Annette Kjaersgaard

Randomized trial of two swallowing assessment approaches in patients with acquired brain injury: Facial-Oral Tract Therapy versus Fibreoptic Endoscopic Evaluation of Swallowing

Objective: To examine whether patients assessed for initiation of oral intake only by Facial-Oral Tract Therapy had a greater risk of developing aspiration pneumonia during neurorehabilitation than patients assessed by Fibreoptic Endoscopic Evaluation of Swallowing. Design: Randomized controlled trial. Setting: Specialized, national neurorehabilitation centre. Subjects: Adult patients with acquired brain injury. Six hundred and seventy-nine patients were assessed for eligibility and 138 were randomly allocated between June 2009 and April 2011. Interventions: Assessment by Facial-Oral Tract Therapy (control group) or Fibreoptic Endoscopic Evaluation of Swallowing (intervention group). Main measure: Primary outcome was the number of aspiration pneumonias that developed after initiation of oral intake. Results: One hundred and nineteen patients were included in the analysis of the primary outcome (62 controls/57 interventions). Sixteen patients were clinically diagnosed with pneumonia (4 controls/12 interventions). Nine patients had to be excluded: 6 patients got pneumonia before initiating oral intake; 3 patients with the clinical diagnosis of pneumonia did not show radiological signs. Seven patients were left for analysis, 4 of whom developed aspiration pneumonia within 10 days after initiating oral intake (1 control/3 interventions). Conclusion: In the presence of a structured clinical assessment with the Facial-Oral Tract Therapy approach, it is unnecessary to undertake an instrumental investigation of swallowing before initiation of oral intake.

Factors affecting return to oral intake in inpatient rehabilitation after acquired brain injury

Abstract Primary objective: To extend previous observations by investigating if differences exist in time to initiation or to recovery of total oral intake in patients with acquired brain injury assessed by either Facial-Oral Tract Therapy (F.O.T.T.®) or Fibreoptic Endoscopic Evaluation of Swallowing (FEES) and to investigate whether other factors influence these outcomes. Research design: Randomized controlled trial. Methods: One hundred and nineteen patients with dysphagia in inpatient neurorehabilitation were randomized. The main outcome was time to maximum on the Functional Oral Intake Scale. Results: There was no difference in time to initiation or recovery of total oral intake using F.O.T.T.® or FEES. Oral intake was initiated for 42% on admission and 92% at discharge; 2.5% of the patients were on total oral intake within 24 hours of admission and 37% at discharge. The likelihood of recovery to total oral intake before discharge was found to depend on age, Functional Independence Measure score, length of stay and number of dysphagia interventions. Conclusion: There was no significant difference in time to initiation and recovery of total oral intake before discharge, whether assessed by F.O.T.T.® or FEES, indicating that an instrumental assessment is unnecessary for standard evaluation. Age, functional independence and length of stay had a significant influence.

Review of the “Quick reference neuroscience for rehabilitation professionals: the essential neurologic principles underlying rehabilitation practice” (3rd edition), edited by S. Gutman, Slack Incorporated, 2016, 434 pp., 55.52, ISBN: 9781630911522

Neuroscience is a very important foundational science for professionals within neurorehabilitation. Functional neuroanatomy is often taught as memorization at the bachelor level of education and is difficult to use and transfer into clinical practice. We will like to congratulate Dr. Sharon Gutman, PhD, OTR, FAOTA, with her 3rd edition of the Quick Reference Neuroscience for Rehabilitation Professionals: The Essential Neurologic Principles Underlying Rehabilitation Practice, which really fulfils the title. The material is presented in a simple bulleted format, which organizes the material and makes it easy to access. The large-scale colour illustrations bring the text to life and the figures allow the readers to visualize difficult neuroanatomical structures that are often challenging to comprehend. The textbook reviews material and topics that are most relevant to neurorehabilitation professionals in their daily clinical practice. The book is also relevant for students in neuroscience or neurorehabilitation, courses in occupational and physical therapy, speech and language therapy, as well as nursing. The book is divided into three main sections: the first addresses neuroanatomy; the second addresses the function of neurological systems underlying physical, psychological, cognitive, and visual perceptual disorders; and the third addresses clinical neuropathology related to aging, addiction, memory, sex and gender. We really recommend this book and would urge Dr. Gutman to add other clinical neuropathologies, such as dysphagia, language and communicational disorders and other cognitive disorders in order to cover the complexity of multidisciplinary neurorehabilitation in the 4th edition. Another idea for the next edition could be to allow electronic access to the excellent illustrative figures, for easier use in clinical practice and in education.

Brain Injury and Severe Eating Difficulties at Admission—Patient Perspective Nine to Fifteen Months after Discharge: A Pilot Study

The purpose of this pilot study was to explore and interpret the way that individuals with acquired brain injury, admitted to inpatient neurorehabilitation with severe eating difficulties, experienced eating nine to fifteen months after discharge. Four individuals with acquired brain injury were interviewed via qualitative semi-structured interviews. An explorative study was conducted to study eating difficulties. Qualitative content analysis was used. Four main themes emerged from the analysis: personal values related to eating, swallowing difficulties, eating and drinking, meals and social life. Three predominating experiences were: fed by tube, “relearning” to eat, and eating meals together. The preliminary results regarding the four participants suggest that the meaning of food and being able to eat and take part in meals may be nearly the same as before the injury; however, having the ability to eat reduced or lost completely, even temporarily, was unexpected and difficult, and caused strong emotional reactions, even 18 months after injury. Time spent using a feeding tube had a negative, but not persistent, impact on quality-of-life. The preliminary findings provide knowledge regarding the patient perspective of adapting to and developing new strategies for activities related to eating, however, further prospective, longitudinal research in a larger scale and with repeated interviews is needed.

A validation study of the Facial-Oral Tract Therapy Swallowing Assessment of Saliva:

Objective: To investigate the validity and reliability of the Swallowing Assessment of Saliva in detection of aspiration risk. Design: Validation study. Setting: Inpatient neurorehabilitation centre. Subjects: Adult patients with acquired brain injury. A total of 43 patients for concurrent validity and 33 other patients for inter-rater reliability. Interventions: Concurrent validity was established with blinded Swallowing Assessment of Saliva and endoscopic evaluation within a 24-hour time interval. Inter-rater reliability was established with two blinded Swallowing Assessments of Saliva within a one-hour time interval. Main measures: The Swallowing Assessment of Saliva is a seven-item scale with a combination of swallowing and non-swallowing items. It is based on the Facial-Oral Tract Therapy approach. Results: The Swallowing Assessment of Saliva had a sensitivity of 91%, 95% confidence interval (CI) (59; 100), a specificity of 88% %, 95% CI (71; 97) and a kappa coefficient of 0.87 ±0.17 in detection of aspiration risk. Furthermore, analyses showed that experienced and inexperienced occupational therapists performed equally in detection of aspiration risk. Conclusion: The Swallowing Assessment of Saliva is a simple, sensitive and reliable assessment for detecting aspiration risk in patients with acquired brain injury.