Dysphagia following stroke is common and can lead to severe complications such as aspiration pneumonia, but there is inconclusive evidence on how poststroke dysphagia should be treated. This study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with the traditional dysphagia therapy on the swallowing function in patients with poststroke dysphagia. In this pilot double-blind randomized clinical trial, 18 patients with poststroke dysphagia were allocated randomly to three groups: (i) traditional dysphagia therapy, (ii) rTMS, and (iii) combined intervention. Patients received traditional dysphagia therapy for 18 treatment sessions three times per week. The inhibitory rTMS was applied to the intact cerebral hemisphere at 1 Hz with a train of 1200 for 5 consecutive days. The patients in the combined intervention group received traditional dysphagia therapy and rTMS simultaneously. The Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale were performed before treatment, after the end of the fifth session, after the end of the 10th session, after the end of the 15th session, and after the end of the 18th session. All groups had improved on MASA and Functional Oral Intake Scale scores over time (P<0.01). The improvements achieved in all outcomes were significantly greater in the combined intervention group than those of the traditional dysphagia therapy and rTMS groups. The large effect sizes were found for the MASA score in all groups: traditional dysphagia therapy group (d = 3.57), rTMS group (d = 2.67), and combined intervention group (d = 3.87). This pilot randomized-controlled trial showed that the combination of rTMS and traditional dysphagia therapy significantly improved swallowing function in patients with poststroke dysphagia.

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Background: Dysphagia is frequently observed in patients with multiple sclerosis (MS). Dysphagia and its complications are common causes of morbidity and mortality in final stages of MS disease. This study aimed at determining the prevalence of dysphagia in Iranian patients with MS and identifying predictors associated with dysphagia. Methods: A total of 230 MS patients were enrolled in this cross-sectional study. Dysphagia was evaluated using Mann Assessment of Swallowing Ability (MASA). Demographic characteristics (age and gender), duration of the disease, disease course, and Expanded Disability Status Scale (EDSS) were recorded for all participants. Results: In total, dysphagia was found in 85 participants (37%) with mild to severe dysphagia (mild 50.6%; moderate 29.4%; and severe 20%). The logistic regression model demonstrated that disability status in EDSS (OR= 2.1; 95% CI 0.5-1.2) and disease duration (OR= 2.3; 95% CI 0.4-1.1) predicts a high risk for dysphagia in MS patients. Conclusion: Dysphagia is prevalent in Iranian patients with MS. Disability level and disease duration are significant predictors of dysphagia after MS.

Dysphagia after multiple sclerosis (MS) is a common disabling symptom which can lead to serious complications. Regular screening and assessment of dysphagia in patients with MS are important. Using valid and reliable instruments to measure dysphagia in MS patients is a crucial component in clinical practice and of research quality. There are various strategies to diagnose and assess the dysphagia in patients with MS. Screening strategies are for early diagnosis of the dysphagia. Clinical, non-instrumental strategies are used to verify the presence and to determine the severity and cause of dysphagia. Instrumental strategies are complementary to clinical examination to provide objective data on the various aspects of swallowing dysfunctions. This review revealed a few validated tools for dysphagia assessment in MS. The Dysphagia in Multiple Sclerosis Questionnaire (DYMUS) and the Mann Assessment of Swallowing Ability (MASA) are the only validated MS-specific dysphagia tools. Further development of valid and reliable MSspecific screening and assessment tools that can be administered rapidly and scored easily to detect dysphagia and evaluate clinical outcomes in adults with MS is imperative. Until then, validation and metric evaluation of the screening and assessment tools currently available are required.

The aim of this study was to translate and cross-culturally adapt the swallowing quality-of-life questionnaire (SWAL-QOL) to Persian language and to determine validity and reliability of the Persian version of the swallow quality-of-life questionnaire (PSWAL-QOL) in the patients with oropharyngeal dysphagia.The cross-sectional survey was designed to translate and cross-culturally adapt SWAL-QOL to Persian language following steps recommended in guideline. A total of 142 patients with dysphagia (mean age = 56.7 ± 12.22 years) were selected by non-probability consecutive sampling method to evaluate construct validity and internal consistency. Thirty patients with dysphagia were completed the PSWAL-QOL 2 weeks later for test–retest reliability.The PSWAL-QOL was favorably accepted with no missing items. The floor effect was ranged 0% to 21% and ceiling effect was ranged 0% to 16%. The construct validity was established via exploratory factor analysis. Internal consistency was confirmed with Cronbach α >0.7 for all scales except eating duration (α = 0.68). The test–retest reliability was excellent with intraclass correlation coefficient (ICC) ≥0.75 for all scales.The SWAL-QOL was cross-culturally adapted to Persian and demonstrated to be a valid and reliable self-report questionnaire to measure the impact of dysphagia on the quality-of-life in the Persian patients with oropharyngeal dysphagia.

PURPOSE: Feeding problems are common in premature infants (PIs) and may lead to negative consequences such as malnutrition, dehydration, excessive weight loss, as well as developmental and psychological deficits. Moreover, they are associated with increased length of hospital stay/cost. There is not enough evidence on how feeding problems should be treated in PIs. The goal of this study was to investigate the effects of non-nutritive sucking combined with oral motor stimulation and oral support on feeding performance in PIs. METHODS: A single-blind randomized clinical trial was performed on 44 PIs with feeding problems. Patients were randomly categorized into two groups: (1) combined intervention (CI) and (2) non-nutritive sucking (NNS). The CI group received NNS, oral motor stimulation and oral support simultaneously. Infants in both groups received 14 treatment sessions for 14 consecutive days. The Preterm Oral Feeding Readiness Assessment Scale (POFRAS) was used as the primary outcome measure. Weight, volume of milk intake, time to achieve full oral feeding, and length of hospital stay were secondary outcome measures. All measures were assessed before treatment, after the 7th session, after the 14th session, and after 7 days after the end of treatment. RESULTS: Both groups improved in all outcome measures across time (P <  0.001). The improvements in the POFRAS, volume of milk intake, and time to achieve full oral feeding were significantly greater in the CI group than the NNS group (P <  0.001). The improvements attained in weight and length of hospital stay were not significantly different between the CI and NNS groups (P >  0.05). Large effect sizes were found for POFRAS score in both CI (d = 3.98) and NNS (d = 2.19) groups. CONCLUSION: The current study showed that the combined intervention including NNS, oral motor stimulation, and oral support significantly improved the feeding performance in PIs.

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