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

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

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