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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to investigate the distribution of causes of dysphagia and the types of treatments being provided at the Dysphasia/Dysphagia Rehabilitation Clinic of Showa University Dental Hospital. The subjects included 173 dysphagic patients. Fifty-three percent of patients ranged 0-12 age, and 24% of them were over 60 years old. The survey results showed that diseases of the central nervous system, such as cerebral palsy (CP), was a major diagnosis in young patients, and cerebrovascular accident (CVA) was a predominant cause in adult and elderly patients. Diagnosis distribution showed that swallowing dysfunction was the most frequent diagnosis for patients on their first visit when compared to other feeding dysfunctions including malfunction of lips, tongue, and mastication. Almost 40 % of patients still continue to have rehabilitation for their dysphagic symptoms at the end of March 2002. This suggests that dysphagia rehabilitation is needed for a long time for many disabled individuals.
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PMID:Distribution of causes and treatments of dysphagia at dysphasia/dysphagia rehabilitation clinic of Showa University Dental Hospital: 1999-2002. 1583 62

In this observational pilot study, we investigated the effect of swallowing pudding and liquids of different viscosity on the breath-swallow pattern of young people with quadriparetic cerebral palsy (CP) and normal controls. A noninvasive acoustical technique was used to monitor breaths and swallows while the individuals were drinking thin and thick liquids and consuming pudding. The results showed that subjects with CP had a significantly higher rate of post-swallow inspiration than controls when they were drinking thin liquid but not when they were consuming thick liquid or pudding. Subjects with CP had greater variability and duration of deglutition apnea than controls. Whether the differences seen in breath-swallow pattern and deglutition apnea in young people with CP contribute to aspiration risk remains to be determined. Further clarification of these results by a carefully controlled study of individuals with cerebral palsy undergoing concurrent videofluoroscopic swallowing evaluation and acoustical monitoring of the breath-swallow pattern is required to verify these preliminary results and assess their clinical applicability.
Dysphagia 2005
PMID:The effect of viscosity on the breath-swallow pattern of young people with cerebral palsy. 1617 19

Botulinum neurotoxin type B (BT, BT-B) has been used as NeuroBloc/MyoBloc since 1999 for treatment of cervical dystonia, hyperhidrosis, spastic conditions, cerebral palsy, hemifacial spasm, bladder dysfunction, spasmodic dysphonia, sialorrhoea, anal fissures, piriformis syndrome, various pain conditions and cosmetic applications. Generally, its therapeutic effects are comparable to BT type A (BT-A). The adverse effect profiles of BT-B and BT-A, however, differ considerably. BT-B has been found to produce more regional as well as systemic anticholinergic adverse effects, such as dryness of mouth, accommodation difficulties, conjunctival irritation, reduced sweating, dysphagia, heartburn, constipation, bladder voiding difficulties and dryness of nasal mucosa. In BT-B the relationship between autonomic and motor effects known from BT-A is substantially shifted towards autonomic effects. BT-B, therefore, should be used carefully in patients with autonomic disorders and in patients with concomitant anticholinergic therapy. If NeuroBloc/MyoBloc is used to treat cervical dystonia patients with antibody-induced failure of BT-A therapy, 86% of those will develop complete secondary therapy failure after five applications. If NeuroBloc/MyoBloc used to treat cervical dystonia patients without prior exposure to BT, 44% of those will develop complete secondary therapy failure after nine applications. NeuroBloc/MyoBloc, therefore, is associated with substantial antigenicity problems originating from a particular low specific biological potency. Systemic anticholinergic adverse effects and high antigenicity limits the clinical use of NeuroBloc/MyoBloc considerably.
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PMID:Clinical use of non-A botulinum toxins: botulinum toxin type B. 1678 8

