To investigate the prevalence and management of ankyloglossia for infants in Central Australia.
Retrospective chart review consisting of a medical file audit of infants (n = 493) <2 years old ...diagnosed with ankyloglossia from January 2013 to December 2018 in the primary hospital in Central Australia. Patient characteristics, reason for diagnosis, reason for procedure and outcomes of procedures routinely recorded in the patient clinical files were recorded.
The overall prevalence of ankyloglossia in this population was 10.2%. Frenotomy was performed in 97.9% of infants diagnosed with ankyloglossia. Infants with ankyloglossia were more likely to be male (58% vs 42%), diagnosed and managed with a frenotomy on the third day of life. Most ankyloglossia diagnoses were identified by a midwife (>92%). Most frenotomy procedures were completed by lactation consultants who were also midwives (99%) using blunt-ended scissors. More infants were classified with posterior ankyloglossia than anterior ankyloglossia (23% vs 15%). A frenotomy procedure resolved feeding issues in 54% of infants with ankyloglossia.
The prevalence of ankyloglossia and rate of frenotomy procedures were high when compared to previous reports in the general population. Frenotomy for ankyloglossia in infants with breastfeeding difficulties was found to be effective in more than half of the reported sample, improving breastfeeding and decreasing maternal nipple pain. A standardised approach and validated screening or comprehensive assessment tool for the identification of ankyloglossia is indicated. Guidelines and training for relevant health professionals on non-surgical management of the functional limitations of ankyloglossia are also recommended.
This study investigated how swallowing exercise dosage is recorded, and what swallowing exercise dosages are reported in a stroke rehabilitation setting. We additionally explored the relation between ...mean daily swallowing repetitions and likelihood of improvement in functional swallowing status and considered how swallowing exercise dosages in practice compared to evidence-based principles of neural plasticity and strength training. We audited medical records for 42 patients with post-stroke dysphagia admitted to an inpatient rehabilitation unit over 18 months. Data were collected on participant characteristics, swallowing exercises and dosages, and clinical outcomes. The relation between dosage and outcomes was investigated using logistic regression analysis. On average, patients were seen for a median of 2.4 swallowing intervention sessions per week (IQR: 1.7) over 21 days (IQR: 16) and received a median 44.5 swallowing exercise repetitions per session (IQR: 39.6). Results indicated variable reporting of swallowing exercise dosages. Frequency, intervention duration, exercise type, and number of repetitions were routinely recorded in medical records, while intensity, session length, content, and adherence to home exercise programs were not. Frequency of swallowing intervention was lower in practice compared to research studies, and swallowing exercises did not follow specificity or progressive resistance principles. Likelihood of improvement in swallowing status was partially explained by age (B = -.015,
p
= .007) but not by mean daily swallowing exercise repetitions. This study illustrates dosages of swallowing exercises used in clinical practice. Results highlight the need for improved consideration and reporting of dosage, and application of evidence-based principles to swallowing exercise dosages.
Purpose
To investigate the dosages of swallowing exercises reported in intervention studies on post-stroke dysphagia through systematic review.
Methods
Five electronic databases were searched from ...inception until February 2022 with reference tracing of included studies. Studies were included, where adults with post-stroke dysphagia received rehabilitative, behavioural swallowing exercises, pre/post outcomes were reported, and intervention dosage was described in detail, including frequency, intensity, time, and type of exercise. Two reviewers independently screened studies and rated quality using ASHA Levels of Evidence tool. Data was tabulated and narratively described.
Results
54 studies were included with a total 1501 participants. Studies included 28 randomised controlled trials, 8 non-randomised controlled trials, 12 pre/post studies, 3 retrospective case controls and 3 case studies. Results showed inconsistent reporting of intervention dosage, with intensity the least consistently reported dosage component. While swallowing intervention was most commonly provided five times per week for four weeks, there was a wide breadth of type, frequency, intensity and duration of swallowing exercises reported. Dosage under-reporting and variation was particularly observed in “standard care” co-interventions or control groups. Study strengths included following PRISMA guidelines, providing a comprehensive review of swallowing exercise methodology and dosages, and including non-English studies. The limitation was lack of meta-analysis due to the heterogeneity of included studies.
