, asimismo, armonizar las diferentes escuelas de la ópera, considerando a Richard Wagner como el representante alemán más genuino y vanguardista y, por lo tanto, tener en cuenta para crear un género nacional.In the 1860s, Spanish music criticism propounded an opposition between two repertories, considered to be mutually exclusive: Italian opera and Wagnerian music drama. The debate surrounding these two repertories raised the issue of what relationship there should be between music and text in opera, centring on the question of which of the two disciplines should prevail in composition. Italian opera gave total prevalence to music over text, thus reflecting an «idealist conception» of art. Wagner’s point of view, conversely, put the text in a position of superiority: Wagner he believed that music should always be subjected to the requirements of the text to achieve a credible, «realistic» production. Wagner linked his ideas with Gluck’s notion that music must support the text in order to reinforce its dramatic authenticity. However, in the 1870s a change emanated from the influence of a philosophical current imported to Spain: Krausism (from the thinking of German Karl Christian Friedrich Krause). The Krausist followers, who strived for the establishment of a Spanish opera, addressed the issue from the perspective of the harmonisation of opposites, seeking to resolve the opposition between tradition and modernity, nationhood and universality. Concerning the latter, they attempted to reconcile the different operatic schools. They used Richard Wagner as an example, as they considered him to be the most genuine and avant-garde German representative of opera composition at the time, and the figure most likely to be taken into account in the creation of a national genre.Keywords: Richard Wagner (Reception, Controversial, Spain); Bel canto; Aesthetic; Spanish opera; Krausism; François-Joseph Fétis; Manuel de la Revilla.In the 1860s, Spanish music criticism propounded an opposition between two repertories, considered to be mutually exclusive: Italian opera and Wagnerian music drama. The debate surrounding these two repertories raised the issue of what relationship there should be between music and text in opera, centring on the question of which of the two disciplines should prevail in composition. Italian opera gave total prevalence to music over text, thus reflecting an «idealist conception» of art. Wagner’s point of view, conversely, put the text in a position of superiority: Wagner he believed that music should always be subjected to the requirements of the text to achieve a credible, «realistic» production. Wagner linked his ideas with Gluck’s notion that music must support the text in order to reinforce its dramatic authenticity. However, in the 1870s a change emanated from the influence of a philosophical current imported to Spain: Krausism (from the thinking of German Karl Christian Friedrich Krause). The Krausist followers, who strived for the establishment of a Spanish opera, addressed the issue from the perspective of the harmonisation of opposites, seeking to resolve the opposition between tradition and modernity, nationhood and universality. Concerning the latter, they attempted to reconcile the different operatic schools. They used Richard Wagner as an example, as they considered him to be the most genuine and avant-garde German representative of opera composition at the time, and the figure most likely to be taken into account in the creation of a national genre