Simplified cough test can predict the risk for pneumonia in patients with acute stroke

Nakamori, Masahiro; Imamura, Eiji; Kuwabara, Miyu; Ayukawa, Tomoko; Tachiyama, Keisuke; Kamimura, Teppei; Hayashi, Yuki; Matsushima, Hayato; Funai, Mika; Mizoue, Tatsuya; Wakabayashi, Shigeo

doi:10.1371/journal.pone.0239590

Cited by 18 publications

(9 citation statements)

References 31 publications

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“…The cough reflex is an essential function for protecting and clearing materials that are aspirated into the airway. It has also been reported that the cough test is useful for screening silent aspiration [ 24 ]. The decision of fasting should be done by such an assessment, but not by tongue pressure.…”

Section: Discussionmentioning

confidence: 99%

Relationship between tongue pressure and dysphagia diet in patients with acute stroke

Nakamori

Ishikawa

Imamura³

et al. 2021

PLoS ONE

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A dysphagia diet is important for patients with stroke to help manage their nutritional state and prevent aspiration pneumonia. Tongue pressure measurement is a simple, non-invasive, and objective method for diagnosing dysphagia. We hypothesized that tongue pressure may be useful in making a choice of diet for patients with acute stroke. Using balloon-type equipment, tongue pressure was measured in 80 patients with acute stroke. On admission, a multidisciplinary swallowing team including doctors, nurses, speech therapists, and management dietitians evaluated and decided on the possibility of oral intake and diet form; the tongue pressure was unknown to the team. Diet form was defined and classified as dysphagia diet Codes 0 to 4 and normal form (Code 5 in this study) according to the 2013 Japanese Dysphagia Diet Criteria. In multivariate analysis, only tongue pressure was significantly associated with the dysphagia diet form (p<0.001). Receiver operating characteristic analyses revealed that the optimal cutoff tongue pressure for predicting diet Codes 1, 2, 3, 4, and 5 was 3.6 (p<0.001, area under the curve [AUC] = 0.997), 9.6 (p<0.001, AUC = 0.973), 12.8 (p<0.001, AUC = 0.963), 16.5 (p<0.001, AUC = 0.979), and 17.3 kPa (p<0.001, AUC = 0.982), respectively. Tongue pressure is one of the sensitive indicators for choosing dysphagia diet forms in patients with acute stroke. A combination of simple modalities will increase the accuracy of the swallowing assessment and choice of the diet form.

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Section: Discussionmentioning

confidence: 99%

Relationship between tongue pressure and dysphagia diet in patients with acute stroke

Nakamori

Ishikawa

Imamura³

et al. 2021

PLoS ONE

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“…It is an important airway protective behavior intended to clear penetrant and aspirate material out of the airway in order to maintain a healthy and homeostatic pulmonary environment [3]. Disordered coughing (dystussia) is characterized by reductions in cough airflow, expiratory pressures, and blunted sensorimotor responses [4][5][6][7][8][9] and, when present, is associated with an increased risk of pneumonia [10][11][12][13][14][15].…”

Section: Cough and Dysphagiamentioning

confidence: 99%

Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol

Curtis,

Borders,

Dakin

et al. 2023

Folia Phoniatr Logop

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Introduction: Auditory-perceptual assessments of cough are commonly used by speech-language pathologists working with people with swallowing disorders with emerging evidence beginning to demonstrate their validity, however their reliability amongst novice clinicians is unknown. Therefore, the primary aim of this study was to characterize the reliability of auditory-perceptual assessments of cough amongst a group of novice clinicians. As a secondary aim, we assessed the effects of a standardized training protocol on the reliability of auditory-perceptual assessments of cough. Methods: 12 novice clinicians blindly rated ten auditory-perceptual cough descriptors for 120 cough audio clips. Standardized training was then completed by the group of clinicians. The same cough audio clips were then re-randomized and blindly rated. Reliability was analyzed pre- and post-training within each clinician (intra-rater), between each unique pair of raters (dyad-level inter-rater), and for the entire group of raters (group-level inter-rater) using intraclass correlation coefficients and Cohen’s Kappa. Results: Pre-training reliability was greatest for measures of strength, effectiveness, and normality, and lowest when judging the type of expiratory maneuver (cough, throat clear, huff, other). The measures that improved the most with training were ratings of perceived crispness, amount of voicing, and type of expiratory maneuver. Intra-rater reliability coefficients ranged from .580-.903 pre-training and .756-.904 post-training. Dyad-level inter-rater reliability coefficients ranged from .295-.745 pre-training and .450-.804 post-training. Group-level inter-rater reliability coefficients ranged from .454-.919 pre-training and .558-.948 post-training. Discussion/Conclusion: Reliability of auditory-perceptual assessments varied across perceptual cough descriptors, but all appeared within the range of what has been historically reported for auditory-perceptual assessments of voice and visual-perceptual assessments of swallowing and cough airflow. Reliability improved for most cough descriptors following 30-60 minutes of standardized training. Future research is needed to examine the validity of auditory-perceptual assessments of cough by assessing the relationship between perceptual cough descriptors with instrumental measures of cough effectiveness to better understand the role of perceptual assessments in clinical practice.

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“…The recorded data included body mass index (BMI), grip strength, disease duration, alcohol consumption, smoking habits, MDS-UPDRS score [9], medication, Functional Oral Intake Scale (FOIS) score, Eating Assessment Tool-10 (EAT-10) score, and blood test values [13]. Previously reported methods were used to investigate cough re ex, tongue pressure, and peak expiratory ow [14][15][16]. The levodopa equivalent daily dose (LEDD) was calculated according to a recent study [17].…”

Section: Data Acquisitionmentioning

confidence: 99%

Association between motor symptoms of Parkinson’s disease and swallowing disorders

Nakamori,

Toko,

Yamada

et al. 2023

Preprint

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Purpose: Parkinson's disease (PD) presents with motor symptoms that hinder physical activity. This study thoroughly investigated swallowing dysfunction in patients with PD using videofluoroscopy (VF) and the Movement Disorder Society (MDS)-Unified PD Rating Scale (UPDRS) sub-scores. Methods: This study was part of an intervention project to evaluate the effectiveness of cervical percutaneous interferential current stimulation in patients with Hoehn and Yahr stages 2–4 PD. Baseline data, including swallowing-related indicators such as VF, were obtained and compared to the MDS-UPDRS sub-scores including rigidity, tremor, postural instability/gait difficulty, and limb scores. Results: Twenty-seven patients were included in this study. In the VF analysis, laryngeal penetration/aspiration, oral cavity residue, epiglottic vallecular residue, and pharyngeal residue were observed with remarkable frequency. The multivariate analysis revealed that the mean rigidity score of UPDRS was an independent and significantly correlated factor with laryngeal penetration/aspiration during the ingestion of 10 mL of water (odds ratio 1.294, 95% confidence interval 1.035–1.617; p = 0.024). Conclusion: This study revealed a correlation between muscle rigidity and laryngeal penetration or aspiration risk. The detailed comparative analysis of various individual PD symptoms and swallowing disorders was substantial, which enables early detection of the risk of swallowing disorder and the implementation of appropriate measures. Trial Registration number: jRCTs062220013

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Simplified cough test can predict the risk for pneumonia in patients with acute stroke

Cited by 18 publications

References 31 publications

Relationship between tongue pressure and dysphagia diet in patients with acute stroke

Relationship between tongue pressure and dysphagia diet in patients with acute stroke

Auditory-Perceptual Assessments of Cough: Characterizing Rater Reliability and the Effects of a Standardized Training Protocol

Association between motor symptoms of Parkinson’s disease and swallowing disorders

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