We report a case of severe dysphagia in a 29-yr-old woman with cerebral palsy after she was injected with botulinum toxin B to her lower limbs and lumbar paraspinal muscles. Four days after the treatment, she developed difficulty swallowing, more severe for solid foods than for liquids, accompanied by dry mouth, blurred vision, and voice hoarseness. Fifteen days after the injection, with worsening of her dysphagia, she was hospitalized. A laryngoscopic evaluation revealed bilateral vocal cord paresis, and a modified barium swallow test demonstrated delayed oral initiation, upper airway penetration, and no reflexive cough. In the following days, she improved spontaneously and was discharged 12 days later when she re-acquired the ability to swallow solid foods. Her symptoms resolved completely only 75 days after the injection. Although dysphagia is a common side effect of botulinum injection in the neck, to our knowledge, this is the first reported case of severe dysphagia after injection in a distant anatomic site.
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PMID:Severe Dysphagia after botulinum toxin B injection to the lower limbs and lumbar paraspinal muscles. 1703 94

Oropharyngeal dysphagia is not rare in older children before the adult age, especially the patients with cerebral palsy. Non-invasive simple tests are needed for the evaluation of children with neurogenic dysphagia including the patients with cerebral palsy. So we aimed to evaluate non-invasive ways to screen for dysphagia in children and the usefulness of this almost new electrophysiologic method for the detection of dysphagia in children with cerebral palsy. Twenty-eight healthy children and 12 patients with cerebral palsy were investigated for the applicability of this method. The movement of the larynx was monitored using a simple piezoelectric wafer sensor and submental surface EMG activity was recorded by bipolar silver-chloride electrodes taped under the chin over the submental muscle complex. The onset and duration of pharyngeal swallowing was recorded from submental-suprahyoid muscles such as the mylohyoid-genitohyoid-anterior digastric complex. By this method, the maximal water volume capacity was measured in single swallows with progressively increasing water volumes, this was called 'dysphagia limit'. The healthy control children revealed to swallow the bolus at once maximally 11.2+/-0.4 and 2.5 ml in average. Dysphagia limit varied from 7 to above 20 ml water volume from age 5-16 years old. Patients with cerebral palsy had the dysphagia limit of 7.7+/-1.8 and 6.4 ml in average. The dysphagia limit was significantly reduced in patients with cerebral palsy (p<0.05). Dysphagia limit seemed to be less sensitive in demonstrating the oropharyngeal swallowing disorders in childhood period (90% in the adult dysphagic patients). But the majority of patients with cerebral palsy (58%) showed abnormality. This electrophysiologic method is completely non-invasive, devoid from any hazard and applicable to children above 5 years. It may be candidate as a screening test before selection of dysphagic children.
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PMID:An EMG screening method (dysphagia limit) for evaluation of neurogenic dysphagia in childhood above 5 years old. 1718 11

Sialorrhea or excessive salivation, and drooling, are common and disabling manifestations in different neurological disorders. A review is made of the literature, based on a PubMed search, selecting those articles describing clinical trials involving the injection of botulinum toxin A in the salivary glands of patients with different diseases characterized by sialorrhea. The most frequently treated diseases were infant cerebral palsy (30%), Parkinson's disease (20%) and amyotrophic lateral sclerosis (15%). Over half of the authors injected the product into the parotid glands, 9.5% into the submaxillary glands, and 38% into both. The total doses of toxin injected varied from 10-100 units of Botox or 30-450 units of Dysport according to the different authors. A reduction was observed in the production of saliva following these injections, and the duration of the therapeutic effect was 1.5-6 months. Six articles (30%) described the presence of adverse effects such as dysphagia, xerostomia and chewing difficulties. Most of the clinical studies involved small patient samples, with no blinding or randomization, and no control group. Moreover, no data are available on the efficacy and adverse effects of treatment in the context of long-term prospective studies. The effective therapeutic dose and ideal form of application remain to be established, and require the conduction of further controlled clinical trials involving large sample sizes.
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PMID:Salivary gland application of botulinum toxin for the treatment of sialorrhea. 1797 75

