Identification of swallowing disorders: the perception of patients with neurodegenerative diseases

Luchesi, Karen Fontes; Campos, Bruna Magnani; Mituuti, Claudia Tiemi

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Sumário

Original Article • CoDAS 30 (6) • 2018 • https://doi.org/10.1590/2317-1782/20182018027 copy

Identification of swallowing disorders: the perception of patients with neurodegenerative diseases

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

To verify the perception of patients with neurodegenerative diseases regarding swallowing changes and to know the perceptions of swallowing sensations that can promote the early identification of dysphagia.

Methods

It is a cross-sectional study with 44 patients with neurodegenerative diseases. All of them answered a questionnaire to know the sensation perceived during swallowing and its intensity. The Fatigue Severity Scale was applied to measure fatigue and the Swallowing Disturbance Questionnaire was applied to detect swallowing complaints. The Functional Oral Intake Scale was used to classify the swallowing functionality. Videofluoroscopic swallowing study (VFSS) was performed to verify the correspondence between the patient’s perceptions and swallowing physiopathology. A descriptive and exploratory statistical analysis was performed.

Results

There was correspondence between VFSS findings and the patient’s perception in 76.5% of the cases. Sensations such as discomfort and fatigue were perceived during swallowing, especially with solids. Such feelings have predominantly been reported in the throat, from the half to the end of the meal. There was association between fatigue and odynophagia. Fatigue during swallowing was associated with worse functionality of oral intake.

Conclusion

Most participants perceived the disorders in their swallowing. Sensations such as burning, discomfort, tiredness, pain, cramp, or irritation were perceived by participants and were associated with symptoms that may suggest risk of aspiration due to fatigue resulting from weakness, incoordination, and/or stiffness of muscles.

Keywords
Neurodegenerative Diseases; Swallowing; Speech, Language and Hearing; Dysphagia; Prevention

Variables	Min-Max	Mean ± SD	Median
Age (years)	19-81	49.4 ± 14.8	51
Disease duration (months)	6-528	58.7 ± 81.8	36
Number of sensations (n)	0-6	0.95-1.44	0
Intensity of sensations (0-none / 10-maximum)	0-10	3.36 ± 3.79	0
FOIS	5-7	6.23 ± 0.83	6
Fatigue scale score	0-63	17.9 ± 23.3	0
SLT follow-up		56%(28)
Odynophagia complaints		4%(2)
Complaint of fatigue during eating		18%(8)
Presence of overall fatigue		29%(13)

Variables	SPT Follow-up (yes / no)	Fatigue (yes / no)	Fatigue when eating (yes / no)
Age (years) ^a a Mann-Whitney U test;	0.020 ^* * p-value <0.05	0.585	0.165
Disease duration (months)^a	0.384	0.604	0.647
Number of sensations (n) ^a a Mann-Whitney U test;	0.021*	0.084	0.002*
Intensity of sensations (0-10)^a	0.001*	0.380	0.001*
FOIS^a (1-7)	0.003*	0.116	0.001*
Odynophagia^b (yes / no)	0.683	0.082	0.030*
Overall fatigue ^c c Chi-squared; (yes / no)	0.472	-	-
Fatigue during eating^c (yes / no)	0.229	-	-
SLT therapy^c (yes / no)	-	0.472	0.229