Conclusions
Dosages of swallowing exercises are inconsistently reported and vary significantly in post-stroke dysphagia studies. Results indicate the need for consistent and comprehensive dosage reporting in dysphagia studies, and for further research into evidence-based principles to optimise swallowing exercise dosages.
Systematic review registration number
131294
Infant dysphagia is commonly managed using thickened formulas. Substantial research investigates thickening of a variety of beverages for adults and children, yet few studies address the unique ...considerations of thickened formula for infants. Understanding the consistency and behaviour of thickened formula will guide clinicians and parents to make informed decisions to minimise risk of aspiration. To investigate the effect of time and storage temperature on the flow properties of thickened formula, four formulas and two thickeners currently utilised at a major metropolitan children’s hospital in Australia were tested in combinations, at refrigerated and room temperatures. Their flow properties were measured at three time-points (baseline, 1 h, 24 h) using the International Dysphagia Diet Standardisation Initiative (IDDSI) Flow Test, the current clinical standard for classifying drinks based on flow properties. A combination of paired
t
tests, Wilcoxon Signed-Rank tests, repeated measures analysis of variance (ANOVA) and Cohen’s
d
was used to statistically compare flow properties and determine the significance of the observed data. At baseline, 98% (
n
= 48) of the thickened formula bottles were measured as thinner than the “mildly thick” IDDSI category to which they were prepared. Conversely, at 24 h, 17% were measured thicker than “mildly thick” whilst 10% measured too thin for the category “mildly thick”. Refrigerated samples increased in thickness more significantly over time compared to those stored at room temperature. Two of the formulas, when thickened, resulted in a foamy mixture non-compatible with IDDSI Flow Test measurement. As a result, these two formulas were not subjected to further testing. All the tested commercial products behaved differently to each other and were unstable over varying times and temperatures. This finding indicates the need for improved guidelines regarding preparation and storage of thickened fluids. Further investigation is recommended into the chemical processes underlying the observed deviations.
To investigate the opinions and practices of health professionals involved in ankyloglossia diagnosis and management in Australia.
Two hundred and thirty-seven health professionals across Australia ...responded to an online survey including their diagnostic and management practice of ankyloglossia. Descriptive statistics, content analysis and thematic analysis were used to analyse quantitative data and open-ended responses, respectively.
Most (91.6%) respondents reported they are responsible for the assessment and diagnosis of ankyloglossia in their clinical practice. A majority (56.7%) reported using more than one assessment tool in clinical practice. Less than half (46.4%) reported providing treatment to manage ankyloglossia. Surgical management was used by 44.5%, and 56.4% used non-surgical management as their primary treatment of ankyloglossia. Of the total sample, 26.6% had completed no further training or professional development in the field. 46% of respondents stated they always educate parents about ankyloglossia diagnoses, whereas 29.5% reported they always educate parents about management of ankyloglossia. Of respondents, a high level of confidence was reported by 62.6% of health professionals in the assessment of infants with ankyloglossia. Of those who perform surgical management, 53.7% reported feeling extremely confident in their skills. Fifty-two percent of respondents reported they were dissatisfied with the current service delivery for infants with ankyloglossia.
The diagnosis, management and education practices varied greatly amongst health professionals in Australia. Clinical guidelines for all relevant health professionals are needed to ensure standardised diagnosis and management processes. In future, this will help guide evidence-based diagnosis and intervention for infants with ankyloglossia.
The purpose of this systematic review was to review and synthesize the current evidence on speech and language outcomes of children with Obstructive Sleep Apnea (OSA), or more broadly ...sleep-disordered breathing.
A comprehensive literature search was conducted across 5 databases. Studies were selected based on the following criteria: 1) peer-reviewed research published between 2000 and 2020, 2) available in English or accessible non-English data, 3) children aged 2–13 years diagnosed with Sleep Disordered Breathing (SDB) or OSA, and 4) speech and language outcomes examined within research.
