A Comparative Study Between Two Sensory Stimulation Strategies After Two Weeks Treatment on Older Patients with Oropharyngeal Dysphagia

Abstract

Oropharyngeal dysphagia (OD) is a prevalent geriatric syndrome. Treatment is based on compensatory strategies to avoid complications. New treatments based on sensory stimulation to promote the recovery of the swallowing function have proved effective in acute studies but prolonged treatment needs further research. Our aim was to evaluate and compare the effect of two, longer-term sensory treatment strategies on older patients with OD. 38 older patients (≥70 years) were studied with videofluoroscopy (pre/posttreatment) and randomized into two 10-day treatment groups: Group A-transient receptor potential vanilloid 1 (TRPV1) agonist (capsaicin 1 × 10(-5) M) and Group B-transcutaneous sensory electrical stimulation (TSES) (Intelect VitalStim, biphasic pulses, 300 μs, 80 Hz). Patients were analyzed for treatment response. Patients were old (80.47 ± 5.2 years), with comorbidities (3.11 ± 1.59 Charlson Index), polymedication (8.92 ± 3.31 drugs/patient), and mild functional impairment (86.84 ± 17.84 Barthel Index), and 28.9 % were at risk of malnutrition (MNA-sf). Overall, all patients had videofluoroscopic signs of impaired safety of swallow (ISS) with delayed oropharyngeal swallow response (OSR). After sensory stimulation, prevalence of ISS decreased to 68.42 % in both groups (P = 0.019). There were 68.42 % responders in Group A (TRPV1) and 42.11 % in Group B (TSES). Group A responders showed an improvement in the penetration-aspiration scale (PAS, 5.23 ± 2.04 to 3 ± 1.47; P = 0.002), and the same was true for those of Group B (4.63 ± 1.41 to 2.13 ± 0.64; P = 0.007). 10-day sensory stimulation with either therapy improved safety of swallow and OSR in older patients with OD, reducing the severity of OD in a significant subgroup of these patients.

Effect of a gum‐based thickener on the safety of swallowing in patients with poststroke oropharyngeal dysphagia

“…Due to our design, not all patients received all the viscosities, especially the lowest levels. This is a quite common situation in pharmacologic/physiologic studies, to minimize the possibility of serious AEs to patients, for example, during progressive effort tests . A similar “safety rule” was used in all our previous studies with thickening agents as requested by the Ethical Committee .…”

“…We considered the following signs as indication of impaired efficacy: piecemeal deglutition, oral, pharyngeal wall, and vallecular or pyriform sinus residue. The prevalence of residue was described as the presence or absence of residue in the oral cavity or the pharynx including the pharyngeal wall, the vallecula, and pyriform sinus . Timing of oropharyngeal swallow response (OSR) and bolus kinematics.…”

“…Timing of oropharyngeal swallow response (OSR) and bolus kinematics. Timing of swallow response was assessed for each bolus given to the patient during VFSS . We measured the time to LVC (time from the glossopalatal junction (GPJ) opening to the LVC) and the total duration of the swallow response.…”

“…The prevalence of residue was described as the presence or absence of residue in the oral cavity or the pharynx including the pharyngeal wall, the vallecula, and pyriform sinus. 27 Timing of oropharyngeal swallow response (OSR) and bolus kinematics. Timing of swallow response was assessed for each bolus given to the patient during VFSS.…”

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

“…thermal stimulation, black pepper and capsaicin, all mainly leading to a release of substance P in pharyngeal sensory nerve endings, have shown potential to improve swallowing safety and efficacy especially in elderly patients with dysphagia [45][46][47][48][49]. The virtual lesion model introduced in the present study can help expanding our understanding of peripheral and central modes of actions of neuromodulatory and pharmaceutical treatments that come into question as potential future therapeutic options in dysphagic patients.…”