Participant	Sex	Age (years)	Disease duration (months)	Neurological diagnosis	VFSS finding			Unpleasant sensations perceived during swallowing					FOIS	SDQ	Correspondence between complaint and VFSS findings
Participant	Sex	Age (years)	Disease duration (months)	Neurological diagnosis	Liquid	Pudding	Solid	Sensation on swallowing	Duration of sensation	Moment of sensation (eating)	Consistency	Site of sensation	FOIS	SDQ	Correspondence between complaint and VFSS findings
1	M	51	24	Amyotrophic lateral sclerosis	Residue in tongue and pharynx	Nothing noteworthy	Nothing noteworthy	None	-	-	-	-	7	Realize remnants of food in the mouth after swallowing	Partial
2	F	41	96	Spinocerebellar ataxia type 3	Nothing noteworthy	Residue on tongue	Nothing noteworthy	Tiredness	Acute	End	Solid	Neck	6	Feel difficulty in swallowing solid foods	Partial
3	M	67	48	Progressive supranuclear palsy	Residue in tongue and pharynx; laryngeal penetration; SOT	Residue in tongue and pharynx and PET; SOT	Residue in tongue and pharynx and PET; SOT	Discomfort	Continuous	Half	Liquid	Throat	6	Perceives extra-oral escape, has difficulty swallowing saliva, coughing when swallowing liquid, feels the food stopped in the throat	Yes
4	M	50	12	Amyotrophic lateral sclerosis	Pharyngeal residue	Pharyngeal residue	Pharyngeal residue	Tiredness / irritation	Continuous	Half	Solid	Throat	5	Feels difficulty in swallowing solid foods	Yes
5	M	46	48	Amyotrophic lateral sclerosis	Residue in tongue and pharynx; laryngeal penetration; SOT, lingual pumping	Residue in tongue and pharynx; SOT; lingual pumping	Slow chewing; residue in tongue and pharynx; SOT, lingual pumping	Discomfort / irritation	Acute	Beginning	Liquid	Throat	5	Perceives food remnants in the mouth after swallowing, needs to swallow the same bolus several times and coughs when swallowing liquid.	Yes
6	F	67	48	Parkinson’ s disease	Residue in tongue and pharynx	Residue in tongue and pharynx	Residue in tongue and pharynx	None	-	-	-	-	6	Needs to swallow the same bolus several times and coughs when swallowing liquid	Partial
7	M	62	28	Parkinson’ s disease	Absence of lip seal; SOT; lingual pumping, tongue residue; pharyngeal residue; decreased pharyngeal contraction wave	Absence of lip seal; SOT; lingual pumping, tongue residue; pharyngeal residue; decreased pharyngeal contraction wave	Absence of lip seal; SOT; lingual pumping, tongue residue; pharyngeal residue; decreased pharyngeal contraction wave	Burning / tiredness	Acute	Half	Liquid	Throat	5	Feels difficulty in chewing, perceives food debris in the mouth after swallowing, perceives extra-oral escape, has difficulty swallowing saliva and solids, coughing when swallowing liquids and perceives difficulty breathing during meals	Yes
8	M	53	36	Amyotrophic lateral sclerosis	Lingual pumping; tongue and pharynx residue, laryngeal penetration	Lingual pumping; residue on tongue and pharynx	Slow and inefficient chewing; lingual pumping; residue on tongue and pharynx	discomfort / irritation / tiredness	Continuous	Half	Liquid / solid	Throat	5	Feels difficulty in chewing, perceives food debris in the mouth after swallowing, has difficulty swallowing saliva, pasty and solids, needs to swallow the same bolus several times, feels food stopped in the throat, coughing when swallowing liquids and perceives difficulty breathing during meals	Yes
9	F	29	12	Amyotrophic lateral sclerosis	Labial sealing absent	Labial sealing absent, SOT	Labial sealing absent, inefficient chewing, SOT, residue on tongue and pharynx	Discomfort / irritation	Acute	Half	Solid	Mouth	6	Perceives extra-oral leakage and food debris in the mouth after swallowing, has difficulty swallowing solids and feels the food stopped in the throat	Yes
10	F	56	108	Amyotrophic lateral sclerosis	Pharyngeal residue and laryngeal penetration	Nothing noteworthy	Nothing noteworthy	None	-	-	-	-	7	No complaints	NO
11	F	46	24	Spinocerebellar ataxia type 3	Residue in tongue and pharynx	Residue in tongue and pharynx	Slow chewing, residue on tongue and pharynx	tiredness / pain / cramps	Acute	Half	Liquid / solid	Mouth	6	Feels difficulty swallowing solids and liquids	Yes
12	F	63	12	Amyotrophic lateral sclerosis	Nothing noteworthy	Nothing noteworthy	Inefficient chewing	Discomfort	Acute	Half	Solid	Throat	6	Feels difficulty in swallowing solid foods	Yes
13	M	81	48	Parkinson’ s disease	Residue in tongue and pharynx	Lingual pumping; residue on tongue and pharynx	Lingual pumping; residue on tongue and pharynx	Irritation	Continuous	Half	Liquid / solid	Throat	6	Feels difficulty chewing and difficulty swallowing saliva and solids, feels food stopped in throat, coughing when swallowing liquid and perceives difficulty breathing during meals	Yes
14	F	63	8	Amyotrophic lateral sclerosis	Residue in tongue and pharynx; laryngeal penetration	Residue in tongue and pharynx; laryngeal penetration	Residue in tongue and pharynx	Discomfort / tiredness	Continuous	Beginning	Liquid / solid	Mouth	5	Feels difficulty in chewing and swallowing solids, perceives extra-oral escape, swallows the same bolus several times, coughs when swallowing liquids and solids and feels the voice change after eating or drinking	Yes
15	F	64	36	Parkinson’ s disease	Residue in tongue and pharynx; laryngeal penetration	Residue in tongue and pharynx	Slow chewing and residue on the pharynx	discomfort / annoyance / tiredness / irritation	Continuous	Half	Liquid / solid	Throat	6	Notices food debris in the mouth after swallowing, difficulty swallowing saliva, solid and pasty, needs to swallow the same bolus several times, feels food stopped in throat, coughing when swallowing liquids and solids, perceives change in voice after eating or drinking	Yes
16	M	57	48	Amyotrophic lateral sclerosis	Nothing noteworthy	Pharyngeal residue	Pharyngeal residue	None	-	-	-	-	7	Needs to swallow the same bolus several times	Yes
17	M	47	36	Huntington's Disease	Residue in tongue and pharynx; laryngotracheal aspiration	Residue in tongue and pharynx	Inefficient chewing; residue on tongue and pharynx	Burning / discomfort / annoyance / tiredness	Continuous	End	Liquid / solid	Throat	5	Feels difficulty in chewing, perceives food debris in the mouth after swallowing, has difficulty swallowing saliva, feels food stopped in the throat, coughing when you swallow solid and liquid and perceives changes in voice after eating or drinking	Yes

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[1] Conflict of interests: nothing to declare.