Studies were appraised using PEDro-P and the overall certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Six studies met the current review selection criteria: one paper examined speech outcomes and the remaining five examined receptive and expressive language outcomes. The overall quality of the body of evidence was rated as very low, with methodological weaknesses present in study designs and sample sizes.
Speech and language difficulties are common in children with OSA/SDB, in addition to neurocognitive and/or neurobehavioral issues. Further investigation of specific speech and language skills, which are compromised in this population, is needed to guide clinical practice and decision making, with particular involvement from speech-language pathologists.
•Sleep-disordered breathing (SDB) impacts children's behaviour and learning.•Medical, surgical and myofunctional treatments effectively improve SDB symptoms.•Under-diagnosis of SDB in children effects timely treatment.•Impaired communication skills in children with SDB was present.•Speech, language and literacy skills should be assessed in children with SDB.
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.
•38% of adults with MS have swallowing problems.•Swallowing problems in MS cause various physical symptoms including coughing, throat clearing, choking on food and liquid.•Swallowing problems in MS ...result in social consequences including reduced eating desire, increased eating duration and mealtime anxiety.•Swallowing problems, if left untreated will result in serious complications such as dehydration, malnutrition and pneumonia.•Adults with MS with swallowing problems should be referred to speech-language pathologists for further evaluation and management, in order to sustain or improve their swallowing function.
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.
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.
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.
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.
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.
Dysphagia or swallowing difficulties have been reported to be a concern in adults with multiple sclerosis (MS). This problem can result in several complications including aspiration pneumonia, ...reduced quality of life and an increase in mortality rate. No previous systematic reviews on treatment effects for dysphagia in MS have been published. The main objective of this study is to summarise and qualitatively analyse published studies on treatment effects for dysphagia in MS. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied to conduct a systematic search of seven databases, using relevant key words, and subsequent analysis of the identified studies. The studies were required to meet all three inclusion criteria of including a statement on intention to treat, or measure the effects of treatment for dysphagia in adults with MS and data on treatment outcomes for at least one adult diagnosed with MS. Retained studies were evaluated by two independent reviewers using a critical appraisal tool. This study has not been registered. A total of 563 studies were identified from the database searches. After screening and assessment of full articles for eligibility, five studies were included in the review. Three examined electrical stimulation and two examined the use of botulinum toxin. One study testing electrical stimulation was a randomised controlled trial, two were well-designed case series and two were case series lacking experimental control. All studies reported some positive effects on dysphagia; however, treatments that involved the use of electrical stimulation showed larger effect sizes. There is a paucity of evidence to guide treatment of dysphagia in MS, with only electrical stimulation and botulinum toxin treatment represented in the literature search conducted here. While both treatments show initial promise for reducing the swallowing impairment, they require further research using well-controlled experimental designs to determine their clinical applicability and long-term treatment effects for dysphagia across different types and severity of MS.
Objective
The 10-item Dysphagia in Multiple Sclerosis (DYMUS) questionnaire is a self-administered tool used to identify swallowing problems in adults with MS. The questionnaire was not validated ...against other existing questionnaires to assess its convergent validity. Moreover, its test–retest reliability was not measured previously. Therefore, the purpose of this study was to assess the factor analysis, internal consistency and test–retest reliability of the DYMUS, as well as its convergent validity against an established and validated questionnaire, the EAT-10.
Method
English-speaking adults with MS in New South Wales, Australia who were seen for routine medical check-ups were invited to complete two questionnaires across two phases. One hundred participants completed phase 1, while 55 completed phase 2. Statistical analyses were performed to investigate the psychometric properties of the DYMUS questionnaire.
Results
Internal consistency (Cronbach’s Alpha) reduced the DYMUS questionnaire from ten to five items. The shortened version of the DYMUS showed high internal consistency (alpha = 0.904). It also showed satisfactory reproducibility, and adequate correlation with the 10-item Eating Assessment Tool (EAT-10).
Conclusion
Evaluation of the DYMUS resulted in a shortened version of the questionnaire with five questions related to dysphagia. This shortened version is considered an easy and useful tool in identifying patients with MS-related dysphagia.
