The Intensive Dysphagia Rehabilitation approach applied to patients with neurogenic dysphagia: a case series design study

Publication date: Available online 19 December 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Georgia A. Malandraki, Akila Rajappa, Cagla Kantarcigil, Elise Wagner, Chandra Ivey, Kathleen Youse
ObjectiveTo examine the effects of the Intensive Dysphagia Rehabilitation (IDR) approach on physiological and functional swallowing outcomes in adults with neurogenic dysphagia.DesignIntervention study; before-after trial with 4-week follow-up through an online survey.SettingOutpatient university clinics.ParticipantsA consecutive sample of 10 subjects recruited from outpatient university clinics. All were diagnosed with adult-onset neurologic injury or disease. Dysphagia diagnosis was confirmed through clinical and endoscopic swallowing evaluations. No subject withdrew from the study.InterventionsParticipants completed the 4-week Intensive Dysphagia Rehabilitation, including: two oropharyngeal exercise regimens, a targeted swallowing routine using salient stimuli, and caregiver participation. Treatment included hourly sessions twice/week, and home practice for ∼45 minutes/day.Main Outcome Measure(s)Outcome measures assessed pre- and post-IDR were: (1) airway safety using an 8-point Penetration Aspiration scale; (2) lingual isometric pressures; (3) self-reported swallowing-related quality of life (QOL), and (4) level of oral intake. Also, patients were monitored for adverse dysphagia-related effects. QOL and adverse effects were also assessed at the 4-week follow-up (online survey).ResultsIDR was effective in improving maximum and mean Penetration Aspiration scale scores (p<0.05, η²=0.8146; p<0.05, η²=0.799708); and level of oral intake (p<0.005, Cohen's d=-1.387). Of 5 patients who were feeding tube dependent initially, two progressed to total, and two to partial oral nutrition. One remained tube dependent. QOL was significantly improved at the 4-week follow-up (95% CI [6.38, 14.5], p<0.00), but not at the post-IDR assessment. No adverse effects were observed/reported.Conclusion(s)We conclude that IDR was safe and improved physiological and some functional swallowing outcomes in our sample, however further investigation is needed before it can be widely applied.



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