Children with neurodevelopmental disabilities such as cerebral palsy (CP), spina bifida, or inborn errors of metabolism frequently have associated gastrointestinal problems. These include oral motor dysfunction leading to feeding difficulties, risk of aspiration, prolonged feeding times, and malnutrition with its attendant physical compromise. Gastrostomy tube feeding is increasingly being used in these children to circumvent oral motor dysfunction and prevent malnutrition. Foregut dysmotility causes several problems such as dysphagia from oesophageal dysmotility, gastro-oesophageal reflux disease, and delayed gastric emptying. Gastro-oesophageal reflux disease is common in these children but often fails to respond to medical management and may require surgical treatment. Finally, constipation is often a problem that may be overlooked in this population. This article focuses on these associated gastrointestinal manifestations and discusses the current diagnostic and therapeutic options available.
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PMID:Gastrointestinal disorders in children with neurodevelopmental disabilities. 1864 21

Feeding problems are common even in typically developing infants and children. However, they are more frequent and persistent in children with developmental disabilities. This article will provide an overview of current literature and a rationale underlying the interventions used for children with cerebral palsy (CP) who have eating impairments (dysphagia). The review is not intended to be exhaustive, but papers were selected that highlight some of the issues and challenges of the field. Normal oral-motor development is briefly discussed to show how it may inform clinical practice in the understanding of feeding problems. Description of the risk factors and the nature and extent of eating impairments will show how interventions need to be specific to the severity of eating impairments. Examination of sensorimotor therapies, using oral stimulation exercises or an intra-oral appliance, will highlight the range of their effectiveness, as well as their limitations. Similarly, an examination of tube feeding, used for nutritional rehabilitation of the most severely affected children, will address the benefits, controversies as well as moral issues encountered by caregivers and professionals. Multi-center studies will be needed to obtain more homogeneous samples, large enough to address questions of early interventions and their subsequent effect on later development.
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PMID:Interventions and outcomes for children with dysphagia. 1864 23

This study assessed the clinical indicators and severity of dysphagia in a representative sample of children with severe generalized cerebral palsy and intellectual disability. A total of 166 children (85 males, 81 females) with Gross Motor Function Classification System Level IV or V and IQ<55 were recruited from 54 daycare centres. Mean age was 9 years 4 months (range 2 y 1 mo-19 y 1 mo). Clinically apparent presence and severity of dysphagia were assessed with a standardized mealtime observation, the Dysphagia Disorders Survey (DDS), and a dysphagia severity scale. Additional measures were parental report on feeding problems and mealtime duration. Of all 166 participating children, 1% had no dysphagia, 8% mild dysphagia, 76% moderate to severe dysphagia, and 15% profound dysphagia (receiving nil by mouth), resulting in a prevalence of dysphagia of 99%. Dysphagia was positively related to severity of motor impairment, and, surprisingly, to a higher weight for height. Low frequency of parent-reported feeding problems indicated that actual severity of dysphagia tended to be underestimated by parents. Proactive identification of dysphagia is warranted in this population, and feasible using a structured mealtime observation. Children with problems in the pharyngeal and esophageal phases, apparent on the DDS, should be referred for appropriate clinical evaluation of swallowing function.
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PMID:Dysphagia in children with severe generalized cerebral palsy and intellectual disability. 1875 92

Around adolescence and thereafter, many cases with severe cerebral palsy have worsening of respiration and swallowing due to worsening of deformity and other factors. Appropriate management including prone positioning, naso-pharyngeal air-way, and positive pressure breathing with mask and bag or in-ex sufflator is effective for chronic respiratory disorder. Modification of posture or food texture according to the result of video-fluorographic examination may be effective for dysphagia along with intermittent oral catheterization feeding. Gastro-esophageal reflux and stasis in duodenum get worse around this age. Gastro-jejunal feeding with hand-made catheter set is useful. Cervical myelopathy and radiculopathy may be critical in athetoid type of cerebral palsy. Pseudoseizure as expression of conversion disorder should be considered especially around this age.
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PMID:[Care continuity for patients with cerebral palsy during transition from childhood to adulthood]. 2007